Progress 09/15/23 to 09/14/24
Outputs
Target Audience:During this period, we enrolled 98 new participants into the Produce Prescription Program. All 98 of these participants are patients of the Hilltown Community Health Centers, Inc. (HCHC), which is a Federally Qualified Health Center (FQHC) operating three health clinics, one school-based health center, and one community center. All of these clients live in the HCHC's primary service area (population = 109,000), which includes 14 rural hilltowns with populations ranging from 530 to 2,200, as well as the three semi urban communities with populations ranging from 17,660 to 41,000. The mean age among these 98 participants is 51 years old. About 26% identify as men, about 74% identify as women and 1% identify as a trans woman. The majority are white (84%), while one person identifies as Asian/white, 2 people identify as Black or African-American, and 8 people choose Other. About 13% of these participants also identify as Hispanic. All 98 clients in the target audience are low-income and/or food insecure and are enrolled in either SNAP or Medicaid. About 40% reported receiving SNAP benefits in the last 30 days, 50% are enrolled in Medicare, and 49% are enrolled in Medicaid. Of this group, about 59% report that they often or sometimes worried whether their food would run out before getting money to buy more in the last 30 days. About 61% said that the food they bought didn't last the month, and they didn't have money to get more. When asked to rank their own health, 2% said it was excellent, 9% said it was very good, 35% said it was good, 39% said it was fair, and 11% said it was poor. In addition, all 98 clients are experiencing or at-risk for developing a chronic illness. They reported experiencing the following conditions: Arthritis, Bipolar, Depression, Anxiety, Prediabetes, Diabetes, Heart Attack, Ménière's disease, Mitochondrial Disease, Obesity, High Blood Pressure, Kidney Disease, and Thyroid Disease. In total, our program supported 120 people during this reporting period, 22 of which were enrolled during the previous year. When looking at the full group of 120 people, the demographic trends described above are consistent. Another target audience is healthcare professionals. During this reporting period, one Director of Community Programs, one Assistant Director of Community Programs, one Medical Doctor - Family Practitioner, two Dietitian-Nutritionists, and three Community Health Workers, for a total of 8 health care practitioners, collaborated to maintain and utilize a patient screening and referral system in order to enroll patients in the Produce Prescription Program. Students have also been a target audience during this period. Two undergraduate student fellows have participated and built their skills as part of the project. Both are young women earning a BS in Nursing at the University of Massachusetts Elaine Marieb College of Nursing and employed as part time staff at CES. One youth intern has also been a target audience for this period. We worked with a youth intern through Community Action Pioneer Valley who supported the enrollment process to build job skills. Finally, retailers and local farmers are an audience during this period. During this period, produce prescriptions were redeemed at 32 unique brick and mortar supermarket locations, 1 brick and mortar farm store location, and three farmers markets booths. In total, participants spent $27,177 through 1,332 transactions. The client's average transaction amount spent per shopping trip was $20.40. Changes/Problems:Pace of enrollment slower than planned: We planned to enroll 210 patients by April 2024, but recruitment has been slower than anticipated. This is due to a few factors. First, the amount of training and education of healthcare providers around what the program is, how it works, and why they should refer their clients has been more time consuming than anticipated. During this reporting period, we worked with our healthcare partners to expand the number of providers screening and referring patients, which has helped increase recruitment and enrollment. In order to incentivize more participation, we increased the amount of the produce prescription incentive from $40 a month to $80 a month. The increase was made in August 2024. We are working on integrating this change into our evaluation plan and considering how it will impact our research findings as well as what new research questions we may be able to ask given these circumstances. Second, during this reporting period the primary Dietician-Nutritionist conducting recruitment and referrals for the program left her position and was not rehired, which created a gap in coverage and support for the program on the healthcare provider side. Our healthcare partners were able to train additional Community Health Workers to support the recruitment process, but this turnover slowed enrollment. Participants continue to have low utilization of the produce prescription at Farm Direct retailers: We expect this is because so many of our participants live in very rural places and most farmers markets or farm stores are not easily accessible, especially for those who lack access to private transportation. During this period we have deepened our relationship with the Hilltown Market, which is now offering home delivery to clients throughout the rural towns where our participants live, from June-November. We have now successfully onboarded the Hilltown Market as an online retailer, meaning that clients can purchase fruits and vegetables through their online portal and choose to pick up or get home delivery. The ability to pick out their vegetables (vs. receiving a preselected boxed farm share) is expected to be popular once the season begins again in June 2025. We are also working with the Amherst Mobile Market to onboard them as a retailer for this season, which will create another Farm Direct retail option for our participants that live in the more urban part of our service area, in Amherst. Both of these mobile markets could not be onboarded earlier as planned because our partner About Fresh that administers the Fresh Connect produce prescription card (a debit card that is preloaded monthly with the produce prescription amount) would not allow small retailers without sophisticated point of sale systems to accept the card. Over the course of the last two years, we have worked with About Fresh to shift their policies around this and it seems like they are becoming more flexible. We expect this will allow us to move forward with onboarding the Amherst Mobile Market this year. As a result of this change, we decided to eliminate the 20% off local produce discount. Instead, we will use those funds to pay for delivery fees for home delivery. We expect that this will be another way to incentivize the purchase of local produce for home delivery, without having to worry about an added burden of delivery cost. What opportunities for training and professional development has the project provided?The project provided training and professional development to 8 healthcare practitioners to utilize one permanent patient screening and referral system to effectively enroll patients in the Produce Prescription program. Training and professional development was also provided to two undergraduate Student Fellows and one youth intern that increased their knowledge of nutrition incentive programs, nutrition research, community engagement, research analysis, and nutrition education. How have the results been disseminated to communities of interest?
Nothing Reported
What do you plan to do during the next reporting period to accomplish the goals? Continue to work with healthcare providers to screen and refer eligible patients Enroll 111 additional participants in the program Coordinate with one Farm Direct retailer to offer home delivery of fresh produce during summer 2025 Onboard one Farm Direct retailer convenient to Amherst-based participants Collect data through mid-term surveys and cardiometabolic indicators to begin measuring the relationship between produce prescriptions and health behaviors, cardiometabolic risk factors, healthcare use, and food insecurity. Conduct quarterly meetings with the Hilltown Community Health Center staff and retailers Develop and implement five educational workshops or learning opportunties for participants focused on procurement and preparation of fresh produce, with the goal of increasing self-efficacy around cooking fresh produce, shopping for healthy food, and growing fresh produce. Publish one journal article focused on the protocol developed to implement the project
Impacts
What was accomplished under these goals?
O1: To develop and implement workflows that enable healthcare providers to screen and enroll eligible clients in the produce prescription program Implementation of one screening/referral/enrollment systems at healthcare center Continued training with 8 healthcare practitioners in the screening/referral system O2. To prescribe fresh produce to low-income individuals suffering from or at-risk of diet related conditions while incentivizing redemption at direct-to-consumer retailers Completed 77 consent forms Enrolled 77 clients in the program, for a total of 99 participants enrolled Onboarded 1 new Farm Direct retailer to accept the produce prescription card Completed 16 one year follow up surveys O3. To measure the relationship between produce prescriptions and health behaviors, cardiometabolic risk factors, healthcare use, and food insecurity Completed 77 baseline surveys Completed 16 one year follow up surveys O4. To educate participants on the procurement and preparation of fresh produce Disseminated educational materials to 77 clients
Publications
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Progress 09/15/22 to 09/14/23
Outputs
Target Audience:For this period, the project's primary audience includes 22 clients of the Hilltown Community Health Centers, Inc. (HCHC), which is a Federally Qualified Health Center (FQHC) operating three health clinics, one school-based health center, and one community center. All of these clients live in the HCHC's primary service area (population = 109,000), which includes 14 rural hilltowns with populations ranging from 530 to 2,200, as well as the three semi urban communities with populations ranging from 17,660 to 41,000. The mean age among these 22 participants is 49 years old. About 23% identify as men and about 73% identify as women. One person did not report their sex/gender. The majority are white, while one person identifies as African, another as Native Hawaiian, and two identify as African-American. All 22 clients in the target audience are low-income and/or food insecure and are enrolled in either SNAP or Medicaid. About 41% report that they often or sometimes couldn't afford to eat balanced meals over the past 30 days. About 23% said that they cut the size of their meals or skipped meals because there wasn't enough money for food. About 27% reported that in the last 30 days they ate less than they felt they should because there wasn't enough money for food. In addition, all 22 clients are experiencing or at-risk for developing a chronic illness. They reported experiencing the following conditions: Arthritis, Bipolar, Depression, Anxiety, Prediabetes, Diabetes, Heart Attack, Ménière's disease, Mitochondrial Disease, Obesity, and High Blood Pressure, Kidney Disease, and Thyroid Disease. Another target audience is healthcare professionals. During this reporting period, one Director of Community Programs and Family Support, one Dietitian-Nutritionist, and one Community Health Worker collaborated to establish one temporary screening and referral system based on reviewing existing client data and identifying eligible clients. The same three staff also collaborated to establish one permanent screening and referral system that integrates into the Hilltown Community Health Center's newly updated Electronic Medical Record system. The permanent screening and referral system guides healthcare practitioners to screen patients for income level, food insecurity risk, and existence or risk of developing a diet related illness, and refer those who screen positive into nutrition intervention and social service programs, including the Produce Prescription Program. The team trained and built the capacity of 8 healthcare practitioners in the health center's Weight Management/Nutrition program, who are now using the system regularly to understand client needs in a more holistic way. Students have also been a target audience during this period. Two undergraduate student fellows have participated and built their skills as part of the project. Both are young women earning a BS in Nursing at the University of Massachusetts Elaine Marieb College of Nursing. Finally, retailers are an audience during this period. Clients redeemed their produce prescriptions at 10 unique Brick & Mortar retail locations, spending $1,375 during 78 shopping trips. The client's average transaction amount per shopping trip was $17.62. Changes/Problems:Pace of enrollment slower than planned: Planned to enroll 50 clients by March 2023, but enrollment was delayed due to a slower timeline developing the enrollment system, therefore enrollment did not begin until May 2023. Participants are not utilizing direct-to-consumer retailers likely due to the rural communities in which many participants live, which exacerbates transportation challenges: CES is working to onboard more direct-to-consumer retailers, especially those that offer home delivery. CES is also working on developing a farm share delivery option in partnership with Hart Farm and/or the Hilltown Mobile Market. What opportunities for training and professional development has the project provided?The project provided training and professional development to 8 healthcare practitioners to utilize one temporary and one permanent patient screening and referral system system. Training and professional development was also provided to two Student Fellows that increased their knowledge of nutrition incentive programs, nutrition research, and nutrition education. How have the results been disseminated to communities of interest?
Nothing Reported
What do you plan to do during the next reporting period to accomplish the goals? Enroll 188 additional participants in the program. Onboard 3 additional Farm Direct retailers and 3 additional Brick & Mortar retailers Collect data through mid-term surveys and cardiometabolic indicators to begin measuring the relationship between produce prescriptions and health behaviors, cardiometabolic risk factors, healthcare use, and food insecurity. Conduct quarterly interviews with the Hilltown Community Health Center staff and retailers Develop and implement three educational workshops for participants focused on procurement and preparation of fresh produce, with the goal of increasing self-efficacy around cooking fresh produce, shopping for healthy food, and growing fresh produce. Publish one journal article focused on the protocol developed to implement the project
Impacts
What was accomplished under these goals?
O1: To develop and implement workflows that enable healthcare providers to screen and enroll eligible clients in the produce prescription program Developed two screening/referral/enrollment systems at healthcare center Trained 8 healthcare practitioners in the screening/referral system O2. To prescribe fresh produce to low-income individuals suffering from or at-risk of diet related conditions while incentivizing redemption at direct-to-consumer retailers Completed 22 baseline surveys Completed 22 consent forms Enrolled 22 clients in the program Onboarded 6 direct-to-consumer/Farm Direct retailers and 2 Brick & Mortar retailers to accept the produce prescription debit card O3. To measure the relationship between produce prescriptions and health behaviors, cardiometabolic risk factors, healthcare use, and food insecurity Nothing to report O4. To educate participants on the procurement and preparation of fresh produce Identified two educational handouts Disseminated educational materials to 22 clients O5. To disseminate findings demonstrating the impacts of produce prescription programs Nothing to report
Publications
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