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Houghtaling B, Short E, Shanks CB, Stotz SA, Yaroch A, Seligman H, Marriott JP, Eastman J, Long CR. Implementation of Food is Medicine Programs in Healthcare Settings: A Narrative Review. J Gen Intern Med 2024:10.1007/s11606-024-08768-w. [PMID: 38662283 DOI: 10.1007/s11606-024-08768-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 04/10/2024] [Indexed: 04/26/2024]
Abstract
Food is Medicine (FIM) programs to improve the accessibility of fruits and vegetables (FVs) or other healthy foods among patients with low income and diet-related chronic diseases are promising to improve food and nutrition security in the United States (US). However, FIM programs are relatively new and implementation guidance for healthcare settings using an implementation science lens is lacking. We used a narrative review to describe the evidence base on barriers and facilitators to FIM program integration in US healthcare settings following the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework. Evidence surrounding the EPIS Inner Context was a focus, including constructs Leadership, Organizational Characteristics, Quality and Fidelity Monitoring and Support, Organizational Staffing Processes, and Individual Characteristics. Peer-reviewed and grey literature about barriers and facilitators to FIM programs were of interest, defined as programs that screen and refer eligible patients with diet-related chronic disease experiencing food insecurity to healthy, unprepared foods. Thirty-one sources were included in the narrative review, including 22 peer-reviewed articles, four reports, four toolkits, and one thesis. Twenty-eight sources (90%) described EPIS Inner Context facilitators and 26 sources (84%) described FIM program barriers. The most common barriers and facilitators to FIM programs were regarding Quality and Fidelity Monitoring and Support (e.g., use of electronic medical records for tracking and evaluation, strategies to support implementation) and Organizational Staffing Processes (e.g., clear delineation of staff roles and capacity); although, barriers and facilitators to FIM programs were identified among all EPIS Inner Context constructs. We synthesized barriers and facilitators to create an EPIS-informed implementation checklist for healthcare settings for use among healthcare organizations/providers, partner organizations, and technical assistance personnel. We discuss future directions to align FIM efforts with implementation science terminology and theories, models, and frameworks to improve the implementation evidence base and support FIM researchers and practitioners.
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Affiliation(s)
- Bailey Houghtaling
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA.
- Department of Human Nutrition, Foods, and Exercise, Virginia Tech, Blacksburg, VA, USA.
| | - Eliza Short
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | | | - Sarah A Stotz
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
- Department of Food Science and Human Nutrition, Colorado State University, Fort Collins, CO, USA
| | - Amy Yaroch
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
| | - Hilary Seligman
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
- Division of General Internal Medicine and Center for Vulnerable Populations, University of California San Francisco, San Francisco, CA, USA
| | | | - Jenna Eastman
- Gretchen Swanson Center for Nutrition, Omaha, NE, USA
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Egan KA, Xuan Z, Hofman M, Ma Shum J, Fernández-Pastrana I, Fiechtner L, Sandel M, Buitron de la Vega P, Kistin CJ, Hsu H. Food Pantry Referral and Utilization in a Pediatric Primary Care Clinic. Am J Prev Med 2024; 66:444-453. [PMID: 37813171 PMCID: PMC10922354 DOI: 10.1016/j.amepre.2023.10.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/02/2023] [Accepted: 10/02/2023] [Indexed: 10/11/2023]
Abstract
INTRODUCTION This study aimed to characterize progression from screening for food insecurity risk to on-site food pantry referral to food pantry utilization in pediatric primary care. METHODS This retrospective study included 14,280 patients aged 0-21 years with ≥1 pediatric primary care visit from March 2018 to February 2020. Analyses were conducted in 2020-2022 using multivariable regression to examine patient-level demographic, clinical, and socioeconomic characteristics and systems-related factors associated with progression from screening positive for food insecurity risk to food pantry referral to completing ≥1 food pantry visit. RESULTS Of patients screened for food insecurity risk, 31.9% screened positive; 18.5% of food-insecure patients received an on-site food pantry referral. Among patients referred, 28.9% visited the food pantry. In multivariable models, higher odds of referral were found for patients living near the clinic (AOR=1.28; 95% CI=1.03, 1.59), for each additional health-related social need reported (AOR=1.23; 95% CI=1.16, 1.29), and when the index clinic encounter occurred during food pantry open hours (AOR=1.62; 95% CI=1.30, 2.02). Higher odds of food pantry visitation were found for patients with a preferred language of Haitian Creole (AOR=2.16; 95% CI=1.37, 3.39), for patients of Hispanic race/ethnicity (AOR=3.67; 95% CI=1.14, 11.78), when the index encounter occurred during food pantry open hours (AOR=1.96; 95% CI=1.25, 3.07), for patients with a clinician letter referral (AOR=6.74; 95% CI=3.94, 11.54), or for patients with a referral due to a screening-identified food emergency (AOR=2.27; 95% CI=1.30, 3.96). CONCLUSIONS There was substantial attrition along the pathway from screening positive for food insecurity risk to food pantry referral and utilization as well as patient-level characteristics and systems-related factors associated with successful referrals and utilization.
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Affiliation(s)
- Kelsey A Egan
- Division of Health Services Research, Department of Pediatrics, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts.
| | - Ziming Xuan
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
| | - Melissa Hofman
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | - Julio Ma Shum
- Department of Pediatrics, Boston Medical Center, Boston, Massachusetts
| | | | - Lauren Fiechtner
- Division of General Pediatrics, Department of Pediatrics, MassGeneral Hospital for Children, Boston, Massachusetts; Division of Gastroenterology and Nutrition, MassGeneral Hospital for Children, Boston, Massachusetts; The Greater Boston Food Bank, Boston, Massachusetts
| | - Megan Sandel
- Division of Health Services Research, Department of Pediatrics, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Pablo Buitron de la Vega
- Section of General Internal Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - Caroline J Kistin
- Hassenfeld Child Health Innovation Institute, Brown University School of Public Health, Providence, Rhode Island
| | - Heather Hsu
- Division of Health Services Research, Department of Pediatrics, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
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Lowrey J, Maestas D, Beaulieu T, Headings A, Hyder A. Geospatial Determinants of Food Pantry Access in the Mid-Ohio Farmacy Program. Prev Chronic Dis 2023; 20:E113. [PMID: 38096124 PMCID: PMC10723080 DOI: 10.5888/pcd20.230155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2023] Open
Affiliation(s)
- John Lowrey
- D'Amore-McKim School of Business, Northeastern University, Boston, Massachusetts
- Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
- 360 Huntington Ave, D'Amore-McKim School of Business, Bouvé College of Health Sciences, Northeastern University, Boston, MA 02115
| | - Danielle Maestas
- Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | - Thomas Beaulieu
- Bouvé College of Health Sciences, Northeastern University, Boston, Massachusetts
| | | | - Ayaz Hyder
- College of Public Health, The Ohio State University, Columbus, Ohio
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Stroud B, Jacobs MM, Palakshappa D, Sastre LR. A Rural Delivery-Based Produce Prescription Intervention Improves Glycemic Control and Stress. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2023; 55:803-814. [PMID: 37737814 DOI: 10.1016/j.jneb.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 08/19/2023] [Accepted: 08/27/2023] [Indexed: 09/23/2023]
Abstract
OBJECTIVE We examined the impact of a pilot 24-week delivery-based produce prescription (PRx) intervention with tailored education and culinary resources for rural patients (n = 40) with type-2 diabetes in underresourced communities on behavioral and clinical outcomes. METHODS We used a single group pretest-posttest design that included a home-delivered PRx, culturally tailored recipes, and health/nutrition education handouts. Measures included hemoglobin A1c (HbA1c), self-reported fruit/vegetable consumption, and stress. Descriptive statistics, t-tests, and Wilcoxon signed rank tests were conducted. RESULTS Mean HbA1c decreased from 7.6 ± 1.6% to 7.1% ± 1.4% (P = 0.001). Self-reported consumption of fruit/vegetables improved, including frequency and serving size of beans (P = 0.01 and P = 0.01), serving size of lettuce salad (P = 0.02), and serving size of vegetable soup (P = 0.001). Perceived stress decreased (P = 0.01). CONCLUSION AND IMPLICATIONS Findings from this pilot PRx intervention suggest a delivery-based PRx with tailored educational resources has the potential to reduce HbA1c and stress while improving fruit/vegetable consumption within rural patients with type-2 diabetes in underresourced communities.
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Affiliation(s)
- Brandon Stroud
- Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC.
| | - Molly M Jacobs
- Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL
| | - Deepak Palakshappa
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC; Department of Pediatrics, Wake Forest School of Medicine, Winston-Salem, NC; Division of Public Health Sciences, Wake Forest School of Medicine, Winston-Salem, NC
| | - Lauren R Sastre
- Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC
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Walker DM, Garner JA, Hefner JL, Headings A, Jonas DE, Clark A, Bose-Brill S, Nawaz S, Seiber E, McAlearney AS, Brock G, Zhao S, Reopell L, Coovert N, Shrodes JC, Spees CK, Sieck CJ, Di Tosto G, DePuccio MJ, Williams A, Hoseus J, Baker C, Brown MM, Joseph JJ. Rationale and design of the linking education, produce provision, and community referrals to improve diabetes care (LINK) study. Contemp Clin Trials 2023; 130:107212. [PMID: 37121390 PMCID: PMC10330286 DOI: 10.1016/j.cct.2023.107212] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 05/02/2023]
Abstract
BACKGROUND Individuals with type 2 diabetes (T2D) experiencing food insecurity may have other non-medical, health-related social needs (e.g., transportation, housing instability) that decrease their ability to attain T2D control and impact other health outcomes. METHODS A pragmatic randomized controlled trial (pRCT) to test the effect of produce provision, diabetes and culinary skills training and education, and social needs screening, navigation, and resolution, on hemoglobin A1c (A1c) levels in individuals with T2D (A1c ≥7.5%) experiencing food insecurity; a cost-effectiveness evaluation of the interventions that comprise the pRCT; and a process evaluation to understand the contextual factors that impact the uptake, effectiveness, and sustainability of the interventions. SETTING Ambulatory care clinics (e.g., family medicine, general internal medicine, endocrinology) affiliated with an academic medical center in an urban environment in the Midwest. DESIGN 2 × 2 factorial design. INTERVENTIONS Cooking Matters for Diabetes is a 6-week diabetes and culinary education intervention. The Health Impact Ohio Central Ohio Pathways Hub intervention is a community health worker model designed to evaluate and address participants' social needs. All participants will receive referral to the Mid-Ohio Farmacy to provide weekly access to fresh produce. OUTCOMES Primary outcome of the pRCT is change in A1c at 3 months; secondary outcomes include A1c at 6 months, and diabetes self-efficacy, food insecurity, and diet quality at 3 and 6 months. DISCUSSION Food insecurity, unmet social needs, diabetes education and self-efficacy are critical issues that must be addressed to improve T2D treatment, care, and health equity. CLINICALTRIALS gov: NCT05472441.
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Affiliation(s)
- Daniel M Walker
- The Ohio State University College of Medicine, Columbus, OH, United States of America.
| | - Jennifer A Garner
- The School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, United States of America; The John Glenn College of Public Affairs, The Ohio State University, Columbus, OH, United States of America
| | - Jennifer L Hefner
- The Ohio State University College of Public Health, Columbus, OH, United States of America
| | - Amy Headings
- The Mid-Ohio Food Collective, Columbus, OH, United States of America
| | - Daniel E Jonas
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Aaron Clark
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Seuli Bose-Brill
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Saira Nawaz
- The Ohio State University College of Public Health, Columbus, OH, United States of America
| | - Eric Seiber
- The Ohio State University College of Public Health, Columbus, OH, United States of America
| | - Ann Scheck McAlearney
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Guy Brock
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Songzhu Zhao
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Luiza Reopell
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Nicolette Coovert
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Jennifer C Shrodes
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Colleen K Spees
- The Ohio State University College of Medicine, Columbus, OH, United States of America; The School of Health and Rehabilitation Sciences, The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Cynthia J Sieck
- Dayton Children's Hospital Center for Health Equity, Dayton, OH, United States of America
| | - Gennaro Di Tosto
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Matthew J DePuccio
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Amaris Williams
- The Ohio State University College of Medicine, Columbus, OH, United States of America
| | - Jenelle Hoseus
- Health Impact Ohio, Columbus, OH, United States of America
| | - Carrie Baker
- Health Impact Ohio, Columbus, OH, United States of America
| | | | - Joshua J Joseph
- The Ohio State University College of Medicine, Columbus, OH, United States of America
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Alcaraz KI, Yanez BR. Interventions to promote health equity: implications for implementation science in behavioral medicine. Transl Behav Med 2022; 12:885-888. [PMID: 36205475 PMCID: PMC9540972 DOI: 10.1093/tbm/ibac062] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Disparities in health persist despite the development of innovative and effective behavioral interventions. Both behavioral medicine and implementation science are vital to improving health care and health outcomes, and both can play a critical role in advancing health equity. However, to eliminate health disparities, more research in these areas is needed to ensure disparity-reducing behavioral interventions are continually developed and implemented. This special issue on interventions to promote health equity presents a diverse set of articles focused on implementing behavioral interventions to reduce health disparities. The current article summarizes the special issue and identifies key themes and future considerations. Articles in this special issue report on behavioral medicine intervention studies (including those examining aspects of implementation) as well as implementation science studies with implications for behavioral medicine. Articles discuss community-, provider-, and system-level interventions; implementation processes; and barriers and facilitators to implementation. Also included are commentaries calling for greater prioritization of behavioral medicine and implementation research. As evidenced in this special issue, behavioral medicine is primed to lead the implementation of behavioral interventions in historically marginalized and minoritized populations to advance health equity and improve overall population health.
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Affiliation(s)
- Kassandra I Alcaraz
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Betina R Yanez
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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