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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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Hanson E, Albert-Rozenberg D, Garfield KM, Leib EB, Ridberg RA, Hager K, Mozaffarian D. The evolution and scope of Medicaid Section 1115 demonstrations to address nutrition: a US survey. HEALTH AFFAIRS SCHOLAR 2024; 2:qxae013. [PMID: 38577164 PMCID: PMC10986195 DOI: 10.1093/haschl/qxae013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
Poor nutrition and food insecurity are drivers of poor health, diet-related diseases, and health disparities in the U.S. State Medicaid Section 1115 demonstration waivers offer opportunities to pilot food-based initiatives to address health outcomes and disparities. Several states are now leveraging 1115 demonstrations, but the scope and types of utilization remain undefined. To fill this gap, we conducted a systematic analysis of state Medicaid Section 1115 applications and approvals available on Medicaid.gov through July 1, 2023. We found that 19 approved and pending 1115 waivers address nutrition, with 11 submitted or approved since 2021. Fifteen states provide or propose to provide screening for food insecurity, referral to food security programs, and/or reporting on food security as an evaluation metric. Thirteen provide or propose to provide coverage of nutrition education services. Ten provide or propose to provide direct intervention with healthy food. The primary target populations of these demonstrations are individuals with chronic diet-sensitive conditions, mental health or substance use disorders, and/or who are pregnant or post-partum. Since 2021, state utilization of Medicaid 1115 demonstrations to address nutrition has accelerated in pace, scope, and population coverage. These findings and trends have major implications for addressing diet-related health and healthy equity in the United States.
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Affiliation(s)
- Erika Hanson
- Center for Health Law and Policy Innovation, Harvard Law School
| | | | | | | | - Ronit A. Ridberg
- Food is Medicine Institute, Friedman School of Nutrition Science & Policy, Tufts University
| | - Kurt Hager
- Department of Population Health and Quantitative Sciences, University of Massachusetts Medical School
| | - Dariush Mozaffarian
- Food is Medicine Institute, Friedman School of Nutrition Science & Policy, Tufts University
- Tufts University School of Medicine and Division of Cardiology, Tufts Medical Center
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Janda KM, Ranjit N, Salvo D, Nielsen A, Kaliszewski C, Hoelscher DM, van den Berg AE. Association between Fresh Fruit and Vegetable Consumption and Purchasing Behaviors, Food Insecurity Status and Geographic Food Access among a Lower-Income, Racially/Ethnically Diverse Cohort in Central Texas. Nutrients 2022; 14:5149. [PMID: 36501179 PMCID: PMC9738536 DOI: 10.3390/nu14235149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/10/2022] Open
Abstract
The aims of this study were to determine if fresh fruit and vegetable consumption and purchasing behaviors were associated with geographic food access and/or food insecurity status, and to explore the role of sociodemographic characteristics among participants of a lower-income, racially/ethnically diverse cohort. This study used a cross-sectional design and baseline survey data from the FRESH-Austin study (N = 393). Associations between fresh produce consumption/purchasing and food insecurity status and geographic access to food were assessed utilizing univariate, bivariate, and multivariate linear regression methods and potential interactions were examined. The sample 40% reported being food insecure and the majority identified as Hispanic. Geographic food access was directly associated with fresh produce consumption (β = 0.46, p = 0.02); however, the directionality of the relationship between food insecurity and fresh produce consumption varied due to a significant interaction with race/ethnicity. Only utilizing food assistance was associated with purchasing fewer fresh produce (β= -1.83, p = 0.03). Findings suggest that communities experience food insecurity and limited healthy food access in different ways, and in some situations, are associated with fresh produce consumption and purchasing behaviors. Future research adopting an intersectionality-sensitive approach to better understand how to best support communities at risk is needed.
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Affiliation(s)
- Kathryn M. Janda
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA
- Department of Health Promotion and Behavioral Science, School of Public Health in Austin, University of Texas Health Science Center in Houston in Austin, Austin, TX 78701, USA
- Michael and Susan Dell Center for Healthy Living, Austin, TX 78701, USA
| | - Nalini Ranjit
- Department of Health Promotion and Behavioral Science, School of Public Health in Austin, University of Texas Health Science Center in Houston in Austin, Austin, TX 78701, USA
- Michael and Susan Dell Center for Healthy Living, Austin, TX 78701, USA
| | - Deborah Salvo
- Department of Kinesiology and Health Education, University of Texas at Austin, Austin, TX 78712, USA
| | - Aida Nielsen
- Department of Health Promotion and Behavioral Science, School of Public Health in Austin, University of Texas Health Science Center in Houston in Austin, Austin, TX 78701, USA
- Michael and Susan Dell Center for Healthy Living, Austin, TX 78701, USA
| | - Catherine Kaliszewski
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA
| | - Deanna M. Hoelscher
- Department of Health Promotion and Behavioral Science, School of Public Health in Austin, University of Texas Health Science Center in Houston in Austin, Austin, TX 78701, USA
- Michael and Susan Dell Center for Healthy Living, Austin, TX 78701, USA
| | - Alexandra E. van den Berg
- Department of Health Promotion and Behavioral Science, School of Public Health in Austin, University of Texas Health Science Center in Houston in Austin, Austin, TX 78701, USA
- Michael and Susan Dell Center for Healthy Living, Austin, TX 78701, USA
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