Title:
Providers' Perspectives on Produce Prescription Programs in Rural Communities
Brief description:
Food insecurity and obesity were the second highest community health needs identified by Parkview’s Community Health Needs Assessment (CHNA) for Whitley County, Indiana (Parkview Health, 2023). The top community health concern of Whitley County citizens were obesity and chronic disease. Suboptimal nutrition and food insecurity are essential mediators of health disparity and have been closely tied to chronic illness (Mozaffarian, 2024). Obesity in Whitley County is on the rise with a rate of 36.6% compared to Indiana’s 33.4%, and food insecurity is at 10.1%. Limited access to healthy foods is a key contributor to these rates (Parkview Health, 2023).
Produce Prescription Programs are supported by the American College of Cardiology as a prevention strategy for diet-related chronic diseases and a way to improve health equity (Mozaffarian, 2024). A produce prescription program has been successfully implemented by Parkview in Allen County since 2019 and is supported through a USDA grant (https://www.parkview.com/mirro-center/hsir/veggie-rx-to-heal).
This project aims to examine primary care providers’ perspectives regarding barriers and facilitators to implementing a produce prescription program to address food insecurity and diet-related chronic illness in rural Whitley County. The health-related goal is to gather information and concerns to address barriers before implementing a program in Whitley County. There will be a short PowerPoint presentation and discussion with healthcare providers followed by a survey asking about concerns, barriers, and support providers need to refer and educate patients on the program.
Mozaffarian, D., Aspry, K., Garfield, K.. et al. (2024) “Food Is Medicine” Strategies for nutrition security and cardiometabolic health equity: JACC state-of-the-art review. Journal of the American College of Cardiology, 83(8,) 843–864. https://doi.org/10.1016/j.jacc.2023.12.023
Parkview Health (2023). 2023 Implementation strategy: Parkview Whitley Hospital, Inc. https://www.parkview.com/-/media/parkview-media/file/2020-pa---albright/2023-implementation-strategy-whitley-final.ashx
Research Methods:
“For the study, I identified all the providers who would have an ongoing relationship with patients,” Ward explained. “So, I excluded walk-in clinics and ERs but concentrated on 24 providers in our county who did pediatrics, OB-GYN, family practice, and then the federally qualified [Bowen] health center.”
Ward gave the 24 providers a brief presentation about the Produce Prescription Program and then asked them to complete a 10-item survey. She was then able to get a cross-section of different health systems and independent practices to pull from.
Ward followed that theory and its seven constructs, and the model is based on the point that an intervention is successful when the health care providers have buy in. So, the seven constructs follow the attitude and experience of the healthcare providers, how much the healthcare provider perceives that the intervention is going to require them to participate, and how ethical the intervention appears to them.
Providers were asked 10 questions, including, "Before this presentation, how aware were you that Produce Prescription Program existed?”
Findings:
Ward found that nearly 80% of the providers were either not aware or only a little aware of the program.
“So, where the health system may have had trouble in the past launching it in rural communities, I think it shows that talking to the providers and making sure they understand how it works and who qualifies is really important,” she said.
The evaluation is best done through the two-question Hunger Vital Sign screening tool for food insecurity. Only one of the 24 providers had ever used the tool. The biggest barrier they saw was time, because in primary care, providers only get 15-20 minutes per patient, so fitting in another screening and another referral is difficult.
Ward found that providers felt like they did have time to discuss nutrition with the patient, but it was a more abridged version than what they received through the Produce Prescription Program.
“It’s valuable to them, 100% of the 24 providers I surveyed said this program would be valuable to their patients and is needed in their community.”
Hopes for Future Impact:
“A few years ago in Allen County, Indiana, they were able to get a grant of more than $1 million from the Gus Schumacher Nutrition Incentive Program (GusNIP),” said Ward. “We’re hoping other rural areas will be able to apply for grants so that this can be a part of the programming that’s offered... I think that the outcomes speak for themselves.”
“The outcomes from the urban program in Allen County were pretty amazing,” she continued. “There was an almost a full percent, a 0.9%, drop in A1C, people lost weight, and their hospitalization rates and ER visits dropped by 50%. So just in those 6 months of the program, the outcomes were really great. I would like to see that happen in my own community, too.”
Project mentor:
Dr. Sarah Giaquinta, Senior VP of Community Health & Equity for Parkview Health
Faculty mentor:
Dr. Susan Storey, IU faculty