National Women's History Month 2024
National Women’s History Month 2024
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Created by Gus Schumacher Nutrition Incentive Program (GusNIP) grantee Wholesome Wave, Food4Moms is a three-year Produce Prescription (PRx) program in Hartford, Connecticut, that aims to comprehensively assess the feasibility and measure the impact of a PRx program tailored specifically for women who are pregnant, Latina and have limited income.
Wholesome Wave, a national non-profit organization that addresses disparities in diet-related disease and enhances nutrition equity, is partnering on Food4Moms with the Hispanic Health Council (HHC), a Connecticut-based community health organization well-positioned to reach Latino/a/x community members who are socioeconomically marginalized, and the Yale Griffin Prevention Research Center for research and evaluation expertise.
Funding has been provided by the U.S. Department of Agriculture’s (USDA) National Institute of Food and Agriculture (NIFA) under the GusNIP funding mechanism and from the Point32Health Foundation.
In honor of National Women's History Month, we spoke with the team at Wholesome Wave, HHC and the Yale School of Public Health about Food4Moms' impact and how the team is improving maternal and infant health using the principles of fidelity, equity and dignity.
Food4Moms follows a unique and innovative approach that integrates the FED Principle®, with a focus on community fidelity, equity and dignity, a model that Wholesome Wave created and developed in 2021. Could you please share what these three principles mean and how Food4Moms is integrating them?
The FED Principle® refers to Fidelity, Equity, and Dignity.
Fidelity is the belief in and commitment to meeting communities where they are and working together to co-design solutions for the issues that are most relevant to them. Programs should serve communities and not the other way around. In the context of Food4Moms (F4Ms), it has been essential to work with our community-based partner Hispanic Health Council (HHC) who has ample experience providing direct services and engaging the population of the program. Together with Wholesome Wave and Yale School of Public Health, HHC implemented a series of co-design listening sessions specifically with Hispanic women who were either pregnant or had children under three years of age. This innovative approach sought to elicit their thoughts and insights on each program component that would constitute F4Ms. Instead of the traditional top-down approach, these unique sessions help to foster meaningful conversations, allowing the community to actively contribute insights that continue to effectively guide us on their actual needs and preferences. This transformative process allowed for a more organic and responsive development of F4Ms, rooted in the community's own experiences and perspectives.
Equity is ensuring that our efforts increase access to nutritional foods for our community members who are made vulnerable, while also interrogating our policies and practices to ensure that we are achieving that goal. In F4Ms, the study was structured in adherence to inclusion criteria, which specifically target pregnant Latina women coming from backgrounds with limited income. These criteria are designed to ensure our support is directed toward pregnant individuals who are on the socioeconomic margins, belong to a group that is marginalized and may lack the necessary support systems or resources for ensuring a healthy pregnancy. To offer comprehensive support to these women, F4Ms provides bilingual staff support, transcending language barriers in the pursuit of equitable healthcare provision. Moreover, the nutrition education sessions demonstrate sensitivity and awareness of financial limitations, even after receiving the produce prescription (PRx), providing practical recipe ideas and relevant nutritional advice.
Pictured above: Gilma Galdamez, Nutrition Director at Hispanic Health Council
Dignity highlights the fact that human beings have inherent worth regardless of their station in life, meaning we are all deserving of health and wellbeing. Nutritious food is the vehicle by which we affirm and celebrate human dignity. F4Ms inherently upholds this principle due to its nature as a PRx program. Moreover, it empowers women by providing them with the autonomy to choose how they redeem their PRx, acknowledging the participant as a key decision maker in determining their needs. Notably, most participants have opted for the Electronic Benefit Transfer (EBT) card option, granting them the autonomy to choose and buy the fruits and vegetables they prefer. It is also noteworthy that this study takes place in Hartford, Connecticut, a location where the Latino/a/x population has faced historical trauma and harm in the realm of healthcare. HHC was established with the explicit purpose of addressing this issue. It functions as a safe space where Latinos/as/xs can seek assistance and guidance on various health-related matters, including nutrition. This serves as a tangible effort to rectify historical disparities and foster a sense of dignity and trust within the community.
Many existing Food as Medicine (FAM) models are created and implemented with primarily clinicians and our healthcare system in mind. From your perspective, how has co-designing the Food4Moms PRx model together with your community, the Hispanic Health Council staff and partners moved the needle on FAM? Why is it crucial that communities are centered?
HHC is a nonprofit organization with vast experience conducting community-based research and services, as well as strong partnerships with healthcare organizations and other community agencies serving mothers with limited income. These partnerships collaborate in referring clients to HHC maternal health programs, which provide culturally sensitive integrated services for women before, during and after pregnancy. The overall guiding belief of F4Ms is that co-designing the program with the community will maximize participant engagement and redemption of their incentive. As a result, the health of participating moms and their infants will be improved. Following the co-design listening sessions, it is important to assess program feasibility with a pilot study and then continue soliciting feedback from participants through satisfaction surveys and additional listening sessions. With this approach, we are tailoring our program to suit the needs of the participants.
Pictured above: Andrea Tristan Urrutia (at laptop), Research Associate at Hispanic Health Council, Andrea Aleaga (presenting), Nutritionist at Hispanic Health Council, and participants during a nutrition education session.
What milestones have you felt most excited about achieving at Food4Moms? How do you foresee the program evolving and expanding?
Each milestone is exciting in our F4Ms program. This program is unique because we have many women and mothers working to help participating moms and their babies through the PRx intervention. One exciting milestone is that, at this time, our redemption rates are on average 75 percent each month. This rate is generally higher than other PRx programs and means that more moms and their infants are receiving healthy, fresh fruits and vegetables.
We have already applied for funding from a foundation to extend our intervention from 10 months to a full 16 months. This would allow moms to receive fresh fruits and vegetables from about the middle of their pregnancy through their infant’s first full year of life. Our goal is to facilitate the introduction of complementary feeding and fresh pureed fruits and vegetables into the infants’ diets at six months of age. Fruits and vegetables play a vital role in achieving optimal nutrition, leading to favorable maternal health, supporting child survival and promoting the growth and neurodevelopment of the baby. Furthermore, it is important for the mother to maintain healthy nutrition during and following childbirth as the pregnancy, infancy and toddler stages are sensitive periods for the development of food preferences. Flavors are passed from mother to fetus through the amniotic fluid and from mother to infant through human breast milk. It would be most ideal if we could provide the PRx to moms and their babies through the first 1,000 days of life until the babies turn two years old.
What have you heard thus far from Food4Moms participants? What are they excited about? Hesitant about? What are their expectations?
Participants in the F4Ms program have expressed high satisfaction levels. This program has not only alleviated financial burdens but has also empowered them to improve their own nutrition and that of their families. Additionally, it has broadened their perspectives on fruits and vegetables, introducing innovative ideas for preparation and incorporation into daily meals. The financial relief offered by F4Ms is particularly appreciated in light of the escalating costs of food, especially fruits and vegetables.
Enthusiasm among participants extends to the nutrition education classes, characterized by their interactive nature and the valuable insights gained. Topics covered include practical skills like reading food labels and understanding how nutrition contributes to a baby's brain development and overall growth. Participants commend the staff interactions, noting a clear and thorough explanation of the program's details.
Pictured above: Josefa Correa, Nutrition Educator at Hispanic Health Council
A notable aspect of participant satisfaction is the flexibility and autonomy provided by the PRx redemption option. The ability to choose the timing of redemption, as well as the specific fruits and vegetables to be purchased, resonates positively with participants.
Regarding expectations, participants have requested improvements in reminder messages about card balances. Specifically, they have articulated a preference to directly view their actual card balance in these notifications, eliminating the need to call a designated number for this information. An effective solution has been implemented in prompt response to this feedback. The enhanced system seamlessly provides participants with their remaining card balance whenever they receive reminders to use their benefits.
While participants’ desire to optimize the benefit is evident, there are also obstacles that may impede their success. For instance, participants have expressed genuine concern about the challenge of utilizing all allocated funds by the end of the month. Potential complications they shared include transportation barriers that could hinder their ability to reach the store and spend the remaining funds in the allocated period.
Additionally, participants have shared concerns about the virtual nutrition education sessions. While acknowledging the appeal of the virtual option, they have noted occasional complications with links or logging on and stated the need for clearer instructions on how to use Zoom to ensure a smoother and more accessible virtual experience for all.
Lastly, participants have expressed a desire to redeem their PRx in stores beyond the current Walmart and Stop and Shop options, especially those located in their neighborhoods. They noted that these stores do not always have the specific items they want or need, emphasizing the importance of expanding redemption options to better meet their preferences and requirements.
Pictured above: Andrea Aleaga, Nutritionist at Hispanic Health Council
The 2024 National Women’s History Month theme celebrates “Women Who Advocate for Equity, Diversity and Inclusion.” How will Wholesome Wave and Food4Moms continue to advance health, justice and racial equity to improve health and wellness outcomes for Latina mothers and their babies?
Our goal is to leverage the successes of this program to further inform the PRx and broader FAM fields, thereby helping refine and inspire medical interventions that serve patients through fidelity, equity and dignity. Ideally, the F4Ms program learnings will also build an evidence base that demonstrates the impacts PRx programs can have on maternal and infant health to the Connecticut Medicaid Program, also known as Connecticut Husky Health.
How do you foresee the FAM growing and transforming in the next three to five years? What advice would you give other organizations following in your footsteps?
Market analysts predict a surge in the use of FAM tools within the healthcare system over the next three to five years. Enhanced technologies and dissatisfaction with the healthcare system are driving this interest. Identifying patients likely to use FAM interventions and tailoring them to individual tastes and lifestyles will fuel further growth. Some suppliers may limit offerings, but FAM's uniqueness lies in customization. Success hinges on flexibility and matching patient needs with suitable FAM options. Wholesome Wave has repeatedly confirmed this lesson over our 16+ years of operating these types of programs. We are deeply embracing patient choice with our Food4Moms program and encourage others to do this as well.
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We strongly encourage you to visit the Food4Moms website and explore the following materials to learn more about the Food4Moms program and the Wholesome Wave, Hispanic Health Council and the Yale School of Public Health team.