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Through the Produce Perks incentive program, FPC has established relationships with several farmers’ markets in Cuyahoga County to better connect low-income residents to healthy, local food. A 2012 FPC survey of farmers’ market participating in Produce Perks, communicates that many market managers see partnerships with health care institutions and providers as one of the most effective strategies to promote the program better. In June of 2013, our members sought to leverage these relationships and coordinated an extended effort to improve public health through local food by launching a fruit and vegetable "prescription program" known as Produce Prescription (PRx).
By connecting public health agencies and providers to our market locations, the Produce Prescription pilot encourages fresh fruit and vegetable consumption among pregnant woman in order to increase healthy birth outcomes while allowing participants to gain a better understanding of assistance programs, like Produce Perks, that help stretch food dollars at farmers' markets. Additionally, FPC understands that cost is just one of the many food access factors that can be addressed through incentives. Paired with Produce Perks incentives, social incentives have the ability to change consumption behaviors (as patients often show deference to the recommendations of physicians and nutritionists in order to stay healthy enough to care for themselves and loved ones.)
PRx works by each provider location enrolling interested women up to 25 weeks pregnant at the beginning of the market season into the program. All participants are then provided with $40 in Produce Prescription vouchers at each of their regularly scheduled monthly gestational visits up until October. During each monthly visit, the provider counsels participants on their nutrition-related health goals and perceptions of farmers' markets in addition to addressing any barriers that the participant may have in shopping at a farmers' markets and preparing healthy meals. The participants then visit a nearby Produce Perks farmers' market and redeems their vouchers for fresh fruits and vegetables.
- About 69 pregnant women were enrolled in the program from June-October
- Over 42% of participants who redeemed their vouchers had never visited a farmers' market before
- 42 participants redeemed over $3,300 in PRx vouchers over 5 months
In partnership with Cuyahoga County Board of Health's Children and Family Services program and The Prevention Research Center for Healthy Neighborhoods at Case Western Reserve University, PRx was piloted at all 20 participating Produce Perks farmers' markets and 5 provider locations.
The Prevention Research Center for Healthy Neighborhoods at Case Western Reserve University (PRCHN)
PRCHN has provided technical expertise in program design and evaluation. In partnership with FPC and CCBH, PRCHN staff has developed three survey instruments to evaluate the outcomes and impacts of the program including a pre- and post-survey and a monthly survey aligned with program goals. They have also guided program design through the development of two–pronged approach that utilizes a community health worker model and a clinical model for the program to compare the effectiveness of different strategies.
Cuyahoga County Board of Health (CCBH)
A local, multi-sector team, being co-lead by CCBH and Cleveland Department of Public Health utilizes non-traditional partnerships to address the root causes of poor birth outcomes in Cuyahoga County, particularly focusing on improving on African-American birth outcomes. CCBH currently provides support to OIMRI and MetroHealth through the development of initiatives that reduce risk factors for infant mortality. CCBH saw an opportunity to leverage its current partners and resources that support healthy birth outcomes to develop the Produce Prescription program for expectant mothers in targeted communities of Cuyahoga County. CCBH has made connections to health care providers for the pilot program, is developing materials and messaging that support healthy eating, and working with PRCHN to develop a rigorous set of program evaluation tools.
Cleveland-Cuyahoga County Food Policy Coalition/Ohio State University Extension
FPC will leverage its relationships with the 20 farmers markets in the Produce Perks program to offer universal access to Produce Prescription program participants at these same markets. FPC will also lead data collection at the markets to provide information on program participants’ market visits and prescription use at markets. FPC has also provided assistance in branding and promotion of the Produce Prescription Program.
Neighborhood Family Practices
OB/Midwife staff at Neighborhood Family Practices’ Ridge Road and Gordon Square locations in Cleveland will recruit expectant mothers to participate in the program. Their dieticians will meet monthly at each clinic with the program participants to share information and set goals for increasing fresh fruit and vegetable consumption and administer surveys.
MetroHealth – Women, Infants, and Children Program
WIC staff at MetroHealth’s Broadway Clinic will recruit expectant mothers to participate in the program. Their dieticians will also meet monthly at the clinic with the program participants to share information and set goals for increasing fresh fruit and vegetable consumption and administer surveys.
Cleveland Department of Public Health – Moms First Program
Moms First Community Health Workers will recruit expectant mothers through Friendly Inn Settlement House in Cleveland’s Central Neighborhood to participate in the program. Community health workers will meet monthly through home visits with the program participants to share information and set goals for increasing fresh fruit and vegetable consumption and administer surveys.
Ohio Infant Mortality Reduction Initiative at NEON
Community health workers at OIMRI will recruit expectant mothers in East Cleveland and Warrensville Heights to participate in the program. Community health workers will meet monthly through home visits with the program participants to share information and set goals for increasing fresh fruit and vegetable consumption and administer surveys.