Addressing food insecurity and chronic conditions in community health centres: protocol of a quasi-experimental evaluation of Recipe4Health

Lisa G Rosas; Steven Chen; Lan Xiao; Benjamin O Emmert-Aronson; Wei-Ting Chen; Elliot Ng; Erica Martinez; Mike Baiocchi; Ariana Thompson-Lastad; Elizabeth A Markle; June Tester

doi:10.1136/bmjopen-2022-068585

Addressing food insecurity and chronic conditions in community health centres: protocol of a quasi-experimental evaluation of Recipe4Health

BMJ Open. 2023 Apr 6;13(4):e068585. doi: 10.1136/bmjopen-2022-068585.

Authors

Lisa G Rosas^{1

2

3}, Steven Chen⁴, Lan Xiao⁵, Benjamin O Emmert-Aronson⁶, Wei-Ting Chen^{5

3}, Elliot Ng⁷, Erica Martinez⁵, Mike Baiocchi⁵, Ariana Thompson-Lastad⁸, Elizabeth A Markle⁶, June Tester⁹

Affiliations

¹ Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA lgrosas@stanford.edu.
² Department of Medicine, Division of Primary Care and Population Health, Stanford School of Medicine, Palo Alto, CA, USA.
³ Community Engagement, Stanford School of Medicine, Palo Alto, CA, USA.
⁴ Recipe4Health, Alameda County Health Care Services Agency, San Leandro, California, USA.
⁵ Department of Epidemiology and Population Health, Stanford University School of Medicine, Stanford, California, USA.
⁶ Open Source Wellness, Oakland, California, USA.
⁷ Community Health Center Network, San Leandro, California, USA.
⁸ Osher Center for Integrative Medicine and Department of Family and Community Medicine, UC San Francisco School of Medicine, San Francisco, California, USA.
⁹ Department of Pediatrics, University of California San Francisco, San Francisco, California, USA.

Abstract

Introduction: Chronic conditions, such as diabetes, obesity, heart disease and depression, are highly prevalent and frequently co-occur with food insecurity in communities served by community health centres in the USA. Community health centres are increasingly implementing 'Food as Medicine' programmes to address the dual challenge of chronic conditions and food insecurity, yet they have been infrequently evaluated.

Methods and analysis: The goal of this quasi-experimental study was to evaluate the effectiveness of Recipe4Health, a 'Food as Medicine' programme. Recipe4Health includes two components: (1) a 'Food Farmacy' that includes 16 weekly deliveries of produce and (2) a 'Behavioural Pharmacy' which is a group medical visit. We will use mixed models to compare pre/post changes among participants who receive the Food Farmacy alone (n=250) and those who receive the Food Farmacy and Behavioural Pharmacy (n=140). The primary outcome, fruit and vegetable consumption, and secondary outcomes (eg, food security status, physical activity, depressive symptoms) will be collected via survey. We will also use electronic health record (EHR) data on laboratory values, prescriptions and healthcare usage. Propensity score matching will be used to compare Recipe4Health participants to a control group of patients in clinics where Recipe4Health has not been implemented for EHR-derived outcomes. Data from surveys, EHR, group visit attendance and produce delivery is linked with a common identifier (medical record number) and then deidentified for analysis with use of an assigned unique study ID. This study will provide important preliminary evidence on the effectiveness of primary care-based strategies to address food insecurity and chronic conditions.

Ethics and dissemination: This study was approved by the Stanford University Institutional Review Board (reference protocol ID 57239). Appropriate study result dissemination will be determined in partnership with the Community Advisory Board.

Keywords: NUTRITION & DIETETICS; PRIMARY CARE; PUBLIC HEALTH.

Publication types

Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, N.I.H., Extramural

MeSH terms

Chronic Disease
Community Health Centers
Delivery of Health Care*
Food Insecurity
Humans
Obesity*

Abstract

Publication types

MeSH terms

Grants and funding