A Qualitative Evaluation of the Food as Medicine Program at Grady Memorial Hospital in Atlanta, Georgia Open Access

Abstract

Introduction: Hypertension and diabetes are chronic diseases with largely diet-related management. The high cost of nutritious foods creates management gaps for socioeconomically disadvantaged individuals. This cross-sectional qualitative evaluation explores how the Food As Medicine (FAM) program at Grady Memorial Hospital impacts the food-seeking behaviors (procurement, cooking, and eating habits) of food-insecure program participants living with chronic diet-related diseases. 

Methods: In-depth interviews were conducted with 9 FAM participants to explore how FAM program components (Food Pharmacy, Teaching Kitchen, and Nutrition Classes) have influenced their nutrition-based disease management. In-depth interviews were also conducted with 4 staff members on successes and challenges in program implementation. Both participants and staff provided suggestions for program improvement.  

Results: Access to free food encourages participants to join the FAM program. Participants are motivated to engage in behavior change by fear of life-threatening damage from chronic diseases. Health change champions supporting participants as they go through the program include their families as well as FAM staff and peers. Behavior change adoption is facilitated by knowledge and skills gained from the Nutrition Classes and Teaching Kitchen, including the link between food and disease, disease indicator tracking, toolkit of feasible nutrition strategies, hands-on culinary education and making modifications to culturally specific meals. Participants must undergo a mindset shift towards health empowerment to sustain food-seeking behavior changes. Long-term participant benefits include physical, mental, financial, and spill-over community effects. Some participants face barriers to change including not being mentally ready to change, lengthy gaps between FAM classes, and lack of time at home to buy food or cook for their families. FAM staff note that the insignificant number of staff is the most pressing concern for program implementation. 

Conclusion and Recommendations: The three components of the FAM program work collaboratively to create food-seeking behavior change among program participants. Grady Hospital should re-adopt a cohort model of participation and encourage family inclusion in programming to encourage behavior change adoption. Grady Hospital should also hire additional FAM programming staff and invest in a FAM website to disseminate educational resources which can improve public health.

Table of Contents

Chapter 1. Introduction 1

Chapter 2. Literature Review 4

Hypertension and Diabetes: Chronic cardiovascular diseases 4

Inequities in chronic disease distribution 5

Impact of Nutrition on Hypertension and Diabetes 5

Food Insecurity in the US and Georgia 6

Relationship between food insecurity and chronic disease indicators 7

Prevalence and growth of Food as Medicine initiatives across the US 7

Food as Medicine Program Components 8

Food Supplementation 8

Teaching Kitchen 11

Nutrition Education 12

Summary of Findings and Gaps in Literature 14

Chapter 3. Methods 16

Intervention 16

Study Area & Population 17

Evaluation 17

Program Participant Demographics 18

Data Management and Analysis 19

Chapter 4. Results 20

Figure 1. Adopting and Sustaining Food-Seeking Behavior Change among Food as Medicine participants 20

Motivation for Change 21

Health Change Champions 21

Access to Food 23

Knowledge and Skills 24

Understanding the link between food and chronic disease 24

Participant disease indicator tracking 25

Toolkit of feasible nutrition strategies 26

Hands-on plant-based culinary education 27

Culturally specific diet modifications 29

Change Resistance 31

Health Empowerment 32

Nutritious foods support my chronic disease 33

I am open to trying new ways of eating 34

I know how to cook healthy food that tastes good 35

I can modify my cooking to meet my health goals 36

Food-seeking behavior change 36

Food procurement 36

Cooking Changes 38

Eating Changes 39

Long-Term Benefits 40

Physical 40

Mental health 41

Financial 42

Spill-Over 43

Long-term sustainability 44

Gaps and Suggestions for Improvements 44

Chapter 5. Discussion, Recommendations & Conclusion 48

Alignment with Stages of Change (Transtheoretical) Model 48

Figure 2. Mapping Food-Seeking Behavior Change Adoption and Sustainability Process with Prochaska’s Stages of Change Model 49

Alignment with other Nutrition Program Evaluations 51

Public Health Implications and Recommendations 53

Limitations 56

Conclusions 57

References 58

Appendix A: Food as Medicine Program Evaluation Participant In Depth Interview Questionnaire 64

Appendix B: Food as Medicine Program Evaluation: Staff In-Depth Interview Questionnaire 67

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Nutrition Health Sciences, Public Health
Keyword	Food as Medicine Qualitative Nutrition Evaluation
Committee Chair / Thesis Advisor	Dr. Amy Webb Girard, Emory University

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