A Qualitative Evaluation of the Food as Medicine Program at Grady Memorial Hospital in Atlanta, Georgia Público
Peres-da-Silva, Nalini (Spring 2024)
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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