Understanding Georgia Food 4 Health Client Experiences (GF4H) with the Virtual Platform Open Access

Abstract

COVID-19 led to the physical closure of businesses, schools and sporting activities worldwide. In an attempt to adapt to new conditions, many of these activities migrated to an online platform. Similarly, the Georgia Food for Health (GF4H) program shifted to an online learning platform in order to maintain a safe environment for the participants and the instructors. The GF4H program is a “Food As Medicine” interventions that involve medically tailored meals, medically tailored groceries and produce prescriptions, and is delivered through the healthcare system. The goal of these interventions is to improve nutrition, prevent, manage and treat chronic diseases and reduce the number of hospital admissions via improved diet quality. However, although there have been studies which have evaluated general online learning programs, as well as the “Food As Medicine” (FAM) interventions, there have not been any studies which have evaluated online “Food As Medicine” (FAM) interventions. Hence, a process evaluation was performed in order to provide the GF4H program’s implementing partners with feedback from participants’ experiences with the online format of the GF4H program. This feedback will be beneficial for making modifications to the program’s delivery for the 2021 cohort.

Table of Contents

Table of Contents

I.               Preface -------------------------------------------------------------------------------------------9

List of Acronyms --------------------------------------------------------------------------------9

II.             Introduction -----------------------------------------------------------------------------------10

Rationale ----------------------------------------------------------------------------------------10

Problem Statement ----------------------------------------------------------------------------10

Purpose Statement -----------------------------------------------------------------------------11

Significance -------------------------------------------------------------------------------------12

III.           Literature Review ----------------------------------------------------------------------------14

Food Security in the US ----------------------------------------------------------------------14

Food Security in the Atlanta Metro Area ---------------------------------------------------14

Social & Structural Determinants -----------------------------------------------------------15

Health Outcomes ------------------------------------------------------------------------------16

Diabetes -----------------------------------------------------------------------------------------16

Obesity ------------------------------------------------------------------------------------------17

Hypertension -----------------------------------------------------------------------------------17

Mental Health ----------------------------------------------------------------------------------18

Strategies Used to Address Food Security -------------------------------------------------19

Federal Programs -----------------------------------------------------------------------------19

Voucher Programs ----------------------------------------------------------------------------19

School-Based Programs ----------------------------------------------------------------------19

Educational Programs ------------------------------------------------------------------------20

Community-Based Food Strategies ---------------------------------------------------------21

Outpatient Nutrition Programs --------------------------------------------------------------22

Food As Medicine Model ---------------------------------------------------------------------22

Effectiveness of Virtual Nutrition Programs -----------------------------------------------24

Summary ----------------------------------------------------------------------------------------25

IV.           Methods ----------------------------------------------------------------------------------------27

Study Design -----------------------------------------------------------------------------------27

Study Location & Population ----------------------------------------------------------------27

Participant Recruitment ----------------------------------------------------------------------28

Development of Data Collection Tools -----------------------------------------------------28

Outcomes of Interest --------------------------------------------------------------------------29

Data Collection & Management -------------------------------------------------------------29

Data Analysis ----------------------------------------------------------------------------------29

Ethical Considerations ------------------------------------------------------------------------29

V.             Results ------------------------------------------------------------------------------------------30

Technology -------------------------------------------------------------------------------------31

Assignment Difficulty / Workload -----------------------------------------------------------33

Time ---------------------------------------------------------------------------------------------34

Classroom Environment ----------------------------------------------------------------------35

Food Deliveries (Quality & Quantity) ------------------------------------------------------36

Convenience vs. Choice -----------------------------------------------------------------------37

Unfamiliar Foods ------------------------------------------------------------------------------38

Diversity ----------------------------------------------------------------------------------------38

VI.           Discussion, Conclusion & Recommendations ------------------------------------------40

Food Delivery ----------------------------------------------------------------------------------40

Food Delivery Recommendations -----------------------------------------------------------43

Education ---------------------------------------------------------------------------------------43

Education Recommendations ----------------------------------------------------------------44

Participation -----------------------------------------------------------------------------------44

Participation Recommendations -------------------------------------------------------------45

Time ---------------------------------------------------------------------------------------------45

Time Recommendations -----------------------------------------------------------------------46

Length of Program ----------------------------------------------------------------------------47

Length of Program Recommendations ------------------------------------------------------47

Strengths & Weaknesses ----------------------------------------------------------------------48

Conclusion --------------------------------------------------------------------------------------50

VII.         Appendix ---------------------------------------------------------------------------------------51

Table 1. Codebook -----------------------------------------------------------------------------51

VIII.       Literature Cited ------------------------------------------------------------------------------55

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

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, Public Health Education Health Sciences, Public Health
Keyword	Chronic disease Food security Nutrition
Committee Chair / Thesis Advisor	Webb-Girard, Amy, Emory University

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