DOI: 10.3886/e237851v1
title: Enhancing Food as Medicine interventions for food insecure postpartum women in Central Texas

description: Texas has particularly high rates of both food insecurity and maternal comorbidities, with the highest rates among ethnic and racial minorities. To address these disparities, in collaboration with two local community food provider partners, Ascension Seton Medical Center Austin (ASMCA) created the Food is the Best Medicine intervention. This intervention is a food access program which provides new, food-insecure mothers with fresh, locally sourced food delivered to their homes for eight weeks postpartum, ensuring that both mothers and babies have healthy food choices during the critical postpartum period. This study tests the efficacy and feasibility of two enhanced versions of the FBM program: the FBM-In person and the FBM-Virtual. These versions include the original 8-weeks delivered food boxes, as well as an educational and social support component. For the FBM-Virtual, all materials and counseling sessions will be offered on-line while for the FBM-In Person, the materials will be delivered via home-visits from Community Health Workers. The proposed study will answer the research question: Is there a significant difference between in-person programming (FBM-In Person) versus virtual programming (FBM-Virtual) on implementation feasibility and impact on food insecure, postpartum women’s behaviors and food insecurity status immediately upon completion of the program and 3 months upon completion of the program? Food insecure postpartum mothers (n=100) recruited from ASMCA will be randomly assigned to either FBM-In person or the FBM-Virtual group. Each group will receive their respective 8-week intervention. Outcomes will be measured at baseline (T0), upon completion of the intervention (T1), and 3 months after intervention completion (T2). Primary outcomes include: food security status, diet quality, breastfeeding, mental health, rates of home cooking, and rationing coping strategies. Changes in key outcomes will be modeled using the generalized linear mixed effects model, utilizing a time-by-treatment term, adjusted for covariates, and accounting for repeated measures. Process data to assess implementation fidelity and intervention satisfaction will consist of both quantitative and qualitative data from participants, CHWs and partner organizations. The results of this study will provide guidance for scaling up the enhanced FBM interventions to other hospitals in order to reduce health disparities experienced by food insecure, postpartum women.<br>
description: No survey weights were used.
description: Response Rates: Of the 150 women who entered the study and completed baseline surveys, 139 women (93%) completed the immediate post-test (at 8 weeks), and 112 women completed the delayed post-test (at 3 months), for a follow-up rate of 75.5% (of baseline).
description: Presence of Common Scales: Edinburgh postnatal depression scale, Food security scale (6 item, past month), DSQ-10 (for Fruit and vegetable consumption), Nutrition security scale (adapted), Financial Anxiety scale (adapted).<br><br>Questions also ask about breastfeeding behavior (CDC questions), cooking behavior (developed by research team for this study.
description: All post-partum women delivering at a single hospital system in Austin, who met the inclusion criteria (food insecure, 18-44 years, English or Spanish speaking, no dietary restrictions, and living within an eligible area for weekly delivery of food is medicine food packages) and consented to participate in the study were included.
description: Low income women in Austin entering the post-partum period. Smallest Geographic Unit: no geographical indicators included
description: web-based survey;