Optimizing Implementation of Food is Medicine Interventions in a Community-Based Healthcare Setting: Nutrition360...

PurposeThe aim of this study was to optimize essential components for Food is Medicine (FIM) interventions by selecting the modes with the least participant burden and lowest cost-to-burden ratio delivery in community-based outpatient settings.DesignRandomized crossover (Phase 1) and parallel (Phase 2) design pilot trials.SettingCommunity-based outpatient healthcare clinic in Jackson, Mississippi.ParticipantsForty-eight participants were randomized and 32 completed the program.InterventionThe 12-week, phase 2 trial included an integrated and a traditional delivery of two psychosocial-structural combinations of study arms.MeasuresThe primary outcomes were participant burden and cost-to-burden ratio.AnalysisRepeated measures ANOVA were used to analyze differences across time, in intervention arms, and within groups ANOVA to analyze for modality combination differences.ResultsParticipants were mostly women, had a mean age of 40, all identified as Black or African American, and about one-third had not attained a 4-year degree or higher. The study found that face-to-face delivery had the lowest cost-to-burden ratio and achieved higher attendance and satisfaction compared to virtual modalities, though both formats showed high use of meals/vouchers and reduced added sugar intake over time (F(3) = 5.62, P = .001). Attrition was more common among younger (P < .01), less-educated (P = .02), and lower-income participants (P < .01), with recruitment largely driven by social networks.ConclusionThe face-to-face modality was found to be a better approach than the virtual modality, with limited impact of an integrated delivery in this population.