Project Name: Comer Bien (Eat Well)

Project Overview: Mariposa Community Health Center (MCHC) serves a predominantly low-income, Mexican American border community where food insecurity is prevalent and diets don’t often include fresh foods. Healthful eating is hampered by limited transportation options, high food costs and lack of familiarity with the importance of good nutrition to sustain health. Nearly 14% of the health center’s patients have been diagnosed diabetes, and more than 30% adults with diabetes have an A1C over 9%, evidencing poor control. Working with Nogales Community Development, Nogales Community Food Bank, Nogales Mercado/Farmer’s Market, Garrett’s IGA Supermarket, and Villa’s Market, Mariposa CHC launched the “Comer Bien” (Eat Well) Initiative to introduce a comprehensive, community-focused, evidence-based approach to control diabetes and improve health.

The goal of the Comer Bien (Eat Well) project was to improve health outcomes by addressing food-related social determinants and increasing access to healthful and nutritious foods.

Key Project objectives were to:

• Increase access to healthy food through prescriptions for fruit and vegetables and coupons and collaboration with local markets and grocers;
• Address social determinants of health that affect healthy eating and diabetic outcomes; and
• Improve both healthful eating and blood sugar control for a pilot group of 100 patients with uncontrolled diabetes and a subsequent group of 100 patients with the same morbidity.

• • 2017-2018 Project Activities:
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    • Expanded comprehensive care coordination and patient- and family-focused care for high-risk patients;
    • Assigned a Community Health Worker to provide home-based assessment, diabetes education and management and help patients adopt and maintain healthy lifestyles;
    • Designed provider coupons for fruit and vegetable prescription program FVRx, established electronic work flow for documentation in medical record, and pilot-tested FVRx coupon program;
    • Designed, delivered, and evaluated cooking classes and tailored food boxes to encourage and facilitate healthy eating;
    • Provided transportation to classes, farmers markets and groceries to improve access to healthful food;
    • Cultivated collaborative partnerships with community organizations/coalitions including Nogales Mercado/Farmers’ Market, Villa’s and Garrett’s Supermarket, Southern Arizona Community Food Bank, Nogales Community Development;
    • Convened provider training on Fruit and Vegetable (FV) Rx as a best practice, and initiated closer communication with clinical staff at MCHC to foster collaboration and information-sharing to improve patients’ adherence to treatment and generate better health outcomes; and
    • Developed a patient satisfaction assessment and comprehensive evaluation of patient knowledge about health diet and experiences in the program.
  • 2017-2018 Key Project Outcomes
    • One hundred (100) high-risk diabetic patients were enrolled in the Comer Bien program;
    • FVRx fruit and vegetable prescription coupons were redeemable at participating community grocers to all program enrollees (100) as program modules were completed; Ninety-nine (99) patients received five or more coupons and 65 patients received 20 or more coupons. Of 2,060 coupons issued, 81% were redeemed at local grocers;
    • Fifty-two (52) participants participated in one or more cooking demonstration classes, and 33 attended all sessions of the 4-class program. The curriculum covered health and nutrition education, offered healthy food recommendations, and provided fresh produce for the cooking classes;
    • Through partnership with the Southern Arizona Community Food Bank, tailored healthy food boxes were distributed to 47 participants and their family members;
    • Thirty-five (35) patients and family members who completed the cooking classes received vouchers redeemable at Nogales Mercado/Farmer’s Market for fresh fruits and vegetables, with 100% redemption;
    • Twenty (20) participants received CHW home visits to assess services needed to address social determinants of health and provide appropriate referrals; and
    • Those participants who had a check-up at 3 months post-intervention (n=30) or 6 months post-intervention (n=20) had reduced HbA1c by 11% and 14% respectively.
  • 2018-2019 Key Project Activities
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    • Engaged new cohort of 100 patients for the program;
    • Provided home visits and home assessments to 76 patients;
    • Added a 30-minute exercise session (yoga and aerobic) to each cooking class to encourage participants to incorporate physical activity and exercise into their lifestyle;
    • Raffled incentives for healthy eating at the end of each cooking class;
    • Held two (2) cooking demonstrations at Villa’s Market, one of the FVRx redemption grocery store partners;
    • Continued partnership with the Community Food Bank of Southern Arizona to assess and improve quality and value of foods provided in the diabetic-tailored food box;
    • Established processes to improve tracking of 3 and 6-month post intervention A1C levels and BMI;
    • Refined data collection and quantitative evaluation methods, and additional metrics such as tracking coupon redemption;
    • Utilized data collected by the community health workers to identify patient needs and tailor program interventions; and
    • Developed a program evaluation survey.
  • 2018-2019 Key Project Outcomes
    • Of the 100 participants who were enrolled in the program, 98 received monthly FVRx coupons;
    • By the end of the project period, 100% of Villa’s Market coupons were redeemed and 99% of Garrett’s Market were redeemed;
    • Seventy-six home assessments were completed;
    • Diabetic healthy food boxes assembled by the Community Food Bank of Southern Arizona were distributed to 49 program participant families;
    • Forty-six participants attended four healthful cooking classes and 50 attended at least one class;
      • Fruit and vegetable vouchers redeemable at the Nogales Mercado (Nogales Farmers Market) were distributed to those who attended at least four cooking classes, and 100% of the vouchers were redeemed;
    • Eighty-nine participants (89%) had a post-intervention HbA1c check-up at 3 and/or 6 months post-intervention;
      • Of this group, 92% (n=82) had reduced HbA1c. The average reduction from baseline was 17% for those with a 3-month check-up, and 19% for those with a 6-month check-up.

Project Partners: Nogales Community Development, Nogales Community Food Bank, Villa’s Market, Garrett’s IGA Supermarket, Nogales Mercado/Farmer’s Market

About the Grantee

Mariposa Community Health Center was founded in 1980 to serve a predominantly rural, Latino community at the U.S.-Mexico border. The major provider of medical, dental and community health services in Santa Cruz County, Mariposa serves nearly 23,000 patients at four sites. Mariposa is well known for its comprehensive Health Promotion and Disease Prevention Department, Community Health Services or how it is known in the community, Platicamos Salud (Let’s Talk Health) established in 1991. Platicamos Salud is rooted in the concept of Community Health Workers in order to provide outreach, education and referral services that are culture and language appropriate for the largely Hispanic/Latino population. For more information, visit www.mariposachc.net.