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 had 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 will launch 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 is to improve health outcomes by addressing food-related social determinants and increasing access to healthful and nutritious foods.
Key Project objectives are 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.
- 2017-2018 Project Activities:
- 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;
- Twenty (20) participants received CHW home visits to assess services needed to address social determinants of health and provide appropriate referrals;
- 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;
- Distributed healthy food boxes tailored to 47 participants and their family members, through partnership with the Southern Arizona Community Food Bank;
- Issued FVRx fruit and vegetable prescription coupons redeemable at participating community grocers to all 100 participants enrolled in the intervention as program modules were completed;
Ninety-nine (99) patients received 5 or more coupons and 65 patients received 20 or more coupons. Of 2,060 coupons issues, 81% were redeemed at local grocers;
- Thirty-five (35) patients and family members who completed the cooking classes received vouchers redeemable at Nogales Farmer’s Market for fresh fruits and vegetables, with 100% redemption; and
- For those participants who completed the program in its entirety (20 participants with a 6-month post intervention level and 30 with a 3-month post intervention level), observed 11% reduction in HbAIC at 3 months post-intervention, and 14% reduction in HbA1C at 6 months.
- 2018-2019 Expected Project Activities
- Engage new cohort of 100 patients for the program;
- Provide home visits and home assessments to 75 patients;
- Add a 30-minute exercise session (yoga and aerobic) to each cooking class to encourage participants to incorporate physical activity and exercise into their lifestyle;
- Raffle incentives for healthy eating at the end of each cooking class;
- Implement cooking demonstrations at FVRx redemption grocery stores, Villa’s and Garrett’s Supermarket;
- Develop a program evaluation survey;
- Continue 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;
- Establish processes to improve tracking of 3 and 6-month post intervention A1C levels and BMI; and
- Refine data collection and quantitative evaluation methods, and additional metrics such as tracking coupon redemption.
- 2017-2018 Project Activities:
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 4 sites. For more information, visit www.mariposachc.net.