Provider Communica/on Interven/on at a Federally Qualified Health Center- based Farmers' Market: Implica/ons for Implementa/on Science

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1 Provider Communica/on Interven/on at a Federally Qualified Health Center- based Farmers' Market: Implica/ons for Implementa/on Science Daniela B. Friedman, MSc, PhD Associate Professor, Department of Health Promo;on, Educa;on, and Behavior Core Faculty, Statewide Cancer Preven;on and Control Program Faculty Affiliate, Preven;on Research Center & Women s and Gender Studies Program Co- PI, South Carolina Cancer Preven;on and Control Research Network

2 Co- Authors/Collaborators Darcy A. Freedman, PhD (PI, Farmers Market) Seul Ki Choi, MPH Edith Anadu, MD Heather M. Brandt, PhD Natalia Carvalho, MS Thomas G. Hurley, MS Vicki M. Young, PhD James R. Hebert, ScD (PI, SC- CPCRN) Lyn McCracken, MA (Project Coordinator, SC- CPCRN)

3 Presenta;on Objec;ves 1. Describe a communica;on interven;on implemented at a federally qualified health center (FQHC)- based farmers market. 2. Iden;fy the benefit of health care provider communica;on and role modeling on FQHC pa;ents dietary behaviors.

4 Background: Farmers Markets Farmers markets (FM) have the poten;al to: improve the diet and health of low- income, medically underserved communi;es (Freedman, Whiteside, Brandt, Young, Friedman, & Hebert, 2012) shape local percep;ons, values, and behaviors about healthy ea;ng (Feagan & Morris, 2009) serve as a space for social interac;on (Payet, Gilles, & Howat, 2005). First study examining the implementa;on and evalua;on of a FM designed in partnership with an FQHC serving individuals with health dispari;es and low SES.

5 Purpose To examine the influence of health care provider communica;on and providers role modeling of healthy behavior for pa;ents within the context of a FM interven;on, a unique approach for addressing both preven;on and treatment of disease among a medically underserved popula;on.

6 Sedng / Interven;on Mul;- phase process used to iden;fy an FQHC site for a FM interven;on (Freedman et al., 2012) Using a CBPR approach, a FM was established at Family Health Centers, Inc. (FHC) from June- October 2011 for a total of 22 Friday markets. A pa;ent- provider communica;on interven;on, implemented with the market, consisted of three communica;on strategies: (1) providing pa;ents with prescrip;ons and vouchers for the market, (2) talking one- on- one about diet during pa;ent appointments, (3) modeling healthy purchases/ea;ng at the market.

7 Pa;ent Sample FHC pa;ents and diagnosed with type II diabetes as of March 1, 2011 (n=2,306 pa;ents). FHC staff randomly selected 345 diabe;c pa;ents by selec;ng every 5 th diabe;c pa;ent in their database. Each pa;ent received a mailing that described the study purpose. Interested poten;al par;cipants were required to contact the research staff to express interest and determine eligibility. 63 pa;ents expressed interest in the study. Final sample included 45 diabe;c pa;ents. 44 completed surveys at all 3 data collec;on ;me points

8 Provider Sample 13 providers received training on the FM prescrip;on program and a set of pre- printed prescrip;on pads Providers were encouraged to shop at the market and share the prescrip;ons with pa;ents. Providers were instructed to disburse one prescrip;on per pa;ent visit. One provider organized the FHC voucher program for par;cipants alending diabetes educa;on classes.

9 Data Collec;on Pa;ents Data collected by telephone 3 ;mes: T1: Before FM interven;on (May/June 2011) T2: Midway through interven;on (August 2011) T3: Right aner interven;on (November 2011). At both T1 and T2, par;cipants received $20 incen;ve; aner T3 $40 provided. $25 financial voucher for FM provided aner T1 and T2 Social aspects of food shopping ques;ons adapted. Close- ended statements (Likert- type op;ons) included: You have a chance to interact with health providers when shopping there (strongly agree to strongly disagree); How o5en has your health care provider talked to you about the importance of ea;ng the daily recommended number of fruit and vegetables per day? (never to always). Open- ended ques;ons included: Has your health care provider ever talked to you about the farmers market? If yes, what did they say?

10 Data Collec;on Providers Near the end of the FM season, all 13 providers were invited to complete a 19- item Web- based survey about their experiences with the prescrip;on program. Upon comple;on providers received a $5 FM coupon. Survey ques;ons included: How did your pa;ents respond to the prescrip;on program? (very posi;vely to not very posi;vely); How important is it that there is a farmer s market at FHC in the future? (very important to not at all important); How much do you agree with the following statement The farmer s market provided important health benefits to PATIENTS at FHC; How much do you agree with the following statement The farmer s market provided important health benefits to STAFF at FHC (strongly agree to strongly disagree); How o5en did you shop at the farmers market? (never to every week).

11 Analysis Repeated measures ANOVA to assess pa;ents percep;ons of social aspects of food shopping and communica;on and interac;on with health care providers at the FM over ;me (i.e., T1 prior to shopping at the market; T2 during use of the market; T3 following use of the market). Open- ended interview ques;ons collected from pa;ents at T3 analyzed induc;vely to iden;fy emergent themes. Nonparametric frequencies and percentages used to analyze provider survey results and pa;ent demographic characteris;cs.

12 Results: Pa;ent Perspec;ves (n=44) 1. Providers role modeling use of the market influenced pa/ents food choices and percep/ons of the market: It boosted them [providers] up. Most of the employees came over and bought things in great amounts. It s good for them because the doctors and nurses are out there buying fruits and veggies. 2. Market provided opportunity for providers and pa/ents to discuss healthy ea/ng: [Shopping at the market] enabled me to follow more of my doctors orders. It reinforced what my doctors were teaching. 3. Market provided opportunity for informal social interac/ons between pa/ents and providers: I see a lot of personnel at the market; there is more interac;on with them.

13

14 Results: Provider Percep;ons (n=9) 5 reported distribu;ng 25+ prescrip;ons Providers gave pa;ents informa;on about: market hours and loca;on importance of ea;ng fruits and vegetables. Most (66.7%) thought pa;ents responded posi;vely or very posi;vely. Perceived barriers to the prescrip;on program: limited market hours for pa;ents to use prescrip;ons limited ;me with pa;ents to discuss the market forgedng to have prescrip;on pads during appointments. Many strongly agreed (33.3%) or agreed (55.6%) that the FM provided health benefits to FHC pa;ents Strongly agreed (33.3%) or agreed (44.4%) that the market benefiled FHC staff (two were neutral ). Most (88.9%) thought it was important or very important that the FM remain at FHC.

15 Summary Pa;ent- provider communica;on is an effec;ve strategy for disease preven;on and treatment. Mul;ple forms of provider communica;on were implemented and evaluated (i.e., coupon distribu;on, educa;on, modeling behavior). Qualita;ve pa;ent data stressed that seeing providers at the market influenced their purchasing decisions. While providers actual communica;on about diet during medical appointments decreased over ;me, pa;ents s;ll had the opportunity to see their providers in ac;on at the market.

16 Research Implica;ons Implementa;on and evalua;on of a structured skills- based training for providers is needed. Physician training programs can influence providers counseling prac;ces and their adtudes about the usefulness of training. Combina;on of verbal communica;on and role modeling may influence pa;ents health behaviors more than provider communica;on alone. Important to share detail & publish on communica;on /interven;on design for dissemina;on and replica;on.

17 Next Steps Disseminate Building Farmacies manual Sign up today if you are interested!

18 Next Steps Scale up farmacies approach to other community health centers in SC and na;onally. BlueCross BlueShield of South Carolina Founda;on Na;onal Ins;tutes of Health, Dissemina;on and Implementa;on Science grant Other sugges;ons?

19 Funded by the Centers for Disease Control and Preven;on Preven;on Research Centers and Na;onal Cancer Ins;tute- funded Cancer Preven;on and Control Research Network U48/DP (Pilot Project Leader: DA Freedman; PI: JR Hébert; Co- PI: DB Friedman). We are grateful to the South Carolina Primary Health Care Associa;on, Family Health Centers, Inc., and all par;cipants. Contact Informa;on Darcy A. Freedman, PhD Tel: Acknowledgments Daniela B. Friedman, PhD Tel:

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