Cooking Matters for Healthcare Partners (CMHP) is a direct education and policy, systems, and environmental (PSE) change intervention designed to increase participant consumption of fruits and vegetables by 15% based on the pre-post program surveys, increase participant access to direct nutrition education, and link SNAP/WIC eligible individuals to preventative community health interventions. To achieve these goals, the program couples the evidence-based Cooking Matters for Adults (CMA) curriculum with produce distribution at the end of each class so that participants can practice their cooking skills at home. For six months after completing the CMA class, participants have monthly nutrition education sessions with clinic nutritionists and redeem their produce via voucher redemption at Fresh MARTA Markets. Overall, the program increases access to direct nutrition education and produce in locations where SNAP/WIC eligible individuals seek health services, in order to change participant behaviors relating to fruit and vegetable consumption and food resource management.

Target Behavior: Healthy Eating, Food Insecurity/Food Assistance, Other: Food Resource Management

Intervention Type: Direct Education, PSE Change

The CMHP programming targets SNAP/WIC eligible participants within low-income health care systems. The program’s partners have been selected based on their service to low-income population (at least 51% of clients must be SNAP eligible) and capacity to attract SNAP/WIC eligible individuals and families. In 2019 when CHMP was formerly known as the Fruit & Vegetable Prescription Program (FVRx®), the program was conducted primarily across seven Grady primary care clinics in Atlanta, GA, with direct education taking place at community-based sites and monthly nutrition visits in clinics. In 2020, the program will expand to include two more federally qualified healthcare center partners, but the primary settings for produce access will remain at class sites and Fresh MARTA Markets.

Setting: Community (Live), Health care

Target Audience: Adults, Older Adults

Race/Ethnicity: No special focus

The CMHP includes direct nutrition education, produce distribution throughout the program, fruit and vegetable vouchers redeemable at Fresh MARTA Markets, monthly nutrition visits with clinic-based nutrition staff, and data collection. These intervention components provide education about healthy eating, cooking habits, and food resource management throughout CMA classes, ongoing clinic-based support for participants with monthly touch points, and produce access to improve food security status. Participant eligibility criteria included screening positive for food insecurity (USDA two-item screener), being 18 years or older, and receiving healthcare through Grady (for the FY2019 cohorts). A basic timeline of the intervention includes recruitment and screening, baseline data collection, six-week CMA class with produce distribution, midline data collection, five months of produce vouchers and monthly clinic visits, and end line data collection.

The CMA curriculum consists of the following lessons:

• Lesson 1: Healthy Cooking Basics
• Lesson 2: Choosing Fruits, Vegetables and Whole Grains
• Lesson 3: Cooking Lean and Low-Fat
• Lesson 4: Plan to Make the Most of your Meals
• Lesson 5: Shopping Smart
• Lesson 6: Recipes for Success

CMA instructor guides and participant booklets are available via Cooking Matters Fulfillment Center. Survey tools are available via Wholesome Wave Toolkit. A password (available by request) is needed to access Pre-mid-post survey tools.

Materials available at no cost.

Open-ended questions in the midpoint and end line survey tools prompted participants about their satisfaction with the program and potential areas for improvement or change. Feedback from these surveys and comparison data of participants who graduated the program and participants who were lost to follow-up influenced modifications to program implementation and survey tools for following cohorts. For example, participants communicated transportation barriers to attending classes and clinic visits, so programming was modified to make the program locations more accessible to participants. Furthermore, FY2019 data analyses revealed that participants who were lost to follow-up were more likely to classify as food insecure and suffer more severe food insecurity than participants who completed the program. Program partners are using this data to develop additional programming that provides acute support for their most food insecure clients.

Overall, participants showed statistically significant improvements across multiple indicators. These outcomes were assessed when baseline and end line data were used to compare changes in diet, knowledge of healthy eating and shopping practices, confidence in participating in healthy behaviors (like shopping and cooking healthy on a budget), food security, and some biometric markers. For more in-depth discussion of statistical methods and aggregate data for 2019, as well as past cohorts, see the Evaluation Reports on the Wholesome Wave Georgia website.

The unintended benefits of the intervention include:

• Participants valued the ongoing support that came with being part of a long-term cohort in a six-month program
• Produce redemption at the markets provided ongoing social support for program participants
• Participants visited with classmates at the markets (with some even travelling together) and shared tips about shopping and cooking
• Participants talked about cooking and nutrition with the OHCM Registered Dietitian (RD) who was at markets to distribute seasonal recipes and samples
• Continued touch points among participants, as well as between participants and the OHCM RD, helped keep participants engaged and motivated throughout the program

Evidence-based Approach: Practice-tested

Based on the SNAP-Ed Evaluation Framework, the following outcome indicators can be used to evaluate intervention progress and success.

	Readiness and Capacity – Short Term (ST)	Changes – Medium Term (MT)	Effectiveness and Maintenance – Long Term (LT)	Population Results (R)
Individual		MT1, MT2
Environmental Settings
Sectors of Influence		MT11

MT1: Healthy Eating

• MT1h: Statistically significant decrease in frequency of sugar-sweetened beverage consumption at p<0.05.
• MT1i: Participant responses, on a Likert scale, trended towards consumption of low-fat or fat-free milk as well as low- fat or fat-free dairy products
• MT1j: Participant responses, on a Likert scale, trended towards consumption of more whole grain products.

MT2: Food Resource Management

• MT2a: Statistically significant increase (p<0.01) in participants who reported being “very confident” in choosing healthy foods for their families on a budget (baseline = 45.3% and end line = 67.5%)
• MT2b: Participant responses, on a Likert scale, trended towards increased use of nutrition facts labels or nutrition ingredients lists
• MT2f: Statistically significant increase (p<0.01) in participants who reported being “very confident” in buying fruits and vegetables (baseline = 53.6% and end line = 67.5%)
• MT2h: There was no significant difference in participants comparing prices before buying foods from baseline to end line.
• MT2j: There was no significant difference in reporting shopping with a list from baseline to end line.
• MT2m: Statistically significant increase (p<0.01) in participants who reported being “very confident” in cooking healthy foods on a budget (baseline = 47.7% and end line = 66.2%)

MT11: Health Care Clinical-Community Linkages

• MT11d: Seven safety net clinics participated in the 2019 program

Survey tools were developed with input from all partner organizations. Participants complete surveys at baseline, after completing the six-week Cooking Matters course, and at the end of the six-month program. The surveys are used to assess changes in food security, self-efficacy, confidence around healthy eating, perceptions around access to fruits and vegetables, and fruit and vegetable consumption.

Website: The Wholesome Wave Georgia website includes additional information on the Georgia Food for Health  programming, and the Open Hand Cooking Matters website includes additional information about Cooking Matters for Healthcare Partners programming.

Contact Person(s):
Tammy Reasoner – Director of Programs
404-419-3325
treasoner@projectopenhand.org