TheVeggieVanImplementationStudy:History,CurrentWorkandFuturePlans

LuciaA.Leone,PhDDepartmentofCommunityHealthandHealthBehaviorSchoolofPublicHealthandHealthProfessionsUniversityatBuffalo

January17,2019

FORMATIVEWORKNorthCarolina:2009-2011

FoodAccessFocusGroups

•  8+focusgroupswithlower-incomeindividualsinNC

•  AskedpeopleaboutwhatwouldhelpthemeatmoreF&V

•  Exploredseveraloptionsincludingfarmers’marketsincentiveprograms,communitygardens,low-costhealthyfastfoodrestaurant,etc.

3

FeedbackonMobileMarkets•  Generallywell-receivedbyparticipants•  Havingmarketscometoconvenientlocationswould

makeiteasiertopurchasefreshF&V–  Consistenttiming,i.e.,operatingatthesametimeeach

week,andflexiblehourscrucialforaccessibility–  Producesoldatmobilemarketneedstobehighquality

andfresh:•  “Wedon’twantthemtocomethroughourneighborhood

becausewearelowincomerealty.Wedon’twantthemtobringnoleftovers.”

•  Goodcustomerservice,trustingvendors,andbuildingrelationshipswithvendors/farmersincreasesparticipantslikelihoodofshoppingthere

ParticipantspreferredMobileMarkets

•  88%ofparticipantsindicatedonapost-focusgroupsurveythattheywouldbe“verylikely”or“somewhatlikely”touseamobileproducemarket

VeggieVanModel•  WeeklyboxesofNorthCarolinagrownF&V

–  Deliveredtoconvenientlocationsincommunity–  Reducedcost,acceptsmultipletendersincluding

SNAP–  NutritionandCookingEducation,Recipes,

Newslettersandmore

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SocialCognitiveTheory

Food Environment

F&V Consumption

Individual

Educational InterventionExpectations: Nutrition lessons/newsletter content on benefits of healthy dietExpectancies: Social marketing campaigns at community sitesObservational Learning: Cooking demonstrations, social modelingBehavioral Capability: Recipes and food preparation tips

Food Access InterventionSpatiotemporal: Delivery to frequently visited locations in underserved communitiesEconomic: Priced to meet needs of community, accepts SNAP Benefits (food stamps) Social: Responsive to cultural food normsService Delivery: Incentives, quality, customer education

Quality: Fresh, local food

Self- Efficacy

Perceived Access

-0.8

-0.6

-0.4

-0.2

0

0.2

0.4

0.6

Adjusted*(n=142)

OutliersRemoved*(n=138)

First8Sites*(n=114)

IntervenPonControl

1.14cupsP=0.01

0.51cupsP=0.11

0.95cupsP=0.005

RCTin12communities

*Adjustedforbaselinevalues,educaPonandclusteringinsites

OVERVIEWOFCURRENTSTUDY

MainGoal

•  Takethe“successful”VeggieVanmodelandhelpotherorganizationstoadaptandimplementitinnewcommunities– VeggieVantoolkitwillbeusedtohelporganizationsstarttheirownprogram

– Ourteamwillprovidetechnicalassistanceandhelpwithcommunityengagement

– Wewilllookatchangesinfruitandvegetableconsumptionandmonitorimplementation

What’sintheVeggieVantoolkit

•  Marketingmaterials•  Samplebudgetsand“break-evenanalysis”spreadsheet

•  JobDescriptionsandOperationsManuals•  “Point-of-sale”NutritionCurriculumincludingadatabaseofrecipesbyproduceitemandseason,samplenewslettersandactivityideas

KEYINFORMANTINTERVIEWS

Aim1a

KeyInformantInterviewGoals

•  Improvethetoolkitbyincludingadditionalfinancialmodelsandcommunityoutreachstrategiesfromotherorganizations

•  UpdateRFPselectioncriteriabasedonadditionalmeasuresofmobilemarketsuccessidentifiedthroughqualitativeanalysis

Methods

•  IdentifiedexistingMobileMarketsandaskthemtocompleteascreenersurvey

•  Selected21experienced/successfulmarketoperatorstoserveaskeyinformants–  InitialInterview–  Follow-upinterviewsonuniqueprogramaspects–  4organizationsundergoingbusinessanalysis

•  Analyzeinterviewstodeterminebestpractices/barriersandkeystosuccess

RFPPROCESSAim1b

RFPGoals

•  IdentifyorganizationsacrossthenorthandsoutheasttoserveaspartnersintheVeggieVanimplementationstudy– Received58intenttoapplysubmissions–  Invited24applicantstoapply– Received17fullapplications–  Invited12finaliststoattendourtrainingandselectionmeetinginMarch

•  Selectfinal8partnerorganizationsbyApril2019

BenefitsofPartnership•  Upto$50,000tooffsetthecostofrunningamobilemarket

accordingtotheVeggieVanModelandparticipatinginongoingevaluationefforts

•  AccesstotheonlineVeggieVantoolkitwhichincludes:•  Trainingonthetoolkitandongoingtechnicalassistance•  Assistancewithcommunityengagementanddevelopinga

communityadvisoryboard•  FarmersRegisterMobileMarketpoint-of-salesoftware•  Accesstodataandreportingrelatedtomobilemarket

evaluationoutcomes.•  Assistancewithdevelopingasustainabilityplanand

identifyingprogramfundingsources

EFFECTIVENESSEVALUATION

Aim2a.

ParticipantRecruitment

Goals:Recruit30participantsateachof32locations(8organizationsx4sitesperorganizationx30participants=960)•  Potentialstudyparticipantswillbethose

interestedinhavingmorehealthyfoodoptionsintheircommunity.–  Organizationswillidentifytheseindividualsthrough

differentcommunityengagementchannelsandaskthemtocompleteaninterestform

–  ThosewhocompleteaninterestformwillbeinvitedtoVVkick-offORcommunityforum(comparison)

DataCollection– Atthekick-off/forumrecruitedparticipantswill:

•  Haveheightandweightmeasured•  Completeasurvey•  VeggieMeter

– Afterinitialdatacollection,participantswillbecalledandaskedtocompletetwo24hourdietaryrecalls

–  Ifwedon’tget30participantsatthekick-off/forum,additionalparticipantswillberecruitedattheirfirstmobilemarketvisitoratfuturefoodsystemsplanningevents(comparison)forupto2monthsafterinitialdatacollection

INTERVENTIONIMPLEMENTATION

Aim2b.

ImplementationGoals

•  WorkwithorganizationstoadapttheVeggieVanprogramtotheirsetting

•  UnderstandbarriersandfacilitatorstoimplementingtheVVbyeachorganization

•  Documentfidelitytotheintervention,programadaptationsandreach

REVISETOOLKITFORFUTUREDISSEMINATION

Aim3

MobileMarketsinRuralCommunities

•  MostoftheRFPapplicantswhodidnotgetinvitedtoapplywererural– Limitedtourbanduetolackofexperience/testinginruralareas

– Concernsaboutviabilityofmodelinruralareas

Preliminaryquestions/concerns

•  Couldnotreachasmanysitesinonedayorasmanypeopleatonesite?– Wouldtheideaofpartneringwithanorganizationthatpeoplearealreadygoingtostillholdup?

– Wouldhomedeliveryworkbetter?Coulditbescaledatlow-cost?

InvolvingRuralCommunities

•  MobileMarketSummitinBuffalo,NYMarch5th&6th– Networkingandsharing– Trainingandexpertconsultations– Opentoanyone

•  Interviewswithruralmobilemarketstounderstandhowtheyaredifferent?

Yourthoughtsandquestions?

STUFFITHINKISCOOL!OvercomingPreviousChallenges

Challenge#1

CommunityPartnersDon’tLikeRandomizationSolution:RFPProcess•  Organizationsapplytoreceivetechnical

assistanceandfundingtostart/expandamobilemarketprogram

•  Eachorganizationthatappliesidentifies4sites/communitiestheywouldworkwith(2mostbelower-income)

•  RFPteamselects8organizationstoparticipateintheinterventionandrandomizetheir4sites(2tointervention,2tocontrol)

Challenge#2

Mobilemarketprogramslackfinancialsustainability;HowdowepayfarmersenoughandkeepthepricelowforconsumersSolution:BusinessModelAnalysis•  Workwithcurrentsuccessfulprogramstoidentifybestpractices

•  Expertbusinessmodelanalysis•  Explorecostoffset,incentiveandslidingscaleprograms

•  Sharemodelsaspartoftoolkit

Challenge#3

VVhostsiteshadlimitedreach;theunderservedarebynaturehardtoreach;NoteveryoneusedVVwhosaidtheywouldSolution:CommunityEngagement•  Ourteamwillworkwitheachorganization

todevelopacommunityengagementplanandadvisorycommittee

•  Initialrecruitmentanddatacollectionwillhappenatmobilemarketkick-off

Challenge#4IncompletepurchasingdatafrommobilemarketcustomersSolution:PointofSaleSoftwareforMobileMarketswithResearch“Back-End”•  EachorganizationreceivelicenseforFarm

RegistersoftwareandiPadtoruniton•  Back-endaggregatesindividualandsite-leveldata

forresearchaccess;linktopersonalinfousingaloyaltycard

•  De-identifieddatafromanymarketusingFarmRegisterwillbeavailableinperpetuityforresearchaccess

Challenge#5

Self-reportdietarydataisdifficulttocollectandunreliableSolution:Veggie-MeterasaSupplementto24-hourDietaryRecalls•  Allparticipantsneedtodoissticktheirfingerin

themachine•  UsespressuremediatedRamanSpectroscopyto

measuredermalcarotenoids•  Dermalcarotenoidscorrelatewithserum

carotenoidswhichareabiomarkerforfruitandvegetableconsumption