Process Evaluation of a Farm-to-WIC Intervention.

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Date: Oct. 2021
Publisher: Elsevier Science Publishers
Document Type: Report; Author abstract
Length: 760 words

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Keywords Vegetable intake; Farm-to-institution; WIC program; Process evaluation Abstract Background Despite the promise of farm-to-institution interventions for addressing limited vegetable access as a barrier to intake, programs designed for the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) are lacking. As such, little is known about the implementation of, and mechanisms of action through which, farm-to-WIC interventions affect vegetable intake and participant satisfaction with such programs. Objective To examine whether a farm-to-WIC intervention to promote vegetable intake was implemented as intended, differences between participants who received the intervention relative to those in a usual-care control group in intermediate outcomes of vegetable-related knowledge, attitudes, and behaviors, and secondary outcomes of physical activity and weight status; and participant satisfaction with the intervention. Design A process evaluation encompassing descriptive and comparative analyses of implementation fidelity logs and survey data collected as part of a pilot study was conducted. Participants/setting The setting was a large, New Jersey-based, urban WIC agency. Recruited between June 3 and August 1, 2019 through 3 of the agency's 17 sites (1 intervention and 2 control sites), participants were 297 primarily Hispanic adults (160 enrolled at the intervention site and 137 at control sites). Intervention The intervention combined behaviorally focused instruction and handouts with the introduction of a WIC-based farmers' market, field trips to an area farmers' market, telephone coaching and support, and recipe demonstrations and tastings. Main outcome measures Primary outcomes were vegetable intake (measured via self-report and objectively using dermal carotenoids as a biomarker of intake) and the redemption of vouchers provided by WIC for fruit and vegetable purchases at farmers' markets (measured objectively using data provided by WIC). For the process evaluation, logs were used to document program activities. Vegetable-related knowledge, attitudes, and behaviors, physical activity, and satisfaction with the intervention were assessed with participant questionnaires. Weight status was assessed with direct measures of height and weight. Data were collected at baseline and at mid- and post-intervention (3 and 6 months post-baseline, respectively). Statistical analyses performed Descriptive statistics were used to characterize implementation fidelity. Associations between intermediate and secondary outcomes and vegetable intake were examined at baseline with Pearson correlations. Post-baseline between-group differences in the outcomes were examined with linear mixed-effects models adjusted for baseline values and covariates. Satisfaction with the intervention was assessed with inferential and thematic analyses. Results Post-intervention, measures of vegetable intake were higher in the intervention relative to the control study group. Receipt of the intervention was also associated with a greater likelihood of voucher redemption. Nearly all participants ([greater than or equal to]94%) received the intervention as intended at the WIC-based farmers' market; smaller percentages completed 1 or more planned trips to the area farmers' market (28%) and telephone coaching and support calls (88%). Although most intermediate and secondary outcomes were associated with measures of vegetable intake at baseline, the variables did not differ between study groups post-intervention. Mean satisfaction ratings were [greater than or equal to]6.8 on a 7-point scale. Recipe demonstrations, learning about vegetables, field trips, and the rapport with staff were liked most about the program. Although adding days and times for field trips was suggested, limited market days and hours of operation limited the ability to do so. Conclusions Preliminary data highlight the promise of this well-received intervention. Intermediate outcome findings suggest that other potential intervention mechanisms of action should be considered in future large-scale trials of this program. Broad-scale initiatives are needed to improve access to farmers' markets in underserved communities. Author Affiliation: (1) Department of Sociology, William Paterson University, Wayne, NJ (2) Saint Joseph's WIC Program, Paterson, NJ (3) Department of Psychiatry, Michigan State University, East Lansing * Address correspondence to: Jennifer Di Noia, PhD, Department of Sociology, William Paterson University, 300 Pompton Rd, Wayne, NJ 07470. Article History: Received 9 July 2020; Accepted 11 May 2021 (footnote) STATEMENT OF POTENTIAL CONFLICT OF INTEREST No potential conflict of interest was reported by the authors. (footnote) FUNDING/SUPPORT Research reported in this publication was supported by the National Cancer Institute of the National Institutes of Health under Award Number R21CA230476. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. (footnote) The study was registered at, NCT04038385. (footnote) AUTHOR CONTRIBUTIONS J. Di Noia, D. Monica, and A. Sikorskii designed the study and obtained funding for the research. A. Sikorskii analyzed and interpreted the data. All authors contributed substantially to drafting the manuscript and approved the final version. Byline: Jennifer Di Noia, PhD [] (1,*), Dorothy Monica, MPH (2), Alla Sikorskii, PhD (3)

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Gale Document Number: GALE|A676152132