Fresh for Less: Cross-Sector Collaboration for Funding, Implementation, and Evaluation of a Local Initiative to Improve Equitable Healthy Food Access.

INTRODUCTION: This study describes the cross-sector collaboration, dynamic implementation/evaluation, and implications of Fresh for Less (FFL); an equity-focused, multi-strategy healthy food access promotion program that has been implemented since 2017 in underserved communities in Austin, Texas through farmstands, mobile markets, and Healthy Corner Stores. METHODS: Annual evaluation has consisted of repeat cross-sectional quantitative surveys, qualitative customer/staff interviews, audits and cost-effective analyses. RESULTS: Farmstand/mobile market customers reported increased fresh produce consumption and high satisfaction. During COVID-19, mobile markets quickly pivoted to delivery, filling a huge need for safe and affordable grocery delivery. Healthy Corner Stores were not as successful, and this strategy was adapted and reintroduced in 2021. Audits show increased produce provision over time and that mobile markets offered increasingly competitive pricing. DISCUSSION: Fresh for Less demonstrates how cross-sector collaborators can work together to ensure that a program designed to improve equitable food access can be resilient, sustainable, and successful.

The Neighborhood Health Initiative: An Academic-Clinic-Community Partnership to Address the Social Determinants of Health.

BACKGROUND: A medical school, Federally Qualified Health Center, and community-based organizations wanted to improve social determinants of health and health outcomes in an urban area with economic and health inequities. OBJECTIVE: To describe the development of the partnership called the Neighborhood Health Initiative (NHI). METHODS: Community-engaged strategy with multidisciplinary partnerships used an established framework to develop trust, assess needs, and respond. RESULTS: Co-locating primary care services, traditional healers, mental health, and legal services in response to community partners' and residents' concerns helped to create a community-centered health home. As part of the needs assessment, community health workers conducted multiple visits to build trust and ascertain community members' strengths and challenges. Selected shared projects provide solutions to locally identified problems constituted community-driven initiatives. CONCLUSIONS: The NHI is working toward sustainable strategies to improve population health in an underserved area of Austin, Texas. Consistent and frequent contact contributed to developing relationships and trust; limiting partners and objectives focused activities on meeting initial goals of the NHI. Next steps include evaluation of the three aims of the NHI and process evaluation to guide future initiatives.

Design and evaluation of a coalition-led obesity initiative to promote healthy eating and physical activity in low-income, ethnically diverse communities: the Go! Austin/Vamos! Austin initiative.

BACKGROUND: Go! Austin/Vamos! Austin (GAVA) is a coalition-led health initiative that targets low-income communities with disparities in access to healthy food and physical activity. The purpose of this initiative was to increase healthy eating and physical activity among residents by facilitating access to food and physical activity opportunities through environmental and policy changes. Although GAVA is ongoing, this paper describes the original GAVA intervention and the 5-year evaluation study (2013-2018), presenting selected baseline data obtained through its cohort sub-study. METHODS: To assess the impact of GAVA, the evaluation plan included multiple sub-studies and involved collection of quantitative, qualitative, and observational data at different levels. The main cohort sub-study followed 313 parent-child dyads over 5 years. Annually, parents completed self-administered surveys regarding awareness and use of community assets/resources as well as their diet and activities. Heights and weights also were measured. RESULTS: Cohort participants were primarily Hispanic (87%), very low-income (77%), and food insecure (58%), with high overweight/obesity prevalence among both parents (81%) and children (41%). Awareness and use of community physical activity and healthy eating resources were low, and reported barriers to using these resources were many. Engagement in physical activity and healthy eating also was low. CONCLUSIONS: Given the baseline statistics, GAVA resident teams chose and implemented strategies to address the noted barriers and low usage of community resources. This approach built community capacity and governance. Both the GAVA intervention approach and evaluation protocol can serve as models for other community initiatives to be implemented in other locations and contexts.

Designing Place-Based Interventions for Sustainability and Replicability: The Case of GO! Austin/VAMOS! Austin.

Place-based health efforts account for the role of the community environment in shaping decisions and circumstances that affect population well-being. Such efforts, rooted as they are in the theory that health is socially determined, mobilize resources for health promotion that are not typically used, and offer a more informed and robust way of promoting health outcomes within a community. Common criticisms of place-based work include the difficulty of replication, since engagement is so specific to a place, and limited sustainability of the work, in the absence of continued institutional structures, both within the community and supporting structures outside the community, to keep these initiatives resilient. This paper describes a place-based initiative, GO! Austin/VAMOS! Austin (GAVA), which was designed to harness the strengths of place-based work-namely, its specificity to place and community. From the start, the project was designed to balance this specificity with a focus on developing and utilizing a standardized set of evidence-informed implementation and evaluation approaches and tools that were flexible enough to be modified for specific settings. This was accompanied by an emphasis on leadership and capacity building within resident leaders, which provided for informed intervention and demand building capacity, but also for longevity as partners, philanthropic, and otherwise, moved in and out of the work.