UNDERSTANDING SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM-EDUCATION PARTICIPATION AT RURAL FARMERS MARKETS: USING THE THEORY OF PLANNED BEHAVIOR AND SOCIAL MEDIA APPLICATIONS

Low consumption of fruits and vegetables due to various barriers among food insecure populations presents a significant health risk across all ages. Nutrition education is available to low-income populations, but due to the complexity and variety of influences that determine dietary behavior, increasing nutrition knowledge as a singular approach does not successfully result in behavior change. This may be supported by low Supplemental Nutrition Assistance Program (SNAP) redemption rates at farmers markets. There is a lack of data using the Theory of Planned Behavior to assess intentions to purchase fruits and vegetables by SNAP-Ed participants at farmers markets in Southern Illinois. There is also a lack of research on the interest in using social media for nutrition education on fruit and vegetable consumption in low-income populations throughout Southern Illinois. A cross-sectional survey was used to understand SNAP-Ed participants’ intentions to purchase fruits and vegetables at farmers markets, as well as their interest in receiving and using online nutrition education through various social media applications. A survey instrument was distributed to low-income participants of various SNAP-Ed nutrition classes hosted by the University of Illinois-Extension throughout the 16 southernmost counties of Illinois. The survey analyzed constructs of the Theory of Planned Behavior and relationships with intentions using regression analysis. Additionally, questions regarding social media usage were used to determine what technologies and social media applications are most commonly used among the sample, and any interest in receiving nutrition education through such applications. A total sample of n=189 SNAP-Ed participants completed the survey. The study found that attitude regarding fresh fruits and vegetables at farmers markets was the strongest predictor of intent to purchase fruits and vegetables for SNAP-Ed participants who receive SNAP benefits. Second, online nutrition education focused on fruit and vegetable purchases at farmers markets may be more generalizable regarding certain socio-demographic factors for SNAP-Ed participants who receive SNAP benefits. Third, results from the study demonstrate that 76.9% of respondents had Internet access, which is higher than current national rates for Internet accessibility in rural areas. Therefore, it is important to consider an increased Internet accessibility beyond at-home broadband coverage, which may include public libraries, work, school, or on a Smartphone. The most important socio-demographic characteristic to consider regarding social media use was age in the context of generations (Millennials, Working Adults, Seniors). Overall, SNAP-Ed participants were most likely to exhibit interest in nutrition education from text messages, email, or on Facebook. SNAP-Ed participants would like to receive online nutrition education via email (30.1%), Facebook (24.7%), and text messaging (21.0%). Online nutrition education in the form of email, Facebook, and text messaging would be the most successful in terms of recruitment and interaction for SNAP-Ed participants. Therefore, using social media to deliver nutrition education may be an effective supplement to reinforce the current classroom curriculum used in SNAP-Ed programming. Findings from this study support the use of online nutrition education through social media applications as an avenue to increase fruit and vegetable purchases at farmers markets in the Southern Illinois Mississippi Delta Region

Population Health Innovations and Payment to Address Social Needs Among Patients and Communities With Diabetes.

Policy Points Population health efforts to improve diabetes care and outcomes should identify social needs, support social needs referrals and coordination, and partner health care organizations with community social service agencies and resources. Current payment mechanisms for health care services do not adequately support critical up-front investments in infrastructure to address medical and social needs, nor provide sufficient incentives to make addressing social needs a priority. Alternative payment models and value-based payment should provide up-front funding for personnel and infrastructure to address social needs and should incentivize care that addresses social needs and outcomes sensitive to social risk. CONTEXT: Increasingly, health care organizations are implementing interventions to improve outcomes for patients with complex health and social needs, including diabetes, through cross-sector partnerships with nonmedical organizations. However, fee-for-service and many value-based payment systems constrain options to implement models of care that address social and medical needs in an integrated fashion. We present experiences of eight grantee organizations from the Bridging the Gap: Reducing Disparities in Diabetes Care initiative to improve diabetes outcomes by transforming primary care and addressing social needs within evolving payment models. METHODS: Analysis of eight grantees through site visits, technical assistance calls, grant applications, and publicly available data from US census data (2017) and from Health Resources and Services Administration Uniform Data System Resources data (2018). Organizations represent a range of payment models, health care settings, market factors, geographies, populations, and community resources. FINDINGS: Grantees are implementing strategies to address medical and social needs through augmented staffing models to support high-risk patients with diabetes (e.g., community health workers, behavioral health specialists), information technology innovations (e.g., software for social needs referrals), and system-wide protocols to identify high-risk populations with gaps in care. Sites identify and address social needs (e.g., food insecurity, housing), invest in human capital to support social needs referrals and coordination (e.g., embedding social service employees in clinics), and work with organizations to connect to community resources. Sites encounter challenges accessing flexible up-front funding to support infrastructure for interventions. Value-based payment mechanisms usually reward clinical performance metrics rather than measures of population health or social needs interventions. CONCLUSIONS: Federal, state, and private payers should support critical infrastructure to address social needs and incentivize care that addresses social needs and outcomes sensitive to social risk. Population health strategies that address medical and social needs for populations living with diabetes will need to be tailored to a range of health care organizations, geographies, populations, community partners, and market factors. Payment models should support and incentivize these strategies for sustainability