Optimizing Implementation of Food is Medicine Interventions in a Community-Based Healthcare Setting: Nutrition360 Pilot Intervention Results

Purpose The aim of this study was to optimize essential components for Food is Medicine (FIM) interventions by selecting the modes with the least participant burden and lowest cost-to-burden ratio delivery in community-based outpatient settings. Design Randomized crossover (Phase 1) and parallel (Phase 2) design pilot trials. Setting Community-based outpatient healthcare clinic in Jackson, Mississippi. Participants Forty-eight participants were randomized and 32 completed the program. Intervention The 12-week, phase 2 trial included an integrated and a traditional delivery of two psychosocial-structural combinations of study arms. Measures The primary outcomes were participant burden and cost-to-burden ratio. Analysis Repeated measures ANOVA were used to analyze differences across time, in intervention arms, and within groups ANOVA to analyze for modality combination differences. Results Participants were mostly women, had a mean age of 40, all identified as Black or African American, and about one-third had not attained a 4-year degree or higher. The study found that face-to-face delivery had the lowest cost-to-burden ratio and achieved higher attendance and satisfaction compared to virtual modalities, though both formats showed high use of meals/vouchers and reduced added sugar intake over time (F(3) = 5.62, P = .001). Attrition was more common among younger ( P < .01), less-educated ( P = .02), and lower-income participants ( P < .01), with recruitment largely driven by social networks. Conclusion The face-to-face modality was found to be a better approach than the virtual modality, with limited impact of an integrated delivery in this population.