Feasibility of a Home-Delivery Produce Prescription Program in Families with Children with SCD
Blaize Shiebler, Laura Fischer, Ali Qadira, Laila Mahmood, Lisa Thaniel, Pallavi Dwivedi, Elizabeth Edney, Megan Connolly, Steven Hardy, Tyish S Hall Brown, Deepika S DarbariAbstract
Background
Sickle cell disease (SCD) affects over 100,000 individuals in United Sates. Beyond clinical complications such as recurrent pain episodes and other comorbidities, many families with children with SCD also face food and nutrition insecurity. Food and nutrition insecurity are critical social determinants of health (SDOH) that may adversely affect disease management and clinical outcomes, underscoring the need for targeted interventions. The Children’s National Hospital (CNH) Enhanced Integrative Care (EIC) program, funded by the Children’s National Founders Auxiliary, focuses on “whole person health” in individuals with SCD by addressing multiple factors that influence health and disease outcomes while empowering individuals, families, and populations to improve their health in multiple interconnected domains. Produce prescriptions (PRx) are a “Food as Medicine” clinical care strategy to address SDOH such as food and nutrition security by offering greater access to fresh fruits and vegetables and culinary and nutrition education. The CNH Family Lifestyle Program’s PRx (FLiPRx), offers 6-months of fresh fruits and vegetables delivered weekly along with nutrition and culinary education in twice-monthly virtual education sessions. In 2024, EIC partnered with FLiPRx to address food insecurity (FI) risk in patients enrolled in EIC. The goal of this study was to describe the prevalence and severity of FI in families with children with SCD and to evaluate the feasibility of a PRx program in families with a child with SCD participating in EIC program.
Methods
Families with children with SCD participating in the EIC within the delivery radius were referred to FLiPRx. Adult caregivers of EIC participants enrolled in FLiPRx completed self-report surveys at baseline (pre), monthly, and at 6-months post-intervention (post). Surveys asked about family demographics and household FI severity using the USDA Household Food Security Survey (scale 0-6 with 0 indicating no FI and 1 or higher indicating FI). Program feasibility metrics include monthly staff-observed attendance and self-reported monthly produce utilization and program satisfaction. Descriptive statistics for demographics, feasibility, and cross-sectional pre-post FI severity category are provided.
Results
Nineteen EIC families, accounting for twenty EIC patients, were enrolled in FLiPRx of which ten (50%) children had hemoglobin SS, seven (35%) children had hemoglobin SC, and two (10%) children had sickle beta plus thalassemia. Ten children were male (50%), and ten children were female (50%). Median age at consent was 13. In the cohort of EIC families participating in FlipRx, 9 (47%) reported some degree of FI at baseline. Nine (43%) families attended 50% or more of the available FLIPRx monthly education sessions. Median monthly produce utilization was 87%. Monthly satisfaction was rated at “completely” or “very high” by 81% or respondents. At baseline and post-intervention, the rate of marginal FI was 57% and 71%, the rate of high FI was 14% (unchanged), and the rate of very high FI was 28% and 14% (decreased), respectively. Study will also evaluate impact on dietary habits of participants pre and post intervention.
Conclusions
This study shows that families with children with SCD often experience FI and home-delivery produce prescription programs such as FLiPRx are acceptable, feasible, and associated with high satisfaction among the recipients and may be helpful in reducing FI, an important SDOH.