University of Vermont ScholarWorks @ UVM Family Medicine Clerkship Student Projects College of Medicine 208 Skill-Based Cooking Class with the Health Care Share Conner R. Soderquist University of Vermont Follow this and additional works at: https://scholarworks.uvm.edu/fmclerk Part of the Medical Education Commons, and the Primary Care Commons Recommended Citation Soderquist, Conner R., "Skill-Based Cooking Class with the Health Care Share" (208). Family Medicine Clerkship Student Projects. 382. https://scholarworks.uvm.edu/fmclerk/382 This Book is brought to you for free and open access by the College of Medicine at ScholarWorks @ UVM. It has been accepted for inclusion in Family Medicine Clerkship Student Projects by an authorized administrator of ScholarWorks @ UVM. For more information, please contact donna.omalley@uvm.edu.
Skill-Based Cooking Class with the Health Care Share Program Milton Family Practice Conner Soderquist July 208 Mentor: Lisa Hoare
Food Insecurity is a Significant Public Health Concern in Vermont 64,370 Vermonters (0%) live in food insecure households This includes 7,890 (4%) of children under age 8 and 9,82 (8%) seniors There are many contributing factors to food insecurity including lack of affordable housing, decrease in affordable grocery stores, low wages, and lack of public transportation Food insecure families have worse mother and child health outcomes. Food insecurity can be screened for the primary care setting using a 2-question validated screening tool The Children s Health Watch Hunger Vital Sign 2-question Food Insecurity Screening Tool http://academicdepartments.musc.edu/ohp/sfsp/final -Hunger-Vital-Sign-2-pager.pdf
The Cost of Food Insecurity Access to healthy food was identified as a high community need in the 206 UVMMC Community Health Needs Assessment in Chittenden and Grand Isle Counties % of Chittenden County Residents live below the poverty level 23% of adults in Chittenden County eat Vegetables 3 or more times daily and 34% of adults eat fruit 2 or more times daily Health care services related to food insecurity are estimated to be $67 billion annually Food insecure families often resort to eating high calorie, low nutrient dense foods contributing to obesity. Nationwide, as estimated $47 billion is spent on obesity-related health complications. Image from: Hunger Free Vermont https://www.hungerfreevt.org/strategiesinspiration/
Community Perspective on Food Insecurity and role of Health Care Share Lisa Hoare, Coordinator, Health Care Share Working with the Health Care Share (HCS), a program that connects Vermont families experiencing food-insecurity with farm-fresh foods through a weekly farm share has highlighted just how much food insecurity impacts patients lives and their diet in Chittenden County. Food insecurity screening has been helpful in identifying patients that may benefit from the HCS. Engaging in this work has demonstrated the extent that healthy diet can positively impact a patient s overall health The HCS gives patients a positive reason to visit their medical home and reframe how they view their health care facility The community aspect is vital! Participants benefit from seeing friendly faces each week in the program. They share recipes, encourage one another to try new foods, and invest in one another s success. Holly VanWinkle, Practice Manager, Milton Family Practice Food insecurity is a significant problem in the community of Milton. Programs like the Health Care Share along with monthly fundraiser dinners, grant-funded coupons for the farmers market provided at Milton Family Practice, and a summer meals program for kids are some of the many ways food insecurity is being addressed at the local level. Milton FP screens for food insecurity using the 2-question hunger vital sign and will be piloting a social determinants of health screening tool to assess the interconnections of food insecurity, transportation, housing and financial strain. Holly feels that the elderly are a missed demographic in the HCS Transportation to pick up HCS shares is one of the most significant barriers the program faces at Milton Family Practice Even if the HCS can have a positive impact on one family that is enough for it to be a success
Cooking Class Intervention Background One of many strategies for addressing food insecurity in Chittenden Country is the Health Care Share (HCS). The HCS is a partnership between the Vermont Youth Conservation Corps farm and UVMMC that connects Vermont families experiencing food-insecurity with farm-fresh foods through a weekly farm share that includes skills and recipes to prepare healthy meals at home. Participants pick up their share weekly at their family practice. Summary of Need One barrier that families in the program face is knowing how to cook with the produce in the share that may be new or unfamiliar. Strategies that the program has employed to address this barrier include providing recipes, displaying and describing items in the share to participants, and providing samples of different fruits and vegetables for participants to try. One strategy that has been identified as an effective educational tool by the program in the past is conducting cooking demonstrations where participants have an opportunity to learn hands-on skills to create meals from the healthy foods in their share Intervention Conduct a skills-based cooking class with HCS participants where we will work together to cook a Middle Eastern Style Grilled Eggplant dish. Class topics will highlight principals of the Mediterranean diet, basics of kitchen safety and knife handling. Cooking confidence will be assessed using a pre-class survey from Food Standard Scotland. Cooking confidence was previously assessed in the literature by Garcia et al. A recipe card and an information sheet on the Mediterranean diet will be provided to participants at the class. A post-class survey will be administered one week following the class to assess the impact of the intervention on cooking confidence. Image from: http://www.vycc.org/farm/health-care-share/ Image from: https://www.epicurious.com/recipes/food/views/grilledeggplant-with-lebneh-09453
Outcomes Cooking Skill interventions have been shown to have a positive effect on cooking confidence (Garcia et al. 206) Participants were provided a pre-class survey assessing cooking confidence, a recipe card, and an information sheet on the Mediterranean diet from the National Lipid Association. A post-class survey will be provided at one week following class to assess impact of intervention. Survey adapted from: Food Standard Scotland https://www.communityfoodandhealth.org.uk/wpcontent/uploads/206/06/cookwell-pre-jpeg.pdf
Evaluation Evaluation of Effectiveness and Limitations Evaluation of the intervention can be assessed anecdotally by asking participants how confident they feel preparing the recipe made in class following the intervention. More specific evaluation can be established by comparing the results of the pre and post intervention surveys. Anticipated Limitations This is a single-incident cooking class. Prior research evaluating the effectiveness of cooking confidence through cooking skill interventions occurred in longer-term studies with larger sample sizes. Share pick-up times range from 4 pm-5:30 pm, therefore individual participants may not participate in the entire cooking class from start to finish Weekly share pick-up rates vary greatly according to HCS data. Patients that take the presurvey may be lost to follow-up. This may be addressed by mailing out post-surveys with self addressed stamped envelopes with instructions for how to complete the post-survey The materials presented in the handouts are written in English and the class will be conducted in English. This is a potential barrier to accessing the information for all participants. In addition, physical limitations may impede participants ability to actively participate in the cooking demonstration
Recommendations for Future Interventions/ Projects This intervention addressed cooking confidence in an existing farm share program. Further evaluation over a longer period of time with a larger sample size using randomization and controls is warranted to further evaluate the impact of cooking skill intervention The effectiveness of connecting families that screen positive for food insecurity in primary care to resources such as 3SquaresVT and the Health Care Share could be an important follow-up project Skill-based education such as cooking classes take a great deal of coordination and resources. Future projects could identify effective strategies for developing self sustaining cooking classes such as partnering with programs like The Learning Kitchen, a program of Hunger Free Vermont. Future projects could explore the feasibility of developing a medical-school based cooking curriculum similar to the Goldring Center for Culinary Medicine at Tulane University at the Larner College of Medicine to train future physicians in Culinary Medicine. Projects exploring the shared medical appointment model could further inform how the Health Care Share delivers Nutrition and Culinary Medicine education
References Hunger Free Vermont. (208). Hunger in Vermont. [online] Available at: https://www.hungerfreevt.org/hungerinvermont/ [Accessed 8 Aug. 208]. Uvmhealth.org. (206). 206 Community Health Needs Assessment. [online] Available at: https://www.uvmhealth.org/medcenter/documents/about- Us/CHNA.pdf [Accessed 8 Aug. 208]. Apps.health.vermont.gov. (208). Healthy Vermonters 2020 VT Tracking. [online] Available at: https://apps.health.vermont.gov/ias/querytool [Accessed 8 Aug. 208]. Medical Student Led Community Cooking Classes: A Novel Preventive Medicine Model That s Easy to Swallow. (204). American Journal of Preventive Medicine, 46(3), pp.4-42. Community Interventions to Improve Cooking Skills and Their Effects on Confidence and Eating Behaviour. (206). Current Nutrition Reports, [online] 5(4), pp.35-322. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5097072/ [Accessed 8 Aug. 208]. Food Standard Scotland. Pre-Survey. [online] Available at: https://www.communityfoodandhealth.org.uk/wpcontent/uploads/206/06/cookwell-pre-jpeg.pdf [Accessed 8 Aug. 208]. Development and Testing of a Revised Cooking Matters for Adults Survey. (205). American Journal of Behavior Health, [online] 39(6), pp.866-873. Available at: http://development and Testing of a Revised Cooking Matters for Adults Survey [Accessed 8 Aug. 208]. lipid.org. (208). Heart-Healthy Eating Mediterranean Style. [online] Available at: https://www.lipid.org/sites/default/files/mediterraneanstyle_eating_pattern_final_0.pdf [Accessed 8 Aug. 208]. CDC.gov. (206). Keeping Americans Healthy at Every Stage of Life. [online] Available at: https://www.cdc.gov/chronicdisease/resources/publications/aag /dnpao.htm [Accessed 8 Aug. Shared Medical Appointments May Be Effective for Improving Clinical and Behavioral Outcomes in Type 2 Diabetes: A Narrative Review. (207). Frontiers in Endocrinology, [online] 8, p.263. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/pmc5632846/ [Accessed 8 Aug. 208]. Children's HealthWatch Policy Action Brief. (204). The Hunger Vital Sign: A New Standard of Care for Preventive Health. [online] Available at: http://academicdepartments.musc.edu/ohp/sfsp/final-hunger- Vital-Sign-2-pager.pdf [Accessed 8 Aug. 208]. Vermont Department of Health. (204). Food Insecurity in Chittenden County. [online] Available at: http://www.healthvermont.gov/sites/default/files/documents/20 6/2/Food%20Security%20Data%20Brief%20February204.pdf [Accessed 8 Aug. 208]. Vermont Youth Conservation Corps. (208). Food and Farm Health Care Share. [online] Available at: http://www.vycc.org/farm/health-care-share/ [Accessed 8 Aug. 208].
Interview Consent Form Skill-Based Cooking Class with the Health Care Share Program at Milton Family Practice Conner Soderquist July 208 Thank you for agreeing to be interviewed. This project is a requirement for the Family Medicine clerkship. It will be stored on the Dana Library ScholarWorks website. Your name will be attached to your interview and you may be cited directly or indirectly in subsequent unpublished or published work. The interviewer affirms that he/she has explained the nature and purpose of this project. The interviewee affirms that he/she has consented to this interview. Yes X / No Names: Lisa Hoare, Holly Van Winkle If not consenting as above: please add the interviewee names here for the department of Family Medicine information only. Name: