MEND-Poverty “Pathways to Wellness” Program Evaluation
MEND- Meet Each Need with Dignity provides a variety of services to the communities of the San Fernando Valley (SFV) in California. One of its main services is their Emergency Food Bank, which is one of the largest in Los Angeles and the state of California and in 2018, it helped feed more than 38,000 individuals both onsite and through community outreach. Also, their “Buen Provecho” Farmer’s Market has been instrumental in providing and introducing a wide variety of fruits and vegetables into the diets of people from the SFV. Most recently, MEND created their “Pathways to Wellness” program in an effort to supplement its food bank services. By pairing their Wellness Program workshops with its food bank, MEND’s Wellness Program has been successful in identifying and addressing food insecurity for their clients and has made a conscious effort to provide a food insecurity- conscious program that is aware of the challenges that come with eating a healthy diet while being food insecure and/or experiencing home insecurities, too.
Over the years MEND’s wellness program has undergone several modifications since its initiation and program evaluations from participants have been crucial in tailoring these services to the needs of the San Fernando Valley community. Currently, assessment of the program is limited as MEND’s only evaluation tool is a 33-question health questionnaire that asks about health status, diet, exercise, and food insecurity. This survey has not yet been standardized to include questions adapted from other national and state questionnaires that ask similar questions and can benefit from further standardization to obtain a better understanding of the needs of the community.
MEND’s goals for future cohorts includes personalized nutrition coaching for all clients enrolled in their Wellness Program. Through this new initiative, MEND hopes to provide a more personalized experience to each client by providing nutrition counseling that recognizes the challenges of food insecurity with hopes that it will eventually translate into healthy behaviors and healthier lives over time. Literature on community health education programs show that there is space for an organization like MEND to provide nutritional coaching and bring awareness of healthier behaviors to clients while also tackling food insecurity and the adverse health outcomes associated with it. Further analysis will help reassess what is already being done with the Wellness Program and restructure the wellness curriculum to reflect client’s needs using data collected from prior program participants.
In order to better understand how to tailor this new proposed service to MEND wellness program participants, an evaluation of the program and its prior cohort health questionnaire data was completed. Data collected from prior participants will be analyzed to identify areas of focus and improvement to properly tailor the personalized coaching sessions to the needs of the community.
MEND has been administering a 33-question health questionnaire consisting of questions on chronic illnesses, diet and physical activity, as well as, food insecurity, access to a physician, and support systems, which has been used to assess participant’s health status and health behaviors. The questionnaire is available in both English and Spanish and was completed by the 2019 cohort of 30 participants, of which 21 were done in Spanish and 9 in English. The questionnaire was administered at the first wellness program workshop and was completed individually by each participant. For the evaluation of MEND’s wellness program, data from the last cohort’s health questionnaire will be analyzed. Also, a SWOT analysis of the wellness program and the survey will be performed in order to assess the program and the effectiveness of the health questionnaire.
Last year’s cohort of thirty participants completed the preliminary survey. Data was collected and was analyzed to obtain a better understanding about the health demographics of their clients as they pertain to certain chronic illnesses and health behaviors. From the questionnaire, it was gathered that among the 30 participants, 17% consider their health status to be fair and 10% very bad. Also, 33% of participants considered themselves to be overweight or obese, while 40% have high cholesterol, 23% are prediabetic, 20% have hypertension, 20% have depression or anxiety and 7% have diabetes. The questionnaire also revealed that 50% of the cohort did not know the normal ranges for their medical conditions. Also, 60% thought their conditions could be cured and 40% thought that taking medications was more important than their diet. In terms of where they acquired their food, 53% stated that they utilized the MEND Buen Provecho Farmer’s Market program to obtain food.
MEND’s health questionnaire helped identify common chronic illnesses such as obesity, high cholesterol, high blood pressure, and diabetes among its participants. Another common condition was depression and anxiety, which may be due to the socioeconomic factors that place a burden on their health, but more questions need to be incorporated in order to further assess depression and anxiety prevalence among the participants and to be able to properly address through the health education and wellness workshops. Notably, most participants had a PCP, but it was unclear how many times a year they visited their PCP and for what reasons since there were no direct questions addressing this. More questions targeting healthcare access should be incorporated to get a better picture of their healthcare utilization, access, and chronic illness management. Also, questions around health care access were mostly open ended, which led to a lot of variability in the answers given, making it hard to quantify.
Based on the internal assessment of the Wellness program and the literature review, it is clear that MEND’s wellness program provides a very valuable service to the communities of the San Fernando Valley, by not only addressing food insecurity, but doing so in a way that is mindful of health outcomes. Given that food insecure families often do not have the means to buy fruits and vegetables, which often leads to higher prevalence of chronic diseases in these communities, it is crucial that MEND continues to partner with organizations that can provide these types foods and continue with their Buen Provecho Farmer’s Market. From MEND’s health questionnaire it was gathered that the majority of the cohort’s participants had at least one chronic illness that they were managing with overweight or obesity and high cholesterol being the main ones among this cohort. In order to continue addressing the health disparities that come with food insecurity MEND should continue to provide workshops around basic management of these chronic illness by adapting health education material from reliable sources such as the American Heart Association. Once this is accomplished, MEND can work on establishing more personalized health coaching sessions to set specific goals with the participants.
Also, there is need for a standardized health behaviors questionnaire in both English and Spanish that can be administered before and after the completion of the program to track changes in health behaviors as the one currently in place is limiting in the questions it asks and the language used may be confusing, thus hindering full completion of the survey by participants. Health Behavior Questionnaires have been used by national and state organizations to assess the health of its communities and each questionnaire is helpful in gathering data around health status and behaviors. Given the importance of these surveys and their usefulness in acquiring health status and behavior data for the U.S population, it would be ideal for MEND to use and adapt questions from these questionnaires, which are readily accessible online, in order to create a questionnaire with validated questions that have been standardized and properly translated into other languages by professionals in the health and allied fields. By using standardized questionnaires to establish a MEND’s health questionnaire, it can streamline the process of gathering sound data for their program and be able to properly assess the health status and behaviors of their participants.