NOURISH Kentucky

Project Abstract Approximately 12% of residents in Kentucky experience food insecurity, with specific neighborhoods and demographics experiencing very high food insecurity. The COVID-19 pandemic exacerbated these levels, as have recent inflation increases. Multi-level programs addressing policy, systems, and environmental (PSE) changes in communities can improve nutrition- related statuses and promote health equity. The overall goal of NOURISH Kentucky is to improve healthy eating and food security, thereby supporting lifelong health and wellbeing. We will focus on both urban and rural environments for the proposed project in order to identify commonalities and differences in community preferences and implementation tactics for success. Our team will collaborate with local community advisory boards in each community to adapt and implement evidence-based multilevel interventions in the target neighborhoods in order to augment community capacity for disease prevention and health promotion and to enhance fidelity, acceptability, and sustainability of our efforts. We will focus on one urban environment, Louisville, and one rural environment, in Appalachia. Our approach will be guided by the Getting to Equity (GTE) in Obesity Prevention Framework, which provides a conceptual framework for researchers to engage stakeholders and to explicitly employ a health equity lens in obesity nutrition and food insecurity efforts. The GTE Framework acknowledges social injustices in developing PSE interventions to mitigate obesity inequities and has been successfully employed by our team to examine barriers to healthy food access within Appalachia. By intentionally applying a health equity lens, our project will foster a local perspective in all project activities. This project aligns closely with the Humana Foundation priority to shape a healthier approach to nutrition that supports lifelong health and wellbeing. Although we will focus on low-income adults, we will work with Project 2 to target adults who have children in the house in order to have the broadest community impact. To understand how best to use existing assets and engage community partners to improve healthy eating and food security in our target communities, we will adopt a rigorous, stepwise approach. The project will be guided by community-specific priorities and will apply existing, relevant evidence-based resources. Using a community-based participatory research (CBPR) approach local organizations (i.e. Dare to Care) and community partners. Members of these groups will serve on the project’s community advisory board and will collaborate with investigators in all aspects of the study, including designing/selecting/adapting intervention components, providing input on evaluation, interpreting findings and, importantly, disseminating the findings of the project to the community. In Appalachia, we will collaborate with God’s Food Pantry, which coordinates food distribution to food banks in the region, as well as local health departments, non-profit organizations and churches in the region that operate food banks to serve low-income families. For purposes of our evaluation, the primary outcome measures for all interventions will be the same: (1) healthy eating and (2) food security. We will collect data from cohort participants at baseline again and at the end of year 1 and then again at the end of year 2. We will monitor changes in the primary outcome measures (healthy eating and food security) over this time period. By implementing these interventions in one urban and one rural community, our team will be able to note similarities and differences between community preferences, adaptations and acceptability for the interventions as well as key factors for implementation success.