背景:改善健康的社会决定因素,比如获得有营养的食物,对于实现卫生公平至关重要。营养不安全,尤其是在怀孕和产后,可能导致不良的产妇和分娩结果。食品就是药品(FIM)计划,将食物整合到医疗保健系统中以预防或管理疾病,有可能改善营养不安全,但是关于围产期FIM计划的研究是有限的。
目的:这项研究的目的是探索1)从计划实施者和计划支持者的角度对围产期食品药物计划对公共卫生影响的看法,以及2)用于加强计划采纳的实施策略,实施,和维护。
方法:通过半结构化访谈收集定性数据。采访指南是基于触角,有效性,收养,实施,维护(RE-AIM)框架。
方法:/设置:计划实施者(n=16)和计划支持者(n=20)在2022-2023年通过目的抽样在美国各地招募。
方法:使用演绎主题分析和与项目合作伙伴的迭代反馈循环来分析数据。
结果:与计划实施者和计划支持者完成了访谈,并生成了含义单元(N=1942),这些含义单元被编码为与每个RE-AIM维度一致的主题。围产期FIM计划覆盖了主要通过医疗保健系统招募的多个优先人群。有效性措施通常包括营养模式和做法,以及投资回报。采用计划的动机主要包括伙伴关系和联系,融资,和政策/法律。计划组成部分各不相同,并经过调整以满足参与者和设置需求。政策,证据,资金,和伙伴关系可能会导致程序维护。该计划支持者采用的实施策略包括财务策略和基础设施变更。
结论:需要确定围产期FIM计划的核心功能和适应性形式,这可能导致标准评估指标的识别。这可能导致潜在的递送剂更多的摄取,增加资金和政策支持,并提高了经历健康差异的围产期人口的利益。
BACKGROUND: Improving social determinants of health, such as access to nutritious food, is crucial for achieving health equity. Nutrition insecurity, especially during pregnancy and postpartum, can lead to poor maternal and birth outcomes. Food is Medicine (FIM) programs, which integrate food into the health care system to prevent or manage disease, have the potential to improve nutrition insecurity, but research about perinatal FIM programs is limited.
OBJECTIVE: The purpose of this study was to explore perceptions of public health impacts of perinatal FIM programs from the perspectives of both program implementers and program supporters and implementation strategies used to enhance program adoption, implementation, and maintenance.
METHODS: Qualitative data were collected through semi-structured interviews. The interview guide was based on the Reach, Effectiveness, Adoption, Implementation, Maintenance framework.
METHODS: Program implementers (n = 16) and program supporters (n = 20) were recruited across the United States through purposive sampling in 2022 and 2023.
METHODS: Data were analyzed using deductive thematic analysis and an iterative feedback loop with the project partner.
RESULTS: Interviews were completed with program implementers and program supporters and generated meaning units (n = 1,942), which were coded into themes aligned with each Reach, Effectiveness, Adoption, Implementation, Maintenance dimension. Perinatal FIM programs reached multiple priority populations who were mainly recruited through health care systems. Effectiveness measures typically included nutrition patterns and practices, as well as return on investment. Motivations for adopting programs primarily included partnerships and connections, financing, and policies and laws. Program components varied and were adapted to meet participants and setting needs. Policy, evidence, funding, and partnerships could lead to program maintenance. Implementation strategies applied by the program supporters included financial strategies and infrastructure changes.
CONCLUSIONS: There is a need to identify the core functions and adaptable forms of perinatal FIM programs, which could lead to identification of standard evaluation metrics. This could result in greater uptake by potential delivery agents, increased funding and policy support, and enhanced benefits for perinatal population experiencing health disparities.