Intervention Plan ABD BG 120813 Unformattedcitations

8/11/2019 Intervention Plan ABD BG 120813 Unformattedcitations

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Intervention Plan: Mobile Food Market to Alleviate Transportation

Constraints on Fresh Food Access

Amber Donaldson

Rebecca Graves

NUTR 505University of Tennessee- Knoxville

Dr. Marsha Spence

November 26, 2013


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Table of Contents

Summary: ............................................................................................................................................................. 2Background: ......................................................................................................................................................... 3Project Partners: ................................................................................................................................................. 6Goals and Objectives: ........................................................................................................................................ 7

Intervention Research: ...................................................................................................................................... 7Strategy Mix and Logic Model: ....................................................................................................................... 9Evaluation Plan: ............................................................................................................................................... 13Table 2. Activity Planning for the Mobile Market in Lonsdale........................................................... 16Budget: ............................................................................................................................................................... 18Table 3. Project Schedule for the Lonsdale Mobile Market, 2014:.................................................... 18Table 4. Risk Management Plan for the Lonsdale Mobile Market, 2014:........................................ 20Table 5. Communication Management Plan for the Lonsdale Mobile Market, 2014:.................. 21References: ........................................................................................................................................................ 23


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Summary:

Overweight and obesity rates are higher than average among Knox County children,

especially in underserved communities with limited access to healthy foods. One explanation for

this disparity is that families in these communities lack transportation resources and are unable to

acquire healthy foods from full-service grocery stores. This intervention plan will involve a team

of community partners and stakeholders to provide a Mobile Market, which will deliver healthy

foods to community members. The Mobile Market will be a renovated Knoxville Area Transit

(KAT) bus that will have the technology necessary to safely and efficiently transport healthy

foods. Transported foods will include items such as fresh fruits and vegetables, low-fat dairy

items, whole grains, and lean protein options. Community members will be able to purchase

these foods at rates comparable to rates at local grocery stores, and the Mobile Market will

accept Supplemental Nutrition Assistance Program (SNAP) benefits and the Special

Supplemental Nutrition Program for Women, Infants, and Children (WIC) vouchers. Based on

the funding resources available, involved programs will ideally be able to partially subsidize

healthy food items so that they are more affordable for these low-income families. A nutrition

educator will be present on the Mobile Market to provide nutrition information, healthy recipes,

and cooking demonstrations. The plan will be piloted in the Lonsdale community in Knoxville,

Tennessee, and the Mobile Market will be stationed at Lonsdale Elementary School, since a

collaborative effort has been made to make this school the heart of the Lonsdale community and

to offer services to the community as a whole. Community members will have access to the

Mobile Market at least three days per week no more than five months after the project start date.


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Background:

The obesity epidemic in the United States (US) is a well-established public health crisis

associated with immense national healthcare expenditures.{Ogden, 2006 #231;Cali, 2008

#230;Francischetti, 2007 #232;Oldridge, 2008 #233} The 2010 Knox County Community

Assessment estimated that 61.7% of Knox County adults (>18 years old) are either overweight or

obese.{, 2010 #173} Although this percentage is comparable to the national average, Knox

County has a much higher proportion of children ages 6-18 in the overweight or obese range

(39.6% in Knox County compared to the national average of 28.8%).{, 2010 #173} An effort to

prevent and reduce childhood obesity prevalence is of particular interest, because overweight or

obese children are more likely to be overweight or obese later in life, leading to chronic and

possibly fatal diseases such as type 2 diabetes and cardiovascular disease.{Whitaker, 1997

#39;Freedman, 2001 #40;Eriksson, 2003 #41} Making lifestyle changes, like following the

United States Department of Agricultures (USDA) Dietary Guidelines for Americans, is an

evidenced-based approach to prevent and reverse overweight and obesity.{Knowler, 2002 #229}

However, many families are unable to incorporate healthy foods into their diets because

of limited access to these foods and insufficient financial resources.{, 2012 #170;Michimi, 2010

#228} Food insecurity is associated with a decreased consumption of healthy foods, such as fresh

fruits and vegetables, and an increased prevalence of overweight and obesity.{, 2013

#165;Nackers, 2013 #167;Michimi, 2010 #228} About 15% of Tennessee households are food

insecure, and the Tennessee Obesity Taskforce has identified food access as an important

problem to address.{Taskforce, #234} The taskforce has responded by developing a team to

create initiatives aiming to increase food security in Tennessee.{Taskforce, #234} Increasing


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access to healthy foods is also a key objective of the Association of State Public Health

Nutritionists (ASPHN).{, 2006 #168}

Although a complex matrix of interrelated environmental and social factors may affect

obesity prevalence, food insecurity is a relevant target for interventions aiming to decrease

overweight and obesity rates in Knox County.{Michimi, 2010 #228} According the USDA Food

Access Research Atlas, Knox County has about 20 food deserts, where residents are of low

socioeconomic status (SES) and have limited access to healthy foods.{Service, #235} The

USDA defines a food desert as urban neighborhoods and rural towns without ready access to

fresh, healthy, and affordable food. Instead of supermarkets and grocery stores, these

communities may have no food access or are served only by fast food restaurants and

convenience stores that offer few healthy, affordable food options.{USDA Agricultural

Marketing Service, #237} These food deserts encompass about 38% of Knox County residents;

thus, food insecurity is a significant public health problem in Knox County.{Council, #236}

Lonsdale Elementary School has been chosen as the pilot site for this intervention plan

because it is located in a food desert (defined by the USDA), and because they have been open

and receptive to community-based interventions in the past. Lonsdale Elementary has an obesity

rate of 51%, and 100% of the 395 students receive free or reduced lunch.{, 2013 #165} These

statistics represent the health status of the children and families living in this community and

demonstrate the imminent need for health interventions. Lonsdale Elementary is one of the seven

community schools in Knox County, which aim to make the school the heart of the

community.{, 2013 #165} Thus, this would be an excellent location to implement an

intervention targeting the health of the entire community. In addition to the Lonsdale community

being located in a food desert, many of the residents lack transportation resources to access full-


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service grocery stores, even if they could afford healthy foods and desired to obtain these

foods.{, 2012 #170} Furthermore, the public transportation in this neighborhood has been

described as unreliable, not easily accessible, and not customer-friendly.{, 2012 #170} Thus, the

Lonsdale community has limited resources to access healthy foods, placing residents, both adults

and children, at risk for overweight and obesity and the associated chronic diseases.


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Project Partners:

Note: Many of the project partners were chosen by building upon existing, effective community

partnerships in an effort to maximize partnership involvement and strengthen communicationbetween community partners and stakeholders.

Figure 1. Project Partners for the Mobile Market Project in Lonsdale, 2014

Knox County Health Department (KCHD)

The Supplemental Nutrition AssistanceProgram (SNAP)

The Special Supplemental Nutrition Programfor Women, Infants, and Children (WIC)

Healthy Kids, Healthy Communities (ETCH)

Health Organizations

Knoxville Area Transit (KAT) Knoxville Food Policy Council

City of KnoxvilleCity/County Officials

Kroger

Three Rivers Market

Food City

Second Harvest Food Bank of East Tennessee

Beardsley Community Farm

Food Vendors

Knox County Schools Lonsdale Community Members

Community Schools Directors

Great Schools Partnership

Lonsdale CommunityRepresentatives

The University of TennesseeAcademic Institutions


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Goals and Objectives:

Goal:Improve dietary quality and increase healthy food options for underserved, at-risk Knox

County residents with limited transportation resources.

Process Objectives:

1. By the second month, have a schedule in place for food vendors and create a reliablesource to access healthy food items for Lonsdale community members.

2. By the fifth month, increase awareness of the program to at least 50% of the Lonsdale

community by promotion through community churches, schools, and other

community outlets.3. By the seventh month, implement at least three strategies (coupons, recipe cards, etc.)

to address the barriers of program participation among community members (low

cooking self-efficacy, price, time, unawareness of the program) based on community

feedback.4. By ninth month, increase community member participation in the program to at least

8% of households in the Lonsdale community weekly.

5. By the twelfth month, assess feasibility and acceptability of the Mobile Marketamong food vendors and community school personnel. Assess whether or not these

project partners find the program valuable to the community.

Impact Objectives: By the twelfth month, increase access to foods such as fresh fruits and

vegetables, low-fat dairy items, and lean proteins (at least 3 days per week) to underserved, at-

risk Knox County residents in the Lonsdale community with limited transportation resources by

decreasing walking and/or driving distance required to access these healthy food items.1. Reduce the distance to nearest grocery store with healthy food items for those in the

Lonsdale community by at least 50%.

2.

Reduce the travel time to the nearest grocery store with healthy food items for thosein the Lonsdale community by at least 50%.

3. Determine the effect of access to healthy food items on purchasing behavior and

dietary intake in the Lonsdale community.

Outcome Objective: By the thirteenth month, and by collaboration with community partners and

other Knox County public health initiatives, decrease obesity rates in the targeted community by

2.5%.

Intervention Research:

Transportation constraints are frequently cited as contributing factors to limited food

access and, therefore, to poor health across the nation and around the globe.{United States

Department of Agriculture, 2009 #5646} However, no single strategy can be employed to

alleviate this issue because each community has a unique transportation environment that


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requires a tailored transportation intervention in order to target that communitys specific

barriers. Therefore, when examining methods used in other communities in regards to

transportation and food access, it is necessary to consider the generalizability of those methods to

other situations.

While many strategies have been implemented to address transportation constraints, such

as rerouting bus routes and improving public transit, an increasingly popular initiative is to

alleviate the need for transportation for individuals altogether by bringing a mobile grocery store

to the underserved communities.{Ringstrom, 2011 #5647} This allows members of these

communities the chance to access fresh food without having to use a car or public transportation,

which can be difficult to access and unreliable. Tennessees two largest cities, Memphis and

Nashville, have already employed this intervention, using the model of the National Mobile

Market Foundation, which is a non-profit organization based in Nashville, Tennessee.

The National Mobile Market Foundation is working to become the leader in mobile

market research and development.{The National Mobile Market, 2013 #5648} They have

developed a step-by-step manual on how other communities can adopt their model with the

hopes of eliminating food deserts across the nation.{The National Mobile Market, #5649} The

foundation has formally evaluated and disseminated the effects of the Nashville Mobile Market

on health and food security within the targeted communities by generating a report that is

publically available, which includes the program objectives, methods, results, and evaluation

strategies.{The National Mobile Market, 2013 #5648} Their evaluation tools, such as the Food

Procurement Survey, aim to provide an understanding of the local food insecurity environment,

valuable resources available, and existing initiatives. They also provide resources for adapting

their tools based on the community to which they will be used.{The National Mobile Market,


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#5649} In their 2011 report, the foundation stated that 25% of their customers reported an

increase in fruit and vegetable consumption as a result of the Mobile Market.{The National

Mobile Market, 2013 #5648}

Strategy Mix and Logic Model:

Rationale

Currently, many residents of underserved communities within Knox County lack

transportation resources to access full service grocery stores.{, 2012 #170} Therefore, even

though one or more grocery stores may exist in these communities, some individuals are not able

to easily and safely acquire healthy foods, such as fresh fruits and vegetables.{, 2012 #170} For

example, these stores may be too distant from residential areas or nearby roads may be highly

trafficked, while lacking sidewalks; these conditions discourage traveling to grocery stores by

foot. In addition, it is important to consider safety and feasibility of walking to stores with

regards to the possibility of crime in that neighborhood and the physical capabilities of that

individual. Public transportation does exist in some areas, but it is often unreliable, inefficient,

and may not be able to transport passengers close enough to the store entrance due to various

regulations.{, 2012 #170}

As noted by food security organizations in communities similar to Knox County, it is

relatively unlikely that areas like Knox County will gain the resources and capacity to develop an

innovative and high-tech transportation system like many of the more urban cities in the United

States.{Ringstrom, 2011 #5647} However, some communities, such as Memphis, Tennessee,

have alternatively addressed food insecurity by transforming an existing bus or vehicle into a

mobile grocery store.{, 2013 #171} This proposes a practical and tailored, fast-acting solution

for communities, such as Knox County, who may lack resources to completely remodel the


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present public transportation infrastructure. It is important to research interventions that have

been implemented in other communities to solve similar problems; however, a reasonable

strategy must be developed to increase access to healthy foods, while considering the unique

qualities of this community as well as the resources available within Knox County.

Strategies/Methods

In order to increase access to fresh food for individuals with limited transportation, the

primary strategy of this intervention is to bring fresh food to Knoxville communities with low

access to these foods. This initiative will involve collaboration between the University of

Tennessee, Knoxville food vendors, Lonsdale community representatives, community

stakeholders, and local health officials in order to plan, implement, and evaluate the intervention.

The premise for this intervention is to create a mobile grocery store that travels to various

communities within Knoxville each week. These mobile units will set up at the community

schools, which are designed to serve as the heart of the community, thereby providing a

centralized, wide-reaching location to offer the foods.

First, input from members of these communities, community school officials, and local

food vendors must be collected. This will assess the feasibility of the project and will serve as the

driving force in the design of the intervention. In its first year, the project will be pilot tested in

the Lonsdale community in Knox County, Tennessee. The selection of this community will be

contingent upon the willingness of community members and stakeholders to participate. It is

vital that a strong relationship with the food vendors is formed and that they are reassured of the

benefits to participate and of the support they will be provided with from local health officials

and community stakeholders.


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After developing an action plan with the community groups outlined above, local health

officials, community members, and food vendors will work to select fresh foods to be sold that

are healthy, desirable, and cost-effective. The costs to the food vendor to staff to develop the

mobile food vending unit will be slightly offset by funds from local health departments and other

community groups. Identifying these funding sources should be done early on in the

development of the intervention. Once the intervention begins, process, impact, and outcome

evaluations will be conducted as outlined in the Logic Model (Figure 2).


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Figure 2. Knoxville Mobile Market Logic Model

ActivitiesInputsSituation Outputs

- Overweight and obesity

rates are higher than

national rates amongKnox County children.

-These rates are highest in

communities with low

access to healthy food andwith high rates of poverty.

-Several communities in

Knox County, such as the

Lonsdale community,have been classified as

food deserts, lackinghealthy food options in

these communities.

-Limited transportation

resources contribute tolow food access.

-The transportationinfrastructure of Knox

County is unlikely tochange drastically within

the near future.

-Other communities have

had success in servingfood deserts through

mobile markets.

- KAT buses and

renovation materials

(refrigeration, shelving,etc.)

-Staff (driver, health

educators, other needed

staff)

-Collaboration and inputfrom community partners

-Marketing materials

-Fuel/power

-Foodstuffs

-Nutrition/Cooking

education materials andrecipes

-Food prep equipment

-Staff training materials

-Route and schedule

development

-Maintenance

- Assess community needs

-Provide staff andvolunteer training

-Offer nutrition and

cooking education

-Carry out kick-off and

promotional events

-Accept SNAP and WIC

benefits

-Sell healthy foods tounderserved communities

-Evaluate theeffectiveness of the

intervention

-Share evaluation findings

-Expand/alter services

based on communityneeds and feedback

- Fruit, vegetable, lean

protein, and dairy options

at least three days perweek

-Customers served

-Jobs created

-Nutrition educationcurriculum and recipes

-Communityevents/meeting place

-Community

empowerment

-Increased food access

rates, decreased drivingdistance and travel time to

access healthy foods

-Improved health and

weight status

-Publications


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Evaluation Plan:

Process Evaluati on:

Quantitative:

Survey how many times the vendors were scheduled to be in the community andhow many times they actually attended.

Survey how many community members took advantage of the program fromweek to week.

Assess the items that were and were not frequently purchased.

Qualitative:

Interview food vendors and community school personnel to assess the facilitators

and barriers they have encountered to get the food into the community and to

increase awareness and purchases; interviews will also assess the value they see inthe program.

Conduct interviews and focus groups with community members to evaluate

awareness of the program and why they do and do not buy certain items (lowcooking self-efficacy, price, time, unaware of program) in order to see if other

strategies (coupons, recipe cards, etc.) could improve the utilization of theprogram.

Impact Evaluation:Quantitative:

Survey Lonsdale families to evaluate pre and post intervention walking or drivingdistance and travel time required to access healthy foods, pre and post

intervention behaviors related to purchasing healthy foods, and pre and postintervention consumption of healthy foods.

Qualitative: Focus groups with Lonsdale families to evaluate the changes they have observed

in their ability to acquire and consume the specified healthy foods and thepotential barriers and/or facilitators encountered related to acquiring and

consuming these foods (cost, convenience, recipes, etc.)

Outcome Evaluation:Quantitative:

BMI screenings at the school


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Table 1. Evaluation Plan of the Lonsdale Mobile Market, 2014

Evaluation Plan

Evaluation

Stage Method

Description of data

collection/analysismethod

Data Type Output/Disseminations

Process Survey

Survey how many times

the vendors werescheduled to be in the

community and how

many times they actuallyattended

Quantitative

Will be used by researchers in

interpretation and dissemination ofresults

Will be used by the BOD and staffto modify and improve the program

Process Survey

Survey how many

community memberstook advantage of the

program from week toweek

Quantitative

Will be used by researchers ininterpretation and dissemination of

results

Will be used by the BOD and staffto modify and improve the program

Process Survey

Assess the items that

were and were not

frequently purchased

Quantitative


interpretation and dissemination of

results

Will be used by the BOD and staff

to modify inventory offered

Process Interviews

Interview food vendors

and community school

personnel to assess thefacilitators and barriers

they have encountered to

get the food into thecommunity and to

increase awareness and

purchases; interviews

will also assess the valuethey see in the program

Qualitative

Will be used by the BOD to modifyand improve the program



results

Process

Interviews

and Focus

Groups

Conduct interviews and

focus groups with

community members toevaluate awareness ofthe program and why

they do and do not buy

certain items (low

cooking self-efficacy,price, time, unaware of

program) in order to see

Qualitative

Will be used by the BOD and staff

in order to see if other strategies

(coupons, recipe cards, etc.) couldimprove the utilization of the

program



results


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Evaluation Plan

if other strategies

(coupons, recipe cards,

etc.) could improve theutilization of the

program.

Impact Survey

Survey Lonsdale

families to evaluate pre

and post interventionwalking or driving

distance and travel time

required to accesshealthy foods, pre and

post intervention

behaviors related to

purchasing healthy

foods, and pre and postintervention

consumption of healthyfoods.

Quantitative

Will be distributed to county health

officials, researchers, and other

appropriate community groups

ImpactFocus

groups

Focus groups withLonsdale families to

evaluate the changes

they have observed intheir ability to acquire

and consume the

specified healthy foods

and the potential barriersand/or facilitators

encountered related to

acquiring andconsuming these foods

(cost, convenience,

recipes, etc.)

Qualitative

Will be used by the BOD to modify

and improve the program


interpretation and dissemination ofresults

Outcome ScreeningsBMI screenings at theschool

Quantitative

Will be distributed to county health

officials, researchers, and other

appropriate community groups


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Table 2. Activity Planning for the Mobile Market in Lonsdale

Activity Planning

Activity/Task Method Who When

Hold meeting with

county health officials,community schoolofficials, transportation

personnel, and local food

security organizations(i.e. Food PolicyCouncil) to generate

ideas and gain feedback

Announce meeting toappropriateorganizations, allow

those attending to

submit items to theagenda, hold meetingsin an open format

Individuals/organizations leading

the development of the

intervention0-1st months

Form a board of directors(BOD)

Nomination and votingprocess

Health officials, communitymembers, school personnel, otherappropriate organizations

1st-2ndmonths

Hold meeting with BOD,local food vendors,community stakeholders

Announce meetingthroughout community

and to appropriateorganizations, allow

those attending tosubmit items to theagenda, hold meetings

in an open format

BOD

1st-2ndmonths

Gather communityassessment data

Recorded health data,

surveys, focus groups,interviews

Researchers 1st-3rdmonths

Finalize food vendingpartners

Through meetings andformal documentation

BOD and food vendors 3rdmonth

Finalize start dates and

schedule

Through meetings and

voting

BOD and community school

officials3rdmonth

Hire employees to staffthe bus

Through interviewsand voting

BOD 3rd-4thmonths

Acquire a bus andrenovating materials

Through purchasingand/or formaldocumentation of

donations/renting

BOD, KAT officials2nd-4thmonths

Generate media coverage

and have build up events

Through press releases

and media eventsBOD, Mobile Market staff

3rdmonth-as

needed

Renovate the busBy using approvedplans

Mobile Market staff, volunteers 3rd-5thmonths

Plan kick off eventsThrough meetings andcommunity feedback

BOD, community schoolpersonnel, Mobile Market staff 4thmonth


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Activity/Task Method Who When

Finalize staff trainingThrough predetermined

methodsBOD, Mobile Market staff 4thmonth

Stock busThrough predeterminedmethods

Mobile Market staff 5thmonth

Implement the pilotintervention

Through predeterminedmethods

BOD, community schoolpersonnel, Mobile Market staff,volunteers

5th-12thmonths

Conduct process

evaluations

Through surveys, focus

groups, and interviewsResearchers 5th-12thmonths

Make changes based on

process evaluations

Through methodsfitting the neededchanges

Researchers, BOD, communityschool personnel, Mobile Marketstaff

5th-12thmonths

Communicate with local

health agencies andcommunity partners asspecified in the

communicationmanagement table


Researchers, BOD, Mobile Marketstaff

As specified

Continue pilot

intervention

implementation


BOD, community school

personnel, Mobile Market staff,

volunteers5th-12thmonths

Conduct impactevaluations

Through surveys andfocus groups

Researchers9thmonth

Make changes based on

impact evaluations

Through methods

fitting the neededchanges

Researchers, BOD, community

school personnel, Mobile Marketstaff

9thmonth

Continue pilot

interventionimplementation

Through predetermined

methods


personnel, Mobile Market staff,volunteers 9th-12thmonth

Conduct outcome

evaluation

Through BMI

screeningsResearchers 12thmonth

Reassess the role and

need of the bus serviceand the communitiesserved and not served

Through communityassessments, dataanalysis, and meetings

Researchers, BOD, health officials 12th-13thmonths

Implement the full

intervention

Through predetermined

methods


personnel, Mobile Market staff,

volunteers

13thmonth

Continue same process As needed

Disseminate findingsTrough publications,media, and

presentations

Researchers and BOD13thmonth andbeyond


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Budget:

The budget for this intervention will vary depending on the contribution of the project

partners. The primary cost of this intervention will likely be acquiring a bus and renovating

materials. However, in some cases, as seen in the Memphis Green Machine mobile market, the

city or organizations may donate or rent the bus for little to no cost.{Backer, 2013 #5650} A

sample budget detailing the cost of a trailer rather than a bus, shelving, and other needed

materials can be found in the National Mobile Meal Foundation manual.{The National Mobile

Market, #12;The National Mobile Market, #12}

Table 3. Project Schedule for the Lonsdale Mobile Market, 2014:

Project Schedule

Activity

Duration Months

(adjust timeframe

as necessary)

Hold meeting with county health officials, community members, community

school officials, transportation personnel, and local food securityorganizations (i.e. Food Policy Council) to generate ideas and gain feedback

0-1st months

Form a board of directors (BOD) 1st-2

ndmonths

Hold meeting with BOD, local food vendors, community stakeholders 1st-2

ndmonths

Gather community assessment data 1st-3

rdmonths

Finalize food vending partners 3rd

month

Finalize start dates and schedule 3rd

month

Hire employees to staff the bus 3rd-4thmonths

Acquire a bus and renovating materials 2nd

-4th

months

Generate media coverage and have build up events 3rd

month-as needed

Renovate the bus 3rd

-5th

months


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Plan kick off events 4th

month

Activity

Duration Months

(adjust timeframe

as necessary)

Stock bus 5thmonth

Implement the pilot intervention 5th

-12th

months

Conduct process evaluations 5th

-12th

months

Make changes based on process evaluations 5th

-12th

months

Communicate with local health agencies and community partners as specified

in the communication management tableAs specified

Continue pilot intervention implementation 5

th

-12

th

months

Conduct impact evaluations 9th

month

Make changes based on impact evaluations 9th

month

Continue pilot intervention implementation 9th

-12th

month

Conduct outcome evaluation 12th

month

Reassess the role and need of the bus service and the communities served andnot served

12th

-13th

months

Implement the full intervention 13th

month

Continue same process As needed

Disseminate findings13

thmonth and

beyond


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Table 4. Risk Management Plan for the Lonsdale Mobile Market, 2014:

Risk Management

RiskRisk Management Activities

Preventive Contingent

Low participation

loss of revenue

Targeted marketing, participation

incentives, kick-off events, acceptance ofSNAP and WIC benefits, culturally

appropriate educational and recipematerials, cooking demonstrations,strategic scheduling and placement of bus

Surveying community members on theirawareness of the bus and on their

reasons for or for not participating,adapting services based on customer

feedback (inventory, scheduling,placement, marketing, etc.), adjustinginventory based on sales history and

customer feedback

Pushback from localstore owners

concerned with

competition andthreat to sales

Including local store owners in theplanning process, allowing store owners

who comply with product standards to

participate in the intervention, placing busa nonthreatening distance from stores

Meeting with store owners to discuss

the ways in which they feel threatenedand how the services of the bus can best

differentiate to lessen competition whilestill meeting the needs of the

community

Staffing changes

Development of effective training

materials and training procedures,

selection of committed employees,offering appealing salary and engagementand advancement opportunities,

development of alternative employeeframeworks in case of staffing cuts

Evaluation of the current employee

framework and restructuring based onresults, rigorous interviewing of newstaff, employment of training materials

and procedures with new staff

Establishment of alocal supermarket or

other fresh foodvendor in the same

proximity

Research development plans of the areawith local city planning officials and usethis information to guide the selection of

the communities the bus will serve,

meeting with new vendors to discussforming a partnership and workingtogether to meet the needs of the

community

Reevaluation of the need for the bus

services in the community and altering

the route/services to best align with thenew needs of the community

Increased demandbeyond currentcapacity and days

offered

Develop a plan for how to adapt to

changing demands and needs of thecommunity, secure funding, gatherdemographic and descriptive data on the

community to project the growth and

changes in need for the bus services

Meet with community members anddirectors of the bus program to assessthe feasibility of expanding the program

and the most effective ways of doing so

Zoning regulations orpolicies that prevent

or limit the sale offood in this format

Meet with personnel who haveimplemented the program in othercommunities to discuss challenges they

faced and solutions they used, meet with

city and county officials to gain feedbackon the intervention plan and on changesthat should be considered

Advocate with community members andgroups for favorable policy changes,

adjust services to comply withregulations


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Table 5. Communication Management Plan for the Lonsdale Mobile Market, 2014:

Communication Management

What HowWith/To

WhomWhen/How Often

SteeringCommittee/

ManagementMeeting

Notified by email invitation-choose time that works best for

most people

All communitypartnershiprepresentatives

andstakeholders

Quarterly (4 times per

year)

Strategic Plan

Each team member will receive a

copy of the written strategicintervention plan so that everyteam member is aware of the

action steps and strategiesproposed for successfulimplementation


andstakeholders

Prior to the first steering

committee/management

meeting in electronicform (after acceptingposition as a team

member for thisproject)- Each team

member will alsoreceive a hard copy at

the first steeringcommittee/managementteam meeting

Meeting Agendas

Quality Improvement agendaswill be developed for each team

meeting, and each team memberwill have the opportunity to

make changes or additions to theagendas prior to each meeting


and

stakeholders

Quarterly (4 times peryear)

Meeting Minutes

One team member (volunteer)will document minutes for each

team meeting, and will distributethe minutes to all team members(including those not present atthe meeting). Minutes will

include action items and

deliverable dates so that eachteam member is aware of thetasks he or she must complete

and the relevant deadlines forthese tasks

All communitypartnershiprepresentativesand

stakeholders

Quarterly (4 times per

year)

Dissemination ofstrategic plan,evaluation

strategies, andresults

Intervention Plan and outcomeswill be first distributed tocommunity partners and

stakeholders for internal review.

After incorporating feedbackfrom the team members, the plan(with outcomes) will be

accessible online (PDF)

Easilyaccessible bypartnership

representatives,

stakeholders,communitymembers, and

the public

Following projectcompletion(implementation,

evaluation, and dataanalysis)


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22

What HowWith/To

WhomWhen/How Often

Participationrates/reach,qualitative

feedback from

participants,changes in dietaryquality, foodsecurity, and BMI

Summary reports, meetings,

presentations

Great Schools

Partnership

Semesterly, when

needed

Changes in food

security and BMISummary reports

Knox County

Mayors OfficeYearly, when needed

Participation

rates/reach,process evaluation

data, qualitativeevaluation data,

future plans

Summary reports, meetings,

presentations

Food Policy

CouncilQuarterly, when needed

Future plans,

changes in foodsecurity

Social media, signs and

information on or with bus

CommunityMembers andOrganizations

Bimonthly, when needed

Participation

rates/reach,qualitativefeedback fromparticipants,

changes in dietaryquality, foodsecurity, and BMI

Conference presentations,summary reports, publishedpapers, professional networks

NationalMobile Market

foundation andother foodsecurity

organizations/researchers

Yearly, when needed

Changes in foodsecurity and

information onservices offeredand on special

events

Press releases, local newcoverage of special events,

interview with staff andparticipants, social mediaupdates

Media Bimonthly, when needed


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23

References:

1. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of

overweight and obesity in the United States, 1999-2004.JAMA : the journal of the

American Medical Association. Apr 5 2006;295(13):1549-1555.2. Cali AM, Caprio S. Obesity in children and adolescents. The Journal of clinical

endocrinology and metabolism. Nov 2008;93(11 Suppl 1):S31-36.

3. Francischetti EA, Genelhu VA. Obesity-hypertension: an ongoing pandemic.

International journal of clinical practice. Feb 2007;61(2):269-280.

4. Oldridge NB. Economic burden of physical inactivity: healthcare costs associated

with cardiovascular disease. European journal of cardiovascular prevention and

rehabilitation : official journal of the European Society of Cardiology, Working Groups

on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology.

Apr 2008;15(2):130-139.

5. Community Health Status Assessment. Knox County, Tennessee: Knox County Health

Department;2010.6. Whitaker RC, Wright JA, Pepe MS, Seidel KD, Dietz WH. Predicting obesity in young

adulthood from childhood and parental obesity. The New England journal of

medicine. Sep 25 1997;337(13):869-873.

7. Freedman DS, Khan LK, Dietz WH, Srinivasan SR, Berenson GS. Relationship of

childhood obesity to coronary heart disease risk factors in adulthood: the Bogalusa

Heart Study. Pediatrics. Sep 2001;108(3):712-718.

8. Eriksson JG, Forsen T, Tuomilehto J, Osmond C, Barker DJ. Early adiposity rebound

in childhood and risk of Type 2 diabetes in adult life. Diabetologia. Feb

2003;46(2):190-194.

9. Knowler WC, Barrett-Connor E, Fowler SE, et al. Reduction in the incidence of type 2

diabetes with lifestyle intervention or metformin. The New England journal ofmedicine. Feb 7 2002;346(6):393-403.

10. The WIC & KAT Intersection: Community Needs Assessment of Urban Transportation

Routes to Grocery Stores in Knox County, Tennessee, 2012.The University of

Tennessee 2012.

11. Michimi A, Wimberly MC. Associations of supermarket accessibility with obesity and

fruit and vegetable consumption in the conterminous United States. International

journal of health geographics. 2010;9:49.

12. Larson C, Haushalter A, Buck T, Campbell D, Henderson T, Schlundt D. Development

of a community-sensitive strategy to increase availability of fresh fruits and

vegetables in Nashville's urban food deserts, 2010-2012. Preventing chronic disease.

2013;10:E125.13. Nackers LM, Appelhans BM. Food Insecurity Is Linked to a Food Environment

Promoting Obesity in Households With Children.Journal of nutrition education and

behavior. Sep 7 2013.

14. Tennessee Obesity Taskforce. Food Access. Eat Well Play More Tennessee

http://www.eatwellplaymoretn.org/state-initiatives/action-teams/food-access-

action-team/.Accessed November, 2013.
http://www.eatwellplaymoretn.org/state-initiatives/action-teams/food-access-action-team/http://www.eatwellplaymoretn.org/state-initiatives/action-teams/food-access-action-team/http://www.eatwellplaymoretn.org/state-initiatives/action-teams/food-access-action-team/http://www.eatwellplaymoretn.org/state-initiatives/action-teams/food-access-action-team/http://www.eatwellplaymoretn.org/state-initiatives/action-teams/food-access-action-team/


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15. Blueprint for Nutrition & Physical Activity: Cornerstones of a Healthy Lifestyle.

Association of State & Territorial Public Health Nutrition Directors

(ASTPHND);2006.

16. USDA Economic Research Service. Food Access Research Atlas.

http://www.ers.usda.gov/data-products/food-access-research-atlas/go-to-the-

atlas.aspx - .UqUG8GRDuGo.Accessed November, 2013.17. USDA Agricultural Marketing Service. Food Deserts.

http://apps.ams.usda.gov/fooddeserts/foodDeserts.aspx.Accessed November,

2013.

18. Knoxville Food Policy Council. http://knoxfood.org/.Accessed November, 2013.

19. United States Department of Agriculture. Access to Affordable and Nutritious Food:

Measuring and Understanding Food Deserts and Their Consequences. Report to

Congress2009.

20. Ringstrom E, Born B. Food Access Policy and Planning Guide.University of

Washington; December 2011 2011.

21. The National Mobile Market. Research. 2013;

http://www.nationalmobilemarket.org/.Accessed October 25, 2013, 2013.22. The National Mobile Market. The National Mobile Market Full Manual.

23. The Green Machine Mobile Food Market. 2013;

http://www.memphis.edu/planning/GreenMachine.php.Accessed October, 2013.

24. Backer JJ. Green Machine Brings Food to Neediest Areas. 2013;

http://www.memphisdailynews.com/editorial/Article.aspx?id=76351.Accessed

October 28, 2013, 2013.
http://www.ers.usda.gov/data-products/food-access-research-atlas/go-to-the-atlas.aspx#.UqUG8GRDuGohttp://www.ers.usda.gov/data-products/food-access-research-atlas/go-to-the-atlas.aspx#.UqUG8GRDuGohttp://www.ers.usda.gov/data-products/food-access-research-atlas/go-to-the-atlas.aspx#.UqUG8GRDuGohttp://apps.ams.usda.gov/fooddeserts/foodDeserts.aspxhttp://apps.ams.usda.gov/fooddeserts/foodDeserts.aspxhttp://knoxfood.org/http://knoxfood.org/http://www.nationalmobilemarket.org/http://www.nationalmobilemarket.org/http://www.memphis.edu/planning/GreenMachine.phphttp://www.memphis.edu/planning/GreenMachine.phphttp://www.memphisdailynews.com/editorial/Article.aspx?id=76351http://www.memphisdailynews.com/editorial/Article.aspx?id=76351http://www.memphisdailynews.com/editorial/Article.aspx?id=76351http://www.memphis.edu/planning/GreenMachine.phphttp://www.nationalmobilemarket.org/http://knoxfood.org/http://apps.ams.usda.gov/fooddeserts/foodDeserts.aspxhttp://www.ers.usda.gov/data-products/food-access-research-atlas/go-to-the-atlas.aspx#.UqUG8GRDuGohttp://www.ers.usda.gov/data-products/food-access-research-atlas/go-to-the-atlas.aspx#.UqUG8GRDuGo

Documents

Intervention Plan ABD BG 120813 Unformattedcitations