Medically tailored groceries (MTG) generally involve fresh and shelf-stable grocery items
to be prepared at home, selected by a nutritional professional based on a treatment plan
and are typically picked up at a clinic, market, or pantry. This clinic-based market or
pantry model (CB-MTG) is a growing approach adopted by health care systems in their
effort to address food insecurity in their patient population, including University
Hospitals of Cleveland (UH) and MetroHealth Medical Center (Metro), two of the three
largest health systems in Cleveland, Ohio. Often offered to patients with food-related
chronic conditions, CB-MTGs have shown to improve medication adherence, increase fruits
and vegetable consumption and decrease HbA1c in people with diabetes. However, less
evidence is available on the impact of CB-MTGs with food insecure pregnant individuals,
where food insecurity has been strongly associated with prematurity and other negative
birth outcomes.
While promising, the CB-MTG approach requires transportation, having the tools and
equipment to prepare meals at home and some basic food preparation skills, all potential
barriers for low-income pregnant individuals, especially younger parents-to-be or those
already with children. The Greater Cleveland Food Bank and partners, seeking to address
these barriers, recently developed a home delivered version of MTG (HD-MTG), offered to
Medicaid-eligible pregnant individuals across the county, with promising results. The
investigators seek to integrate these approaches into patient care for food insecure,
pregnant women and test the effectiveness of these two approaches, alongside an
additional intervention arm that adds supplemental nutrition and culinary education and
support to the home-delivered approach (HD-MTG PLUS). These three approaches will be
offered (via randomization) to 360 pregnant individuals (120 per arm) with food
insecurity who are patients within UH and Metro's largest urban obstetric practices, each
with direct electronic health record (EHR) referral systems to their "food as medicine"
clinics/markets. Data are collected at baseline, near/at delivery and 6 months
post-delivery. This study seeks to understand the unique contribution of each approach,
as well as implementation and intervention uptake barriers, with the goal of building the
evidence base of MTG interventions and making recommendations to providers and health
systems seeking to address food insecurity and nutrient deficiencies during pregnancy.
