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Eat Green Fredericksburg

State: VA Type: Promising Practice Year: 2019

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Rappahannock Area Health District
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Eat Green Fredericksburg

Eat Green Fredericksburg Project

Background, Planning, Implementation and Outcome Summary

The Rappahannock Area Health District is located between Richmond, VA, and Washington, D.C. The geographic area of RAHD is 1,413 square miles. The Health District (HD) provides medical, environmental and public health services to residents of the City of Fredericksburg, Caroline, King George, Spotsylvania, and Stafford counties in Virginia. Rappahannock Area Health District (RAHD) along with its partners has planned and conducted a Community Health Assessment in 2016/2017. The assessment was conducted using the Mobilized for Action through Planning and Partnership (MAPP) tool.

The geographical focus of the assessment was Fredericksburg City. Based on the CHA data gathered and analyzed, food insecurity was one of the issues identified by stakeholders and the community members. The fact that 16% of the population is food insecure and 26% of children who are food insecure are ineligible for assistance were some of the data points used to support the decision-making process. The USDA defines food insecurity as limited or uncertain availability of nutritionally adequate foods or uncertain ability to acquire foods in socially acceptable ways. Food insecurity is associated with chronic diseases such as high blood pressure, diabetes, obesity, hyperlipidemia, and mental health issues.

Based on the finding from the 2017 CHA, the Rappahannock Area Health District has initiated a community health improvement project to address food insecurity among WIC participants in Fredericksburg City. The name of the project is Eat Green Fredericksburg (EGF) and was launched on June 19, 2018. During the initiation phase of the EGF project, the team reviewed the three pillars of food insecurity—availability, access, and usage—to guide the identification of resources and gaps in the community. Thus, availability of assets such as the farmers markets in the city, the Supplemental Nutrition Assistance Program (SNAP) match, and the Women, Infant, and Children (WIC) program were of value to the project.

The SNAP match and the WIC program provide support to low-income families to improve their financial access to healthy food items, and the farmers market makes fresh fruits and vegetables available to the community. Lack of awareness about the farmers market and the SNAP match benefit were also identified as gaps among the WIC participants. As a result, the EGF project was developed with a long-term goal to increase food security among WIC participants by educating them about the availability of the farmers markets and the SNAP match program. The project also provided a $10 incentive for the target population to visit the farmers market, and encouraged repeat visit through raffle prizes. Moreover, the EGF team distributed booklets which have 16 recipes and tips on how to purchase and safely use fruits and vegetable from the farmers market.

The implementation sights of the project were the Fredericksburg Health Department and the farmers market by the Hukamp Park. The beneficiaries were initially contacted at the health department where they show up for their scheduled WIC appointment. An outreach worker approached each participant and held short conversations to create awareness about the farmers market and SNAP Match program, collected data, demonstrated how much fruits and vegetables could be purchased with a $10 using a display of fruits and vegetables and handed out a $10 coupon. The farmers market at the Hurkmp Park was also another implementation site. WIC participants showed up at the EGF table to redeem their coupons, fill out a short survey and were offered a tour of the farmers market. The EGF project ran until September 25, 2018, at the Fredericksburg Health Department, and until September 29, 2018, at the Hurkamp Park Farmers Market.

The EGF project aimed at achieving the following objectives by September 29, 2018.

  • Inform at least 275 WIC participants, who are scheduled to visit the Fredericksburg Health Department, about the EAT GREEN FREDERICKSBURG project and provide them a $10 coupon
  • Aim for 20% coupon redemption at the Hurkamp Park Farmers Market 
  • Educate 100% of WIC participants who have SNAP about the SNAP match program
  • Initiate first-time use of SNAP match by 20% of SNAP recipients who are also enrolled in WIC
  • Provide a tour of the farmers market for 20% of WIC participants who visit the Hurkamp Park market

Even though, the initial objective was to distribute 275 coupons, before the end of the project 275 coupons were distributed. Thus, the EGF team decided to increase the number of coupon distribution to 575. By the end of the project, 364 coupons were distributed. The coupon redemption was 18.7% and the EGF project was able to initiate 27.9% first time SNAP Match use. Even though coupon redemption was low at the beginning, the team applied different marketing strategies such as follow up phone calls, and email and postcard reminders.

Among the 18.7% who redeemed their coupons, 57.4% visited the farmers market for the first time. The survey finding indicated that 69.6% of the participants found out about the farmers market in the city for the first time. In addition, only 9.3% of the total beneficiaries knew about the SNAP match program and of those who knew about it only 7.1% used their SNAP at the farmers market. The data indicated that more work needs to be done in this area and thus EGF will continue its outreach in summer 2019 with a long-term plan of expanding the project to the remaining localities in the Rappahannock Area Health District.

The long-term public health impact of EGF is improved food security among low-income WIC participants by empowering them to utilize available resources in the community. Families will have access to fresh fruits and vegetables leading to healthy eating habit. The project also aims to teach skills on how to cook and handle fruits and vegetable from the farmers market.












Based on the finding from the 2017 CHA, the Rappahannock Area Health District has initiated a community health improvement project to address food insecurity among WIC participants in Fredericksburg City. The planning, implmentation, monitoring and evaluation of the project was guided by the MAPP tool. The name of the project is Eat Green Fredericksburg (EGF) and was launched on June 19, 2018. During the initiation phase of the EGF project, the team reviewed the three pillars of food insecurity—availability, access, and usage—to guide the identification of resources and gaps in the community. Thus, availability of assets such as the farmers markets in the city, the Supplemental Nutrition Assistance Program (SNAP) match, and the Women, Infant, and Children (WIC) program were of value to the project.

The SNAP match and the WIC program provide support to low-income families to improve their financial access to healthy food items, and the farmers market makes fresh fruits and vegetables available to the community. Lack of awareness about the farmers market and the SNAP match benefit were also identified as gaps among the WIC participants. As a result, the EGF project was developed with a long-term goal to increase food security among WIC participants by educating them about the availability of the farmers markets and the SNAP match program. The project also provided a $10 incentive for the target population to visit the farmers market, and encouraged repeat visit through raffle prizes. Moreover, the EGF team distributed booklets which have 16 recipes and tips on how to purchase and safely use fruits and vegetable from the farmers market.

The implementation sights of the project were the Fredericksburg Health Department and the farmers market by the Hukamp Park. The beneficiaries were initially contacted at the health department where they show up for their scheduled WIC appointment. An outreach worker approached each participant and held short conversations to create awareness about the farmers market and SNAP Match program, collected data, demonstrated how much fruits and vegetables could be purchased with a $10 using a display of fruits and vegetables and handed out a $10 coupon. The farmers market at the Hurkmp Park was also another implementation site. WIC participants showed up at the EGF table to redeem their coupons, fill out a short survey and were offered a tour of the farmers market. 

As of March 2018, there were 775 WIC participants in Fredericksburg City. Initailly, the team planned to reach 275 of those participants. However, before the end of the project 275 coupons were already distributed. Thus, the EGF team decided to increase the number of coupon distribution to 575. By the end of the project, 364 coupons were distributed. The coupon redemption was 18.7% and the EGF project was able to initiate 27.9% first time SNAP Match use. Even though coupon redemption was low at the beginning, the team applied different marketing strategies such as follow up phone calls, and email and postcard reminders. Among the 18.7% who redeemed their coupons, 57.4% visited the farmers market for the first time. The survey finding indicated that 69.6% of the participants found out about the farmers market in the city for the first time. In addition, only 9.3% of the total beneficiaries knew about the SNAP match program and of those who knew about it only 7.1% used their SNAP at the farmers market. The data indicated that more work needs to be done in this area and thus EGF will continue its outreach in summer 2019 with a long-term plan of expanding the project to the remaining localities in the Rappahannock Area Health District.

The project has innovatively identified gaps by bringing together implementers who are already working to address food insecurity. Moreover, instead of replicating what's already in the community, the project was made to supplement the current effort by other stakeholders. It leveraged on availably resources to close the identified the gap and address food insecurity among a specific target population. 











During the community health assessment and health improvement planning process, the health district identified over 50 stakeholders who are directly or indirectly impacting the health of the community. Workgroups and a steering committee were formed to participate in the process. The identification process was guided by looking at the Ten Essential Public Health Services. The health district ensured that organizations providing one or more of these services were represented at the table. The stakeholders were oriented and trained about the MAPP tool. They engaged from the planning of the assessment to conducting it, analyzing the data and making a decision to identify priority community health issues. Once the assessment was complete, stakeholders who were interested or are working on the priority issues were assigned to be part of the workgroup for planning and to implement the community health improvement for each issue. The workgroup which was assigned to plan the improvement project for food insecurity consisted of partners who are already working to address the issue. Eventually, additional stakeholders were added to the workgroup. The planning process was participatory, beginning from identifying resources to finding out the gap and initiating a project. The group also developed the goal, objective and strategies following the MAPP tool. During the implementation process, the workgroup trained interns and identified interns and provided free space for implementation. The project was implemented with a budget of $8050. The total budget did not include, the estimated cost of interns and volunteer time and free space for implementation. 

The EGF project aimed at achieving the following objectives by September 29, 2018

  • Inform at least 275 WIC participants, who are scheduled to visit the Fredericksburg Health Department, about the EAT GREEN FREDERICKSBURG project and provide them a $10 coupon
  • Aim for 20% coupon redemption at the Hurkamp Park Farmers Market  
  • Educate 100% of WIC participants who have SNAP about the SNAP match program
  • Initiate first-time use of SNAP match by 20% of SNAP recipients who are also enrolled in WIC
  • Provide a tour of the farmers market for 20% of WIC participants who visit the Hurkamp Park market

The initial objective was to distribute 275 coupons, before the end of the project 275 coupons were distributed. Thus, the EGF team decided to increase the number of coupon distribution to 575. By the end of the project, 364 coupons were distributed. The coupon redemption was 18.7%, and the EGF project was able to initiate 27.9% first time SNAP Match use. Even though coupon redemption was low at the beginning, the team applied different marketing strategies such as follow up phone calls, and email and postcard reminders. Among the 18.7% who redeemed their coupons, 57.4% visited the farmers market for the first time. The survey finding indicated that 69.6% of the participants found out about the farmers market in the city for the first time. Also, only 9.3% of the total beneficiaries knew about the SNAP match program and of those who knew about it only 7.1% used their SNAP at the farmers market. None of the participants were interested in touring the farmers market. 

The project was monitored and evaluated throughout the process. Outcome evaluation was also conducted following the completion of the project. The data collected from the beneficiaries were used to evaluate the outcome. Data were collected at both implementation sites by the outreach workers. MS Excel was used to store and analyze the data collected. Throughout the implementation period, the data was monitored, and feedback for improvement was collected from all team members and beneficiaries. Based on an observation made from the data changes were made to the implementation process. The team noticed that the coupon redemption percentage was low and thus designed marketing methods to encourage participants to redeem their coupon. Moreover, displays of fruits and vegetables were used to illustrate to participants about what they could buy from the farmers market using their coupon. The performance measures identified during the planning processes were number of coupons distributed, number of WIC coupon recipients who redeemed their coupon, number of WIC participants who were given a tour at the farmers market and number of WIC participant who started using the SNAP match for the first time. 

Stakeholders were involved beginning form the assessment to planning and implementing the project. Every individual in the team is an advocate for the project and is seeking support to maintain the plan by sharing information with the workgroups and coalitions he/she is involved. The team has gathered during the fall season to find ways to continue the project in summer 2019 and has secured a budget for the second cycle of implementation. The long-term plan is to collect enough data and present the outcome and impact of the project to city official and request for support. 

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