ENHANCE: Enhancing Nutrition in Home-visiting programs to Advance PareNt-Child health

Dietary factors are the number one modifiable health determinants of the burden of chronic diseases globally. There are many barriers to achieving a healthy diet: in addition to lack of knowledge, skills, and support to incorporate healthy food in daily routine, one of the main challenges is access to healthy food. Food insecurity affects more than one third of families with lower incomes in the US. Promoting healthier eating patterns or providing nutritionally appropriate food to people with existing chronic diseases can improve health outcomes, however, targeting the pregnancy and early life periods offers the unique opportunity of primary preventive intervention to lower the risk of developing chronic disease over the life course. We propose a Nutrition Enhancement that will be integrated within established, evidence-based, federally funded Home Visiting (HV) programs that typically serve families from lower incomes and underserved communities. This multi-level Nutrition Enhancement will be based on national evidence-based dietary guidelines for pregnant women and young children, include culturally appropriate resources and group activities to support healthy eating and cooking, and deliver food boxes to each household for six months. We will co-design and implement the intervention with HV programs (Healthy Families Massachusetts (HFM) a network of 23 community-based HV programs overseen by the Children’s Trust) and multi-sectoral partners, including community food assistance resources (regional food banks and their local food pantries), federally funded food assistance programs (e.g., Women, Infants, and Children (WIC) state-wide and locally), and state-wide non-profit organizations that support healthy food access. During the UG3 phase, we will co-design, pilot and refine the Nutrition Enhancement with two HFM program sites (Aim 1) and convene multi-sectoral partners to coordinate activities towards initiation of the UH3 phase (Aim 2). During the UH3 phase, we will evaluate the effectiveness (Aim 3) and implementation (Aim 4) of the Nutrition Enhancement in a step-wedge cluster randomized control trial (cRCT) in 21 HFM program sites. Our primary outcome is healthy eating (American Heart Association validated score) in primary parent-child dyads who received HV services. We will also assess food security (USDA validated module), other health behaviors (sleep, physical activities, tobacco use), mental health, and overall well-being (using NIH-validated instruments). We will explore impact of the intervention in other household members and HV staff. We will evaluate implementation using the RE-AIM framework. Our multi-sectoral partners will allow successful dissemination of the novel nutrition enhancement in HV programs nationwide and promote healthy eating to prevent chronic disease in multiple generations in populations that experience health disparities.