Update from Root Causes

Project Recap

Let’s do a quick recap on the project I have been working on. Food insecure patients from the Duke Outpatient Clinic (DOC) are referred to a Duke organization called Root Causes, which partners with Farmer Foodshare to package and distribute weekly bags of fresh produce to these patients. It is pertinent to allocate resources to this at-risk population. The patient population served by the DOC is disproportionately poor, black, elderly, and affected by chronic diseases including diabetes and heart disease – all significant risk factors for COVID-19 co-morbidity. My research with the organization aims to examine the biweekly delivery of fresh produce and shelf stable items to low-income, food-insecure patients, in hopes of increasing food security and reducing perceived stress levels.

Project Detours

In this experience so far, I am learning a lot about how important it is to appropriately frame your research questions and draw out analysis designs before you start. New data has also shaped my perspective on this project. Sure, we all have pretty hypotheses designed and standing proud at the beginning of any research project. But hypotheses are often there to be proved wrong, at least in part. And they also serve to remind us that virtually everything is much more complicated and non-linear than we thought. This is certainly the case in determining FPP efficacy. Through some constructive feedback with a Duke community health physician, I realized that the analyses I have been conducting need a closer look at the a priori hypotheses of the study.  Essentially, there is a lot of data and a lot of analyses we have been itching to do, but we have lost sight of what the main dependent variable that we want to study is, and what independent variable we think is influencing this.

Let us explore this feedback. I have been utilizing the statement “the primary aim of this prospective observational study was to measure the impact of biweekly fresh produce delivery on the food security, perceived stress, and biological health markers of food insecure patients during the first five months of the Coronavirus pandemic.” If it is prospective, then what effect did we think that the produce delivery had on each of these scores?  It seems that the expectation or hypothesis was that a period of receiving food deliveries improved each of these measures. However, since we do not have a control group, it looks like you we are comparing those who reported FPP benefit against those who did not perceive benefit. This is concerning because that piece of data is currently only part of what we report in our current manuscript draft, at the end, whereas with the given hypothesis, it should be present throughout. Our physician notes that he is not sure that is what the study set out to measure, and we may need to regroup.

At this time, the way forward is to decide what the central hypothesis is in terms of outcome and independent/dependent variables.  We do not want to use any kind of patient parameters, regardless of how cool the data looks, that are relatively independent of the Food Delivery.  So how can we better capture something related to the food delivery itself?  This will require a more in-depth assessment of what data is actually available from the organization, and something I am working through now.

Let me be clear: we have some valuable data here.  We just need to approach it with a clearer question.    I am currently not just looking through data constructs from the organization, but also attempting some freehand conceptual models of variables and study design to more clearly delineate the data we have and what we can analyze and what we can even show with this data. I hope to share these models with my group shortly and get back on track with data analysis.

Project Status

There are many things currently in the works for this project, including some analysis restructuring, but fear not! What we DO know is that we have useful and interesting data that will be valuable to people trying to respond to the needs during this pandemic, which will be with us in one shape or form for many months to come, which makes what we’re doing here really important.

It helps that, through all of this, the people I am working with are thoughtful and inspired. They continuously push me to be involved in all aspects of the organization and really be immersed in the issue of food insecurity. Many, if not all, are involved in medicine, which provides the perspective of the “food as medicine” concept in many of our meetings and projects, and the desire to do better for our patients is pervasive. This is a highly motivating factor, as you can imagine.

Food insecurity was already an urgent need before COVID hit, but now with reduced access to many normal activities, our patients are struggling to maintain food access and mobility. In addition, continued delay of any further governmental aid is exacerbating the issue. If the collected data confirm the intervention to be successful in increasing healthy behaviors and reducing patient stress, especially during strenuous times such as during the COVID pandemic, it could be expanded to other communities to address food insecurity and improve health outcomes among a wider patient population. This means that the fresh produce delivery model to food insecure patients could have wide impact across other communities and other health networks.