healthy food in a dash

HEALTHY FOOD IN A DASH

UCLA School of Public Health CHS 211B Assignment 8: Final Proposal with Evaluation Plan

June 1, 2015

Group 14: Nicole Garcia, Priscilla Schaper, Shayla Spilker, Nicole Wainwright

Group 14, Assignment 8

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Glossary of Terms ............................................................................................................................. iii I. Abstract ......................................................................................................................................... iv II. Problem Statement ........................................................................................................................1 The Issue: --------------------------------------------------------------------------------------------------------------------------- 1 What is Known? ------------------------------------------------------------------------------------------------------------------- 1 What is Being Done? -------------------------------------------------------------------------------------------------------------- 2 Population Description: ---------------------------------------------------------------------------------------------------------- 2 Needs Assessment: ---------------------------------------------------------------------------------------------------------------- 3 III. Program Description .....................................................................................................................4 Program Goal: ---------------------------------------------------------------------------------------------------------------------- 4 Program Objectives and Rationale: -------------------------------------------------------------------------------------------- 4 Theoretical Framework: --------------------------------------------------------------------------------------------------------- 6 Strategies and Activities: --------------------------------------------------------------------------------------------------------- 7 Phase I Implementation Plan: --------------------------------------------------------------------------------------------------- 9 Phase II Implementation Plan: ------------------------------------------------------------------------------------------------- 11 IV. Formative and Process Evaluation Plans ...................................................................................... 12 V. Impact/Outcome/Summative Evaluation Plan .............................................................................. 14 Research Question: --------------------------------------------------------------------------------------------------------------- 14 Research Strategy: --------------------------------------------------------------------------------------------------------------- 14 Research Design: ----------------------------------------------------------------------------------------------------------------- 14 Sample Description:-------------------------------------------------------------------------------------------------------------- 15 Hypotheses and Variables: ----------------------------------------------------------------------------------------------------- 16 Unit of Analysis and Sampling:------------------------------------------------------------------------------------------------- 18 Data Collection: ------------------------------------------------------------------------------------------------------------------- 20 VI. Discussion ................................................................................................................................... 23 References ....................................................................................................................................... 26 VIII. Appendices ............................................................................................................................... 31 Appendix A: Area Map ----------------------------------------------------------------------------------------------------------- 31 Appendix B: Logic Model -------------------------------------------------------------------------------------------------------- 32 Appendix C: Gantt Chart--------------------------------------------------------------------------------------------------------- 33 Appendix D: Research Design -------------------------------------------------------------------------------------------------- 35 Appendix F: Budget -------------------------------------------------------------------------------------------------------------- 37 Appendix G: Budget Justification ---------------------------------------------------------------------------------------------- 38


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Glossary of Terms

CDPH California Department of Public Health

CFL Community Food Leader

DV Dependent Variable

EET Empowerment Education Theory

FFQ Food Frequency Questionnaire

FFV Fresh Fruits and Vegetables

GIS Geographic Information System

HBM Health Belief Model

HFD Healthy Food in a Dash

IV Independent Variable

LA Los Angeles

LAC Los Angeles County

MOU Memorandum of Understanding

MM Market Match

NHANES National Health and Nutrition Examination Survey

NCG Non-Equivalent Control Group

OCT Organizational Change Theory

PA Physical Activity

PC Program Coordinator

PD Program Director

SNAP Supplemental Nutrition Assistance Program

SPA Service Planning Area

URA Undergraduate Research Assistant


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I. Abstract

Food access is an issue of health equity and chronic disease prevention. Limited food access can

result in chronic disease conditions such as: obesity, heart disease, type 2 diabetes, and many

other diseases. Los Angeles County’s Service Planning Area 6 leads the County in multiple

health disparity indicators, particularly those related to access to healthy foods. Due to the

inequitable distribution of food resources in SPA 6, and absence of healthful food vendors in

census tracts 2352.01 and 2352.02, Healthy Food in a Dash aims to increase access to fresh

produce and improve affordability. Constructs from the Health Belief Model, Empowerment

Education Theory, and Organizational Change Theory will be applied at all levels of the

Ecological Model to improve knowledge and attitudes among the target population, empower

them to advocate for change in the food environment, and to make comprehensive infrastructural

changes to a corner store. A two-phase intervention will facilitate a corner store conversion in

Hank’s Mini Market and pilot Market Match to double CalFresh beneficiaries’ purchases.

Program staff will monitor the success of the intervention through a detailed process and

outcome evaluation for both phases. Quantitative methods will be utilized to properly assess the

increase in fresh produce consumption and purchases, as well as community and storeowner

experience with the program. Program success will be assessed using a quasi-experimental, pre-

post test design with a non-equivalent control group during the outcome evaluation. Data will be

collected from intervention participants and the comparison group during Phase I, and from the

intervention group alone in Phase II using a nationally validated food frequency questionnaire.

This program may provide a better mechanism for increasing access to healthful foods in low-

income, low access areas. Furthermore, it may inform future policy implementation related to

expanding Market Match beyond farmers’ markets in order to reduce health disparities.


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II. Problem Statement

The Issue: Food insecurity and inaccessibility are associated with higher rates of a host of

chronic conditions, including obesity and heart disease, because they limit healthful food

consumption.1 Residents of food insecure communities tend to rely on corner stores for basic

food needs.2 The abundance of energy-dense, low-nutritive foods offered at these retailers has

contributed to increasing obesity rates among children and adults.3,4 In 2011-2012, 69% of

American adults aged twenty and over were overweight or obese.5 The skyrocketing costs of the

largely preventable diseases associated with obesity on the United States’ healthcare system are

also of societal concern as rates of chronic disease continue to rise.6,7 Obesity has become so

prevalent in the United States that Healthy People 2020 identified the following objectives in

order to combat it: increasing the consumption of fresh fruits and vegetables (FFV) and

increasing the proportion of Americans who have access to healthful food retailers.8

What is Known? Communities of color rely heavily on local corner stores for their food needs

as a result of institutional racism and disinvestment that pushed large-scale grocers away.9–11

Black and Latino neighborhoods are half as likely to have an accessible grocery store compared

to white neighborhoods, contributing to racial health disparities and increased rates of obesity-

related diseases.2 Consequently, those living one or more miles from a grocery store are 46% less

likely to have a healthy diet than those with a grocery store in their neighborhood.1 The

inequitable distribution of food resources has resulted in people of color consuming less FFV and

more nutritionally devoid foods.12 Changing the food environment in low-income communities

of color by implementing interventions in corner stores can reduce health disparities by

increasing access to healthful foods.12–14


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What is Being Done? Many efforts have sought to change the food environment in food

insecure communities in order to improve access to healthful foods.1,15,16 Corner store

conversions, which have primarily focused on urban, low-income communities of color, are one

such effort.17,18 A systematic review of sixteen corner store conversions found that the most

impactful strategies included a combination of healthy food provision, health communication,

and infrastructure changes.15 Price reductions for healthful foods and moving unhealthful foods

to the back of the stores also had positive results.15 Storeowner motivation and the skill set to

manage a store with perishables were identified as necessary elements of an effective corner

store conversion.19

Sixty-seven percent of storeowners cited lack of customer demand as the number one

obstacle to selling FFV, followed by conversion cost and insufficient infrastructure.12,14,20 The

idea that customers do not want FFV has been refuted by many studies.14,21 Low-income

consumers prefer some FFV over energy-dense foods and are willing to buy them from local

corner stores.14 Additionally, greater variety of FFV items increases purchase.21 Previous

research suggests that subsidizing the cost of refrigeration and shelving would improve store

infrastructure and eliminate many of the start-up costs associated with corner store conversions.1

Population Description: Target area: Home to over one million people, South Los Angeles

(LA) has one of the poorest food retail environments in Los Angeles County (LAC).22 One of the

most striking disparities is the distribution of liquor and corner stores.23 There are approximately

8.5 liquor stores per square mile in South LA compared to only 1.97 in West LA.23 This

inequitable distribution highlights the need for interventions that target both the quality of

products sold and access to fresh food in these stores. South LA, which includes Service

Planning Area (SPA) 6, leads LAC in various health disparity indicators, including obesity (see


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Appendix A for Area Map). Thirty-five percent of adults in SPA 6 self-identified as obese and

28.9% of children in grades 5, 7, and 9 were identified as obese by a parent or guardian.24

SPA 6 is a low-income area with limited access to healthful, affordable foods.25 Roughly

60% of the 7,300 residents of census tracts 2352.01 and 2352.02 are Black, 30% are Latino, and

30-35% of residents live below the 100% federal poverty level.25 The California Department of

Public Health’s (CDPH) geographic information system (GIS) mapping tool identified both

tracts as having dual “low income and access” issues, and as having a large proportion of

CalFresh beneficiaries, who qualify for the federal Supplemental Nutrition Assistance Program

(SNAP).25–27

The primary direct target of this intervention is Black and Latina women, aged 18+, living

within the two identified census tracts located in SPA 6. Women were selected as a direct target

as they are often the principle shopper for a household, and their purchasing influences other

household members, including men and children.28 In addition to targeting women, this

intervention will also directly target Hank’s Mini Market’s (Hank’s) storeowner by providing

coaching on the store conversion and maintenance process; changing attitudes around product

sales; and encouraging the owner to value community health. The remaining census tract

residents who make purchases at Hank’s are all indirect targets of the intervention.

Needs Assessment: In order to select the direct and indirect target populations, we conducted a

comprehensive literature review looking at corner store conversion interventions in urban areas.

SPA 6 is an area with little attention in peer-reviewed literature regarding corner store

conversions. To further assess the community’s need we searched CDPH GIS census tract data

and visited the census tracts to select potential store conversion sites. The site visit confirmed


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CDPH data identifying the two census tracts of focus as low access—there are no grocery stores

and not one of the corner stores offered FFV.

Key informant interviews with local organizations provided background on past efforts to

address food access in the community, highlighted strategies for engaging the community, and

pinpointed challenges and gaps in the resources available. Community focus groups and an

interview with Hank’s storeowner helped explain challenges to purchasing healthful foods,

barriers to corner store conversion, and feedback on what is needed to sustain the intervention.

III. Program Description

Program Goal: Increase the availability of and access to fresh, healthful foods in a low-income,

low-access community in SPA 6. A long-term outcome of increased access to healthful food is

that it can reduce the incidence of new chronic diseases and improve quality of life for those

currently living with chronic diseases.13,29 The logic model for this project links strategies,

activities, and outcomes and can be found in Appendix B.

Program Objectives and Rationale: Healthy Food in a Dash (HFD) is a two-phase program

aiming to increase access to, and affordability of, FFV in SPA 6. Phase I involves a corner store

conversion and collaboration with Hank’s storeowner and trained Community Food Leaders

(CFLs). Phase II involves a pilot Market Match (MM) program. California’s MM program is a

CalFresh benefit-matching program that matches the amount a beneficiary spends (up to $10) on

state-grown FFV at farmers’ markets.30 HFD will pilot MM for the first time in Hank’s corner

store. HFD operates at every level of the Ecological Model and will run from Dec 2015 through

Nov 2017 (see Appendix C for Gantt Chart).

Community Capacity Objective: By Mar 2016, HFD will recruit and train ten paid CFLs in

SPA 6. CFLs will be trained on the importance of food access issues and how to conduct simple


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surveys, as they will support staff in the implementation and evaluation portions of HFD. CFLs

will also learn how to conduct community forums, a method for engaging fellow residents in

food justice issues which also helps to ensure program sustainability. Previous community health

worker initiatives have shown community peers to be ideal messengers for health information

and critical for program sustainability because they are invested in program success.31,32 The

CFLs allow us to equitably integrate individuals in the community into the program in order to

improve SPA 6’s food environment.16,33–35

Environmental Objective: By Mar 2016, Hank’s Mini Market will have increased the

number of FFV available from zero items to 15 items. Currently, 51.1% of residents in South

LA report ease in accessing FFV, and only 6.1% report eating the recommended five servings

daily.36 For comparison, West LA resident responses show 95.8% and 22.1%, respectively.36

Since census tracts 2352.01 and 2352.02 have no grocery stores, providing FFV at Hank’s

increases access so that residents are able to easily find and consume FFV. Based on data from

similar store conversions, an increase of 15 items at Hank’s is both realistic and feasible.12 A

similar community intervention found that a core stock of 15 FFV items was in high demand,

and that those items resulted in an average of 575 pounds sold per week.12

Behavior Change Objective: FFV consumption will increase among HFD participants,

from approximately 6% of individuals currently consuming the recommended servings of

FFV to 18%, by Nov 2016. Food availability, including access and variety, are useful measures

that predict food consumption.1,14,20 As highlighted above, 22.1% of West LA residents eat the

recommended serving of FFV daily whereas only 6% do in SPA 6, largely as a result of

inequitable access. By increasing access to FFV in Hank’s, HFD anticipates an increase in the

percentage of individuals in tracts 2352.01 and 2352.02 eating the recommended servings of


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FFV. Because Hank’s is only one store, we do not think it would be realistic to match the West

LA rate of FFV consumption; however, an increase of 12% is realistic and attainable.

Policy Objective: In Phase II, HFD will pilot MM in Hank’s in order to increase total FFV

revenue from CalFresh spending. Incoming revenue will be $5,377.58 per week, assuming

each match is at the $10 max, with 268 available matches per week ($2,688.79 from Match

dollars and $2,688.79 from residents’ CalFresh accounts). Given the increase in FFV

revenue at Hank’s, HFD expects at least a 15% increase in CalFresh spending by Aug

2017. Based on CDPH GIS data, we know that residents (N=809 in one block; N=82-214 in

three blocks; and N=1-81 in two blocks) in the intervention tracts are currently enrolled in

CalFresh and thus eligible for the program.25,27 From 2012 to 2013, MM reported that CalFresh

spending increased from 15% to 40% at various MM locations.37 In Phase II, HFD expects to see

at least a 15% increase in CalFresh spending for FFV, which is consistent with current MM

outcomes in LAC, and is realistic with the addition of 15 FFV items. Expecting a 40% increase

is not realistic since farmers’ markets have greater variety than Hank’s will initially support. (See

Appendix G for full Budget Justification).

Theoretical Framework: HFD will increase the access to and availability of FFV for the target

population by employing elements of the Health Belief Model (HBM), Empowerment Education

Theory (EET), and Organizational Change Theory (OCT). Linking multiple constructs from

various theories allows the program to interact effectively with multiple stakeholders at different

levels of influence within the community.

HBM functions at the individual level to change attitudes and beliefs related to improving

food access.38 HFD addresses perceived barriers (under HBM) by increasing access to

affordable FFV, as well as by addressing residents’ attitudes toward advocating for community


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change.39 Cues to action encourage customers to purchase FFV, and increasing CFL and

storeowner self-efficacy results in program sustainability within Hank’s and the community.38,40

EET functions at the interpersonal and community levels. Listening, dialogue, and action

(constructs), facilitate knowledge generation and help to foster relationships among community

institutions to promote change.41,42 EET’s goal, as applied to education and public health, is to

engage participants in a participatory learning process that motivates them to action, rather than

simply educating them didactically.42,43 This approach increases community power and

willingness to engage in advocacy and policy change.41,44 OCT operates at the institutional and

policy levels and is applied in the context of creating organizational change for health

promotion.45 OCT facilitates the infrastructural changes necessary for Hank’s to function as an

FFV purveyor and helps to sustain the MM policy over time. HFD will apply three constructs

from OCT (adapted from the Transtheoretical Stages of Change Model): initiation of action

(preparation for change), implementation of change (action steps have been taken for change),

and maintenance of change (maintenance of the change).46,47

Strategies and Activities: CFL Training: Develop CFL training curriculum; develop survey

instruments; recruit ten CFLs to conduct community forums; conduct training. Rationale: HFD

will recruit ten CFLs to deliver a curriculum in community forums during Phases I and II. CFL

delivery of the curriculum is an effective empowerment model since peer-learning and

promotora models are successful public health education tools.31,48 The CFL curriculum will be

pilot tested before the training with ten adult women who live in the target census tracts (not

program participants) to ensure that all materials are culturally relevant and appropriate. During

the initial training, through a process of listening and dialogue, HFD staff and CFLs will work

together to develop CFL capacity and ownership of community issues, driving them to take


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action in their community.41,42 Trained CFLs will possess the knowledge and skills to educate

other members of the direct target population; to involve them in supporting the initial

conversion and MM pilot; and to engage them in policy advocacy beyond the program timeline.

This strategy is necessary to achieve the Community Capacity Objective.

Storeowner Training: Understand storeowner needs; develop storeowner-training curriculum;

develop pre- and post-tests; conduct training. Rationale: Storeowner training is necessary to

engage the storeowner in the conversion and to build capacity to ensure program

sustainability.1,33 HFD will have conversations with the storeowner and use the information

gathered to develop a storeowner training curriculum focused on effective management of

perishable items, vendor relationships, and sales tracking. The storeowner will receive a $200

incentive upon completion of both trainings (see Appendix F & G for Budget and Justification).

OCT is operationalized to create the necessary stages of organizational change. The storeowner

curriculum is a critical resource for the initiation of action stage to prepare the storeowner for the

organizational change. Tailoring the curriculum to address the storeowner’s perceived barriers to

change and including the storeowner in the planning process ensures readiness for change.45

Building capacity is an important aspect of OCT. It allows the storeowner to understand links

between the change and his own business interests, and increases the likelihood that he will

engage in organizational problem solving in order to succeed with the implementation and

maintenance of change.45 This strategy is necessary to achieve the Environmental Objective.

Store Conversion: Procure FFV for Hank’s; rearrange store inventory; beautify store;

disseminate information about the conversion. Rationale: Procuring FFV for Hank’s increases

access for SPA 6 residents, enabling them to purchase and consume more FFV daily.14,21

Availability of FFV is correlated with increased sales and consumption,20 making it beneficial


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for both the storeowner and customers. Increased access also removes barriers associated with

having to travel to obtain FFV, which increases the likelihood than an individual will adopt a

new health behavior.21,38 Procuring FFV, rearranging store inventory, and store beautification are

steps that ensure organizational change (initiation of action) and serve as a cue to action,

influencing customers to make healthier purchases.1,15,45 Promotional materials support

implementation and maintenance of change by alerting community members to the new

organizational change at Hank’s and encouraging them to support it through their FFV

purchases.45 These activities support the Environmental Objective.

Pilot MM Development: Develop and implement a reloadable card system; disseminate

information about MM pilot. Rationale: Following the store conversion, the pilot MM program

will allow HFD to further increase sales of FFV in Hank’s. Offsetting the cost for CalFresh

beneficiaries with MM reduces barriers for the target population by matching the funds spent on

FFV. CFL distribution of promotional materials raises awareness of the pilot MM program in the

community in order to influence purchasing behaviors (cue to action). HFD will also develop a

reloadable card system as part of the implementation of change stage as a means to distribute the

funds for the MM component to CalFresh beneficiaries.46 Program sustainability will be built

into the maintenance stage by training the storeowner and CFLs to continue the progress of the

intervention. These activities support the Policy Objective.

Phase I Implementation Plan: Hiring/MOU: HFD will hire and train a Program Director (PD),

a Program Coordinator (PC) and two unpaid Undergraduate Research Assistants (URAs) from

Dec 2015-Jan 2016. URAs will receive class credit while enrolled in a research-oriented course

as compensation for time. The PD and PC will create an MOU with Hank’s by late Jan 2016.


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Details will include: HFD program objectives, Hank’s responsibilities, and HFD’s timeline.

Monthly HFD meetings with Hank’s will allow for updates and facilitate open communication.

Storeowner Training: HFD staff will develop the storeowner training curriculum in Jan 2016.

Training will begin Feb 2016 to establish best practices for managing a store with perishables.

One training will cover the following topics: maintaining perishable items; vendor relationships

and ordering; using a computerized register; monitoring sales; and general business practices.

The owner will receive a $100 incentive after the training. The storeowner will also be

responsible for collecting in-store satisfaction surveys from customers.

Community Food Leaders: HFD staff will develop and pilot the CFL training curriculum from

Jan-Feb 2016. In Feb 2016, CFL materials will be pilot tested and amended if needed.

Concurrently, the PC will recruit and supervise the CFLs, who will be hired under a contractual

basis and reimbursed per forum held. They will also be paid for contributions during the outcome

evaluation. The incentive for attending the initial 6-hour CFL training in Mar 2016 is a $100

stipend. CFLs will have a final launch meeting with HFD staff and Hank’s storeowner prior to

the grand re-opening on Apr 4, 2016. From Mar-Nov 2016, individual CFLs will receive $75

reimbursements for each forum held that meets the following requirements: at least ten attendees

(must live in 2352.01/2352.02), completed sign-in sheet, and evaluations from all participants.

CFLs will choose forum locations. The PC will hold monthly meetings with CFLs to discuss

progress and potential issues, and to provide them professional development. The success of

HFD program implementation relies heavily on the active participation of CFLs. In the event that

CFL retention becomes problematic, HFD will hold a second call for applications.

Store Beautification: The store renovation and beautification will take place in Mar 2016

following the completion of the CFL training. HFD staff, CFLs, the storeowner and volunteers


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will paint, remove advertisements of unhealthful products, install a computerized cash register,

stock the FFV, and conduct general repairs. Store inventory will also be rearranged making the

store ready for the program launch and store reveal on Apr 4th, 2016. The PD will review sales

metrics with the storeowner on a weekly basis from Apr-Oct 2016. During this time HFD staff

will measure any changes in sales history, track CalFresh spending, and identify best selling

items. The PC will evaluate customer surveys and storeowner satisfaction at these times. The

Phase I program evaluation will run from Oct-Dec 2016.

Store Conversion: In early Jan 2016, HFD will work with Hank’s storeowner to procure a

contract with a local FFV vendor. With the help of a graphic designer, HFD staff will develop

and pilot test promotional materials to advertise the store conversion from Jan-Feb 2016. All

flyers, door hangers, and recipe cards will be printed at a local copy shop. HFD staff will

distribute flyers (5,000) within the census tracts beginning Feb 2016 until CFLs take

responsibility for promotional activities following their completed training in March. CFLs will

distribute door hangers the week prior to the store opening. These will include a coupon for three

free pounds of FFV to encourage patronage at Hank’s to help address a common storeowner

concern of low demand for FFV.12,14,20 The storeowner will incentivize patrons to fill out

satisfaction surveys by offering a free weekly recipe card that incorporates the available FFV.

Phase II Implementation Plan: Market Match: From Nov-Dec 2016, HFD staff will

implement a reloadable card system as a means to distribute the MM funds to participating

CalFresh beneficiaries. This system will add a match of up to $10 to the cards of customers who

use CalFresh on FFV purchases at Hank’s. During Dec 2016-Jan 2017, HFD staff will create and

print materials (5,000 door hangers and 5,000 flyers) promoting the MM program. HFD staff

will pilot test the promotional materials with the CFLs to ensure messages are appropriate. CFLs


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will distribute the MM promotional materials Jan-Feb 2017. HFD will train the storeowner on

MM in Jan 2017 to prepare for the launch in Feb 2017. The owner will receive another $100

incentive after the training. The PD will track all FFV sales and frequency of CalFresh match

utilization. Recording the sales of FFV will allow HFD to look at trends in CalFresh spending

from Phase I to Phase II. Recording the frequency of matches will enable the PD to accurately

track the budget for MM funds. The MM pilot will run from Feb-Aug 2017, with evaluation

from Sept-Nov 2017.

IV. Formative and Process Evaluation Plans

HFD will closely monitor program implementation in order to assess program success. The

process evaluation will provide information regarding program integrity, coverage, reach, service

delivery, service utilization, and cost-effectiveness.

CFL Training: HFD will assess the preparedness of the CFLs by conducting an evaluation

during the CFL training workshops. CFLs will take a pre-test to determine baseline knowledge

prior to training. Upon completion of training, a post-test will be administered in order to assess

curriculum effectiveness and CFL knowledge of training content; a post-test score of 80% is

passing. Those who fail will be required to repeat the training and post-test. HFD staff will hold

monthly check-in meetings with the CFLs in order to provide feedback and disseminate

materials to refresh the knowledge and skills delivered in the training.

Community Forums: CFLs are required to deliver a completed sign-in sheet and participant

evaluations after each forum. The PD will monitor attendance to assess community participation

(fidelity). Community forum participants will complete a post-forum evaluation using a 5-point

Likert scale, which will include rating CFL information delivery, individual participant

knowledge of forum content (nutrition and food access issues), how they heard about the forum,


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and satisfaction. Additionally, HFD staff will observe community forums on a monthly basis and

complete a checklist of topics and activities covered in order to evaluate CFL effectiveness.

FFV Inventory: HFD will determine if customers are buying FFV items based on the sales logs

and itemized receipts from CalFresh purchases. The PD will use sales logs to track FFV sales

and discuss outcomes with the storeowner. The storeowner and PD will monitor product

inventory and compare the items delivered with the items remaining at the store (accounting for

spoilage). This information will be used to ensure cost-effectiveness, minimize FFV spoilage,

and maximize the amount of weekly FFV purchases at Hank’s.

CalFresh Spending: The PD will collect data on matching funds, which will be tracked through

sales logs and the frequency of card reloads. This will allow HFD staff to assess how often

CalFresh beneficiaries utilize the program. All data will be collected and reviewed to ensure

appropriate funds are in place for the MM program.

Satisfaction: Customer satisfaction: will be evaluated through in-store surveys located at the

cash register. Customers will rate their experiences on a 5-point Likert scale and have space for

additional feedback. During Phase I, these surveys will ask about satisfaction with the store

conversion, FFV selection, and the CalFresh capabilities at Hank’s. Additionally, the surveys

will ask customers how they heard about the store conversion to directly assess material reach.

During Phase II, customer surveys will ask about satisfaction with the MM program regarding

ease and frequency of use, as well as satisfaction related to the adoption of MM in a corner store.

Storeowner satisfaction: HFD staff will collect a completed survey from the storeowner on a

monthly basis to assess the sustainability of the conversion and the self-efficacy of the

storeowner. Items will be formatted on a 5-point Likert scale and include: HFD has provided


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adequate support during the store conversion; I am capable of successfully maintaining

perishable items in my store; I am satisfied with the newly added items and their sales.

V. Impact/Outcome/Summative Evaluation Plan

Research Question:

Does the introduction of HFD increase the availability and consumption of FFV in a low-

income, low-access community?

Research Strategy: We will evaluate HFD using an explanatory research design. Explanatory

strategies aim to determine whether there is a relationship between an independent variable and

any dependent variables.49 An explanatory research strategy allows us to determine whether we

can infer an association between each phase of HFD and increased FFV consumption. A

descriptive design is not suitable because manipulation of variables (i.e. the intervention and its

various components) is a core component of HFD.50 Exploratory design would also be

inappropriate, as ample data already exists related to food access, poverty rates, and CalFresh

enrollment.22,25

Research Design: We will evaluate HFD under a quasi-experimental design to determine

whether program implementation is associated with an increase in the outcome variable of

interest, FFV consumption.50,51 Although ‘true’ experimental design is regarded as the gold

standard in research, random assignment and limitations on multiple variable measures make it

challenging to utilize in a health promotion setting.50,52 Since we cannot randomly assign

participants to shop at specific stores or prevent individuals who are not part of the study sample

from shopping at Hank’s, a true experimental design is not feasible.

HFD will be evaluated using a two-phase pre-post design with a nonequivalent control group

(NCG).50 The intervention group will be residents of census tracts 2352.01 and 2352.02 and the


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NCG will be residents of census tract 6002.02. During Phase I, HFD will compare the

intervention participants to the NCG to determine how access to a converted corner store impacts

FFV consumption. At baseline, both groups will receive a pre-test to determine FFV

consumption habits without access to a converted corner store. The intervention group will

receive six months of access to the conversion at Hank’s while the NCG will receive a

comparison intervention (two in-person physical activity [PA] modules, one at pre-test and one

at month five). After six months, both groups will receive a post-test to measure potential

changes in FFV consumption. Phase II of the study will be a within-subject comparison also

using pre-post design. It will compare FFV consumption among the intervention participants

before and after access to MM. The post-test from Phase I will serve as the pre-test for Phase II.

There will be a second post-test after

the six months of MM in Hank’s (see

Appendix D for Research Design).

Justification: Pre-post design with an NCG is appropriate to study HFD due to the fact that

randomization of communities is not possible.50 The pre-test component strengthens the design

by allowing us to see if there are any differences between the two groups at baseline and to

determine changes in FFV consumption over time.50

Sample Description: The intervention group will consist of female CalFresh beneficiaries, aged

18+, residing in census tracts 2352.01 or 2352.02. The NCG will consist of female CalFresh

beneficiaries, aged 18+, residing in census tract 6002.02.

Sample Appropriateness: Census tract 6002.02 was selected as the comparison tract due to

geographic and demographic similarities. Both groups are located in SPA 6, have a comparable

Table 1: Two-Phase Pre-Post Design

Phase I

O X (store conversion) O

O O

Phase II

O X (conv. + Market Match) O


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number of corner stores, and qualify as having “low income and access” issues, meaning that

there is no full-service grocery store within one mile of the tracts.26,27

The intervention and comparison census tracts are similar demographically. Both have large

Black and Latino populations (2352.02 - 96% combined / 2352.01 – 91% combined / 6002.02 –

96% combined).25,53 Both groups also have a comparable percentage of the population living at

or below 200% of the Federal Poverty Line (2352.02 – 92% / 2352.01 – 84% / 6002.02 – 94%)

and eligible for CalFresh benefits (2352.02 – 15%-25% [FY 2014] / 2352.01 –25%-50% [FY

2013] / 6002.02 – >50% [FY 2014]).27 CalFresh enrollment similarity is necessary because

Phase II of HFD requires matching CalFresh funds for FFV purchases at Hank’s.

Sample Strengths: By selecting a highly similar comparison group, there is a greater likelihood

that potential changes in FFV consumption measured among the intervention group can be

attributed to HFD. A major strength of using an NCG with pre-post design is that researchers can

assess any potential difference in the two groups prior to the start of a study. This makes it

possible to control for differences during the statistical analysis phase,50 while also allowing for

the establishment of temporal precedence.54

Sample Weaknesses: Contamination is a potential threat to this study because both samples are

located in SPA 6, so individuals in the NCG may travel to the intervention tracts and shop at

Hank’s. However, previous research shows that even one to two miles of travel is a barrier to

accessing healthful food. Thus, a 12-mile distance should be sufficient to ensure limited

contamination.1,55 Nonetheless, we will include a question on both the pre- and post-tests about

travel to Hank’s in order to assess and potentially control for any contamination during analysis.

Hypotheses and Variables: Overarching Constructs and Working Definitions: HFD refers to

the implementation of a two-phase intervention with the goal of increasing access to affordable


17

FFV. Phase I involves a corner store conversion and Phase II involves implementation of a pilot

MM program. HFD participants refers to the intervention group described above (see Sample

Description). HFD participants will receive the intervention in two phases, over two years. The

NCG is equivalent to the intervention group aside from census tract and that they do not receive

the intervention (see Appendix D for Research Design).

Descriptive Hypothesis 1: HFD’s introduction of 15 FFV is associated with a higher reported

frequency of FFV consumption among participants. The independent variable (IV) is the

introduction of 15 FFV and the dependent variable (DV) is the reported frequency of FFV

consumed by participants in each group. Higher frequency of FFV consumption is defined as an

increase of at least one additional FFV consumed per day as compared to baseline.56,57 FFV

consumption will be assessed using the National Health and Nutrition Examination Survey Food

Frequency Questionnaire (NHANES FFQ), available in English and Spanish.58 The NHANES

FFQ assesses FFV intake by summing the reported frequency of consumption over the previous

12 months (see Appendix E for Sample NHANES Questions). This sum is then averaged to

obtain daily intake. Frequency of FFV consumed will be rounded to the closest whole number in

order to measure it as a discrete, ratio variable. A ratio variable is appropriate because the

number of servings consumed has an absolute zero point (e.g. 0 servings is equal to no FFV

consumption).59 The introduction of 15 FFV will be measured as a discrete, nominal variable

where the categories are either Yes (15 FFV introduced) or No (0 FFV introduced).

Descriptive Hypothesis 2: Participation in Phase II is associated with higher frequency of FFV

consumption compared to participation in Phase I among intervention participants. The IV is

program phase and the DV is reported frequency of FFV consumed among HFD participants

during participation in Phase I and II. Higher frequency of FFV consumption is defined as an


18

increase of at least one additional FFV consumed per day after Phase II as compared to Phase I.

Using the same NHANES FFQ questions, we will compare the frequency of FFV consumed per

day within the intervention group over time. Frequency of FFV consumed will be measured as a

discrete, ratio variable, which will allow us to compare the number of FFV consumed (e.g. 2:1

FFV consumption).59 Program phase will be measured as a discrete, nominal variable where the

distinct categories are Phase I or Phase II.

Control Variables: We will control for the following in order to prevent potential confounding

and mediation. We will collect race/ethnicity data as a discrete, nominal variable to control for

potential differences in purchasing based on race. We will collect income data as a continuous,

interval variable to control for potential differences in purchasing based on amount of disposable

income. We will also collect data on household size as a discrete, interval variable to control for

potential differences in frequency of consumption as a result of differential distribution of FFV

purchased within differently sized households.

Unit of Analysis and Sampling: The sampling frame is composed of 198,000 CalFresh

beneficiaries living in SPA 6.60 The unit of analysis is at the individual level; we are targeting

adult women and evaluating data on CalFresh eligibility, race/ethnicity, income, and FFV

consumption.

Sample Type: HFD will narrow the sampling frame in order to identify beneficiaries who reside

in the intervention census tracts (2352.01/2352.02) or the comparison tract (6002.02).60

Participants will be selected from this purposive sample using simple random sampling, with

replacement, making the probability of being selected the same for all CalFresh beneficiaries.

Sample Size: Phase I: HFD aims to detect an increase of 12% in the number of residents in

tracts 2352.01/2352.02 who report eating the recommended daily servings of FFV (an increase


19

from 6% to 18%).36 Using Stata 13.1, we determined that the necessary sample size (alpha=.05

and power=.8) for Phase I is 212 participants total (106 participants from the intervention group

and 106 from the NCG). In LAC, CalFresh attrition is about 18% annually because individuals

can be un-enrolled from the program if their financial situation improves or if they fail to provide

appropriate renewal documentation.61 HFD will oversample 24 participants for each group at the

start of Phase I to account for the 18% attrition rate, as well as any other loss to follow-up over

the 6-month period. This will require a grand total of 260 participants for Phase I with 130 in

each group. Phase II: Phase II will follow only the 130 participants living in the intervention

census tracts (excluding those who have been lost to follow-up) to see how the addition of MM

impacts consumption of FFV beyond providing FFV in Hank’s alone.

Obtaining the Sample: This is a purposive sample since we are using predefined criteria (sex,

age, address, CalFresh beneficiary status, etc.) to narrow our pool of potential participants. Based

on these inclusion criteria, HFD will use Stata to generate a random number for each

beneficiary’s CalFresh number. Stata will randomly select, with replacement, from the pool of

eligible individuals in the intervention and NCG tracts until the required sample size (N=260) is

reached. Program staff will contact individuals in-person to explain the study’s purpose and

obtain informed consent. In the event that not everyone selected in the first wave agrees to join

the intervention, we will return to Stata to generate the remaining participants needed.

Potential Sampling Issues: Due to design, an important consideration for recruitment is

CalFresh attrition over the length of the two-phase intervention. HFD will provide incentives

upon completion of each pre- and post-test during Phases I and II. The intervention group and

NCG participants will receive a $5 Target gift card for each completed test. Furthermore, HFD

will attempt to offset potential attrition in the NCG via the in-person PA modules. These will be


20

delivered in a group setting one week after pre-test and during month five of the program to

motivate continued participation and provide an additional benefit to the NCG.

Data Collection: Data will be collected using the NHANES FFQ, a nationally recognized and

validated questionnaire that assesses FFV consumption, which has been adapted to fit multiple

community settings.38,62,63 The FFQ will be administered as the pre- and post-test for each phase

and is a self-administered paper-and-pencil questionnaire.

Measurement of constructs: FFV Consumption among CalFresh beneficiaries will be

measured using the NHANES FFQ. We will adapt the questionnaire to include 35 discrete

response questions related to consumption of specific FFV items that are culturally appropriate

for Blacks and Latinos and have been sold in Hank’s over the course of the intervention. The

estimated time for completion is 30 minutes per survey. Demographic data, including age,

income, race/ethnicity, and number of household members, will be collected from the CalFresh

database. These variables will be used as control variables during data analysis.

For two weeks, prior to Phase I, each CFL will go door-to-door to deliver the pre-test FFQ to

26 individuals total (13 from the intervention group and 13 from the NCG). This will assess

baseline FFV consumption among participants. Six months following the store conversion,

participants from both groups will complete the post-test FFQ. The post-test from Phase I will

serve as the pre-test for Phase II for the intervention group. This will assess FFV consumption

after store conversion (Phase I), but prior to MM implementation (Phase II). A second post-test

will be administered by CFLs to intervention participants six months after MM implementation.

The NCG will not receive a second post-test as their data will only be used to compare

consumption between individuals with access to a corner store with FFV, and those without.


21

The NHANES FFQ is the most appropriate tool to measure the dependent variable, FFV

consumption, due to its validity in English and Spanish and wide utilization.58 The questionnaire

assesses usual dietary intake and the food items will be adjusted for cultural appropriateness.64

The NHANES FFQ has been assessed via validation studies, and its reliability has been

established through cognitive testing that examines questionnaire content.65 Since the full

NHANES questionnaire includes information on dietary intake that is beyond the scope of this

evaluation, we will administer a modified version related to consumption of FFV only. We have

chosen to modify the questionnaire in order to (1) lower participant burden, (2) omit unnecessary

data collection on other food groups, and (3) ensure we are measuring consumption of the most

culturally appropriate FFV (see Appendix E for the Sample NHANES Questions).

Potential Data Collection Issues: One potential issue associated with using any self-reported

questionnaire is response bias.66 Individuals may be inclined to answer with more socially

desirable responses, for example responding that they eat more FFV than they actually do. We

are using a self-administered survey to address this since they are often used with sensitive

topics, such as sexual behaviors and eating habits,67 because they increase the likelihood of more

accurate response.66 Having the CFLs available while participants complete the FFQ can help

reduce the number of missed questions and minimize non-response bias, and they can clarify the

questionnaire and purpose of the study should participants have any questions.66

Analysis Plan: HFD staff will analyze all data in order to test descriptive hypotheses 1 and 2 to

determine if the intervention resulted in any significant changes in FFV consumption. Statistical

significance will be defined as p-value ≤ .05. The plan will incorporate data cleaning and

management, as well as generalized linear models to determine associations between variables of

interest. The first evaluation will be conducted for Phase I and completed after post-test


22

assessment for the intervention group and NCG is complete. Evaluation for Phase II will occur

after the final post-test assessment for the intervention group is complete.

Data Cleaning and Management: URAs will be responsible for entering all NHANES FFQ data

into a centralized database. CalFresh beneficiary information and demographic data will be

matched to individual participant FFQ responses in the same database to complete the data set.

The PD and PC will be responsible for checking the quality of the data to ensure that everything

was entered accurately and is ready for analysis.

The data will be cleaned and analyzed using Stata, and incomplete or missing observations

will be discarded to prevent potential bias in the analysis. Staff will perform univariate analyses

in order to detect visual trends (from histograms and box plots), and will assess descriptive

statistics (means, ranges, and standard deviations). Descriptive statistics will help with assessing

correlation, identifying potential outliers and other influential observations, and confirming

assumptions of normality and independence.

Hypothesis Testing: HFD will assess potential associations between variables using t-tests,

multiple linear regression, logistic regression, and multiple imputations. T-tests will assess

changes related to FFV consumption between the two groups during Phase I, and to assess

differences in FFV consumption among intervention participants after completion of Phase II.

Regression models will determine if any of the control variables (i.e. race, income, household

size) contribute significantly to the primary outcome variable of interest. Data will be run with

multiple imputations at the end of analysis to see whether excluding missing observations

significantly impacted findings or not. All analyses will help staff understand how participation

in Phase I of HFD relates to FFV consumption in the intervention group as compared to the


23

NCG, and how participation in Phase II impacts FFV consumption as compared to participation

in Phase I alone.

Ethical Considerations: The PD will obtain approval to conduct the study from an Institutional

Review Board. When participants complete informed consent forms, they will receive

informational documents detailing: the study, participant expectations, their right to withdraw,

and implications for the community. HFD will collect sensitive information, such as race, age,

household size, and food consumption. Thus, all electronic data will be password protected and

identifying information will be removed from questionnaires and stored in a separate, locked

location. This will alleviate potential privacy issues since individuals living in the community

(CFLs) will be assisting with data collection. Furthermore, all HFD staff and CFLs will sign

confidentiality agreements.

VI. Discussion

Implications: The beneficial effects that a store conversion has on healthful eating are widely

recognized;12,14 however, the benefits of allowing CalFresh beneficiaries to use funds to purchase

FFV in corner stores has yet to be documented. HFD’s program seeks to fill this research gap by

implementing both a corner store conversion and MM at the same store, with the same

population, to compare levels of FFV consumption during each phase. If HFD succeeds in

increasing FFV consumption following the MM pilot, the program may inform the development

of similar interventions in other low-income, low-access communities in LA. Additionally, CFLs

may be incorporated into other corner store interventions in order to incite more community

involvement around such projects.

HFD will be considered successful if analyses demonstrate a statistically significant increase

in FFV consumption during each phase of the program. Assessing FFV consumption at each


24

phase will indicate whether both a store conversion and MM implementation are necessary to

increase FFV consumption, or if a store conversion alone is sufficient to drive behavior change.

Furthermore, an evaluation of the CFLs is crucial as they are an essential component to HFD. If

the program is successful, it is likely that much of the success could be attributed to their

community engagement, outreach and education efforts.

A direct benefit of program success would be increased FFV consumption, which is linked to

a decrease in obesity-related chronic diseases such as heart disease.1 Reducing obesity-related

chronic disease could help alleviate constraints on and reduce spending within the healthcare

system. Indirect benefits of HFD may include more knowledge on nutrition and food access

issues among community members as well as increased business for Hank’s storeowner.

If the program is unsuccessful, HFD will evaluate the amount of time dedicated to

community outreach, community perceptions of healthful eating, and the effectiveness of each

program phase. Should the data not demonstrate significant changes in FFV consumption after

Phase II, that would confirm that implementing MM in corner stores is not an efficient use of

funding. Program failure would indicate that further research is necessary to identify ways to

increase FFV consumption in low-income, low-access communities.

Dissemination: HFD will disseminate program findings, regardless of the program outcome, so

that interested parties can learn from the experience. Findings will be shared with stakeholders,

community members, and policy makers. At the program’s conclusion, HFD will invite

stakeholders and community members to gather for a presentation on program findings.

Furthermore, HFD will prepare a detailed report for publication in peer-reviewed journals, such

as the American Journal of Public Health, and for presentation at professional conferences.


25

Lastly, to build empirically based knowledge of food access issues, HFD will publish all tools,

methods, and findings on the CalFresh website.

Potential Limitations: One major limitation of the MM component of the study is the inability

to make an unlimited number of matches each week. The program runs on a first-come, first-

served basis due to budget limitations. If weekly pre-allotted funds run out, people will have to

wait until the following week to use their CalFresh benefits at Hank’s. Securing funding would

allow HFD to increase the reach of the matching component, but due to the expensive nature of

MM it is necessary to demonstrate effectiveness before requesting funding from outside

organizations (see Appendix G for Budget Justification). Another limitation is generalizability

of the findings. Since the intervention population only examines female CalFresh beneficiaries,

18+ and the chosen population only covers SPA 6, it is possible that the findings may not be

generalizable to other regions or groups of people.

Sustainability: Previous community health worker initiatives have shown that community

members are critical for program sustainability because they are invested in program success and

able to incite participation from other community members.34,35 Proper training and education of

CFLs and Hank’s storeowner will lead to the continuation of the HFD program. Without their

participation, involvement and support, the program changes will not be sustainable after the

researchers depart.20


26

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VIII. Appendices

Appendix A: Area Map


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Appendix B: Logic Model


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Appendix C: Gantt Chart


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Appendix D: Research Design

Phase I: Pre-Post with a non-equivalent control group

Phase II: Pre-Post on Group 1 only, within-subject comparison to Phase I outcomes

Phase I

O X (store conversion) O

O O

Phase II

O X (store conversion + Market Match) O

Timeline for Pre-Post Test Administration to Assess FFV Consumption (using NHANES FFQ as Pre and Post Test Instrument)


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Appendix E: Sample NHANES Questions


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Appendix F: Budget


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Appendix G: Budget Justification

Personnel Expenses

Full-Time Employees:

1. Program Director (PD) $38,812.50/year

Initiate, maintain, and act as point contact person between HFD and partners. Supervise

and meet monthly with PC. Oversee budget, hiring of HFD personnel/staff and any

logistical issues that may arise. Participate in data collection, management and cleaning,

analysis, and dissemination activities. This is a two-year part-time position (0.25 FTE)

with an annual salary of $115,000. PD benefits will be 35% of salary ($10,062.50/year).

Qualifications: Must have a MPH or MSPH with at least 3 years of public-health work

experience working with underserved communities. Ideal candidate has experience in

program development, implementation and data analysis. Must be bilingual (fluent in

Spanish and English).

2. Program Coordinator (PC) $60, 750/year

Work closely with the URAs and oversee all activities with CFLs. The PC will meet hold

two-hour meetings for project updates the PD (monthly) and the URAs (bimonthly).

Participate in data collection, management and cleaning, analysis, and dissemination

activities. This is a full-time position (1 FTE) at $45,000/year. All expenses for PC will

be the same for both years. PC Benefits will be 35% of salary ($15,750/year).

Qualifications: Must have a MPH or MSPH with at least one year of public health work

experience or any related field and program evaluation experience. Ideal candidate has a

passion for working with underserved communities and experience implementing

programs that improve health in these communities. Must be bilingual (fluent in Spanish

and English).

Part-time Employees:

3. Undergraduate Research Assistants (URAs) Receive class credit

Two URAs will work closely with PC and CFLs to assist in all aspects of HFD. There

will be two positions available at 5 to 10 hours/week depending on the amount of class

credit dedicated to HFD. All expenses for URAs will be the same for both years. The PD

will sign a “Term of Agreement” with the students’ respective institution to secure class

credit positions, in which the students will receive a grade based on the work conducted

in the field rather than being compensated monetarily.

Qualifications: Full-time student at an accredited university with Junior or Senior

standing. Student must have a strong interest in community health and working with

underserved populations. Student must be enrolled in a class with research credit at their

respective institution.


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Contractor

Graphic Designer $30.00/hour

The Graphic Designer will be utilized to help HFD design advertisements, including

design of flyers. The graphic designer will work a total of 10 hours for the entire program

(five hours for Phase I and five hours for Phase II). The total paid to the designer will be

$300.

Non-Personnel Costs

1. Facility Costs $12,000

Rent: HFD staff will rent a small office space at a flat rate of $500 per month for the total

two-year period. This office space will include two desks, two chairs, one office

telephone, and will include the cost of all utilities and Internet usage.

2. Operational Costs $16,145.23

Computers $1,299.98

HFD staff will purchase two Lenovo - Edge 15 inch laptops ($649.99/ea). One will be for

the full-time Coordinator, and the other will remain in the rented office space for use by

both the Program Director and the URA when in the office.

Office Supplies $2,400

Office supplies have been calculated at $100 per month and include standard desktop

supplies such as pens, paper, paper clips, etc.

CFL Field Supplies $374.25

HFD will purchase 25 shirts ($307 for 25 total, which is cheaper than ordering 14 shirts)

for staff and CFLs to wear in the field. HFD will also purchase 25 clipboards ($2.69/ea)

for CFLs for keeping track of materials during community forums and door-to-door

surveying.

Local Travel $4,071

The current local travel reimbursement rate is $.575 per mile. It is estimated that CFLs

will drive a total of 30 miles per month after April 2016 (meetings, delivering FFQs for

evaluation purposes, and community forums). This totals 6,000 miles (30 miles X 10

CFLs X 20 months) for a total of $3,450 (6000 miles X $.575). The PC will drive a total

of 45 miles per month for any necessary site visits at Hank’s or to attend CFL

Community Forums. This totals 1,080 miles (45 miles X 24 months) for a total of $621

(1080 miles X $.575).

Non-Local Travel $8,000

The HFD Program Director, Program Coordinator, and two CFLs will attend the

American Public Health Association annual meeting during Phase II of the program to

present program findings. This includes registration, airfare, hotel, and meals at a per

diem rate for a total cost of $8,000 ($2,000 per person X 4 people).


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3. Printing Costs $1455.90

CFL Training Materials $370

Phase I: Includes ten binders ($3/ea), curriculum pages ($10/set), and ten flash drives

($5.50/ea) with electronic version of the curriculum. Phase II: Includes ten binders

($3/ea), curriculum pages ($10/set), and ten flash drives ($5.50/ea) with electronic

version of the curriculum.

Store Owner Training Materials $8.50

Includes one binder ($3/ea), curriculum pages (see above), and one flash drive ($5.50/ea)

with electronic version of the curriculum.

Promotional Items, Surveys and Recipe Cards $9,487

Includes costs related to printing 10,000 door hangers ($444) and flyers ($200), 5,000

recipe cards ($133) and 5,000 in-store customer surveys ($150). Half of these items will

be used in each year of the program. For Phase I, the door hangers will include a coupon

for three pounds of fresh produce for a customer’s first FFV purchase at Hank’s totaling

$8,550 (0.57/lb * 3lbs * 5000 door hangers).

Printing will also include the pages for the storeowner curriculum ($10). These items will

be obtained from a local printer.

FFQ Questionnaires $12

For a 6-page long 35 question FFQ for 260 participants in Phase I and 130 participants in

Phase II, the total cost will be $12.

4. Conversion Costs $18,548

Fresh Produce $16,800

Based on the agreement formed between Hank’s and the contracted vendor, the vendor

will sell 700 lbs of a variety of 15 seasonal produce items per week for $402 at a fixed

rate for two years.

Cash Register with Card Reader and Computer Screen $1,748

The cash register is equipped with: a touchscreen monitor, card reader, laser scanner,

receipt printer, logic control and pole display (for customer to see each item price as it is

scanned/entered), cash register, software, and EBT swipe machine. These features of the

cash register will ensure proper data collection for Phase I and Phase 2. With the

provided software, HFD staff and Hank’s storeowner can add store specific items and

prices, coupon values, and reward card loading capabilities. Once programmed the

storeowner can easily navigate the touchscreen monitor to track sales, redeem coupons,

and reload reward cards for the MM.

General Repairs: $1,352

General repairs may include removing bars from windows, repairing cracks in stucco,

tightening loose shelving, changing locks, etc. In order to do such repairs, we will need

one 67-piece tool kit ($40) and one electric screwdriver ($22). Given the high cost of

consultation and labor for appliance repairs, and the age of the refrigerators, it is more

cost effective for HFD to provide a new refrigerator in the case of a malfunction. The


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average cost of a single door refrigerator with 23 cubic feet is $1,290, which HFD will

hold a retainer of $1,290 should a refrigerator malfunction.

5. Beautification Materials $5,148

Painting (Exterior, Interior, Supplies): $1,621

Includes the purchase of 40 gallons of exterior paint ($20/ea) and 50 gallons of interior

paint ($13/ea). Gallons needed were calculated using a paint calculator for a 4,900 sqft.

space. We will also need the following painting supplies: two sets of three different size

brushes ($9/ea), two sets of four paint rollers and handles ($12/ea), two paint roller

extenders ($10/ea), 10 paint trays ($1.50/ea) one large painter’s tarp ($20, three rolls of

painter’s tape ($2/ea), two gallons of paint thinner ($9/ea) and one multi-size ladder

($50).

Replacing Floors: $2,401

Floors will be replaced with self-install, non-glue laminate flooring at $.49/sqft. We will

need flooring to cover 4,900 sqft.

Cleaning Supplies: $164

Includes two brooms ($5/ea), two mops ($5/ea), two buckets ($3/ea), one 12-roll pack of

paper towels ($18), two 100-oz containers of multi-purpose cleaner ($7/ea), two 26-oz

containers of glass cleaner ($3.50/ea) and one pressure washer to clean the exterior walls

prior to painting ($99).

6. MM Costs

Rewards Cards $1,140

The reward cards are reloadable gift cards that will be designed specifically for spending

at Hank’s. HFD will order 3000 reloadable reward cards in full color ($0.38 per unit)

totaling $1,140. HFD ordered 3000 cards as a means to provide reward cards to all

eligible CalFresh recipients in our census tracts and additional indirect targets from the

surrounding community.

Matching Cost $75,289

The MM Program will run for 7 months for a total Phase II cost of $75,289. HFD will

distribute these total funds equally for the 28 weeks of implementation ($2,688.79 per

week). HFD will match up to $10 per CalFresh recipient per week to be consistent with

the current MM program implemented in LA farmers’ markets. By matching up to $10

(assuming each recipient receives the maximum matching of $10), 268 CalFresh

recipients per week will receive matching funds from the HFD budget.

Other Costs

Community Food Leaders $13,650

Training Incentives $1,400

Ten CFLs will be trained during Phase I as well as Phase II. Incentives for each of the ten

CFLs include $100 per person for completion of the initial 6-hour training session for a

total of $1000 over the course of the full program ($100 X 10 CFLs). The total $100


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reimbursement will consist of a $50 cash reimbursement and a $50 gift card

reimbursement for Hank’s that can be spent on the newly stocked fresh produce. HFD

will also provide food for the CFLs during the trainings. The budget allotment for food to

feed 12 people (10 CFLs + HFD staff) will be $200 ($170 for lunch and $30 for snacks)

per training.

Community Forums $7,500

CFLs will be responsible for conducting small community forums during Phase I and

Phase II of the HFD program. There will be a maximum of 100 allowable forums

reimbursable at $75 each that meet the necessary requirements over the course of both

phases. This cost will not exceed $7500.

Storeowner $200

Incentives for the storeowner include $100 at the completion of two training segments,

one for Phase I and one for Phase II, which results in $200 total.

Pilot testing $50

We will have 10 community volunteers (who are not participating in the program) review

CFL curriculum and HFD promotional items to ensure cultural appropriateness and

message effectiveness. We will compensate with a $5 Target gift card for each participant

totaling $50.

FFQ Questionnaire Completion Incentive (Pre- and Post-tests) $1,950

For Phase I, the intervention group (N=130) and the NCG (N=130) will receive a $5

Target gift card upon completion of the pre- and post-test FFQ Questionnaire. For Phase

II, the intervention group (N=130) will receive a $5 Target gift card for completion of the

post-test FFQ questionnaire. This is a grand total of $1,950 over the course of both

phases.

healthy food in a dash

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