Formative assessment of community health center Food is Medicine programs during COVID-19 in Northern California

The COVID-19 pandemic disrupted implementa­tion of Food is Medicine (FIM) programs and imposed food security and healthcare-related hard­ships. Understanding access to and experiences with FIM programs during crises and among diverse populations can help build resilience of programs to future shocks. This formative, mixed-methods study aimed to (1) assess potential barriers and facilitators to access to health services during the COVID-19 pandemic, with emphasis on Food is Medicine (FIM) programs; and (2) understand the effects of the pandemic on healthcare access, food security, and related coping strategies among Federally Qualified Health Center (FQHC) clients. From December 2021 to September 2022, 19 inter­views (10 in English, 9 in Spanish) were conducted with clients in Yolo County, CA, with close-ended and open-ended questions about their experiences for a pre-pandemic period (before March 2020) and a pandemic period (last 12 months). Qualita­tive analysis was conducted in NVivo and using the Framework Method. Major themes identified for Objective 1 were: (1) perceived benefits of FIM programs, including increased knowledge and skills and increased access to produce; (2) barriers to program participation, including client time con­straints and limited program awareness; and (3) sat­isfaction with FQHC services. Themes identified for Objective 2 were: (1) changes in healthcare access, such as increased difficulty with access and healthcare cost, and the use of telehealth; (2) changes in food security, including economic barri­ers to purchasing quality food and the decreased quantity of food; and (3) use of federal and com­munity resources to cope with difficulties. Our results suggest potential avenues to strengthen Food is Medicine programs, and highlight the role of FQHC programs, community resources, and social networks as coping strategies for food insecurity and decreased access to care.