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please check this case study and reflect based in the attached instruction
Case Study for Outcome Mapping: Boxes for Hunger
Background Context on the Problem to Address
Boxes for Hunger is a program that operates like a large food bank, distributing packages
of food to distribution centers where clients can pick up these pre-selected food boxes.
The clients are low-income and homeless individuals and households across the state.
Their mission is “to provide food to hungry people, advocate for change on their behalf
and engage and mobilize the community to end hunger in Indiana.”
Clients and staff are both concerned about the health issues that many of the clients
may face. With low food security, they often don’t have a choice in types of food that
they get, which can drastically affect health. An informal survey was done conducted at
the distribution centers across the state. Of those who responded, 22% had been
diagnosed with diabetes, while 16% required a low-sodium or low-fat diet.
Boxes for Hunger serves about 600,000 people through food programs that they support.
Given the percentages for diabetes and low-salt or low-fat diets, this means that
114,000 and 96,000 people require special dietary conditions for these needs,
respectively.
Furthermore, clients of food programs that Boxes for Hunger support often have
minimal to no healthcare access. This means that, even if they can visit a doctor
and be diagnosed with a health condition, they likely have no money for further
treatment. Poor nutrition habits and under-nourishment progress disease states that
might otherwise be treatable. It is because of this that staff and volunteers at Boxes for
Hunger are concerned with ways that clients can manage their health conditions before
they worsen.
Even if a client knows of their health condition, the food program they go to may not
always have the best foods for their health condition. Clients often ask for foods that
better fit their dietary needs or ask what foods at the program are best for them.
Sometimes they feel that programs are not adequate. One anonymous client said, “We
should have a choice to fit our diet and cooking facilities. Some people are diabetic,
some homeless and without cooking facilities to cook from scratch.”
Along with low control over choices in food is a lack of education about nutrition. When
people have special diets they have to follow, sometimes they don’t know what kinds of
foods are best for their health condition or how to decipher labeling (i.e., understanding
ingredient labels on cans of vegetables to determine if they are low-sodium or not).
They may not know how to manage chronic diseases or feel like they have enough
choices to do so. Sometimes staff and volunteers are unsure of what kinds of foods to
request from Boxes for Hunger or what kids of foods to pack into pre-packaged boxes or meal plan.
Intervention for the Problem
Given the evidence for health concerns within the population that Boxes for Hunger
serves, diabetes and hypertension are the highest priorities. Also, the expressed interest
in 55% of the food distribution sites in Indiana for nutrition education places a particular
priority on education for affecting the health of the community.
Education is important, but it is also essential to educate in a way that is obtainable to
the community. There is often little extra money to be spent on “healthy” food, and few
choices in the types of food at food programs. Education with these barriers in mind
produces a program that is conscious and respectful of barriers and works with clients
without them feeling angry, upset, or guilty about their current diet. A three-pronged
approach addressing three types of populations are as follows:
1. Educating the clients who receive food packages helps them achieve
greater health with their dietary needs. However, if they are relying on
food programs as their source of food, then choices are limited with the
food that they get. This means that education must focus on this challenge.
Education for clients should be about management and prevention of
chronic diseases. Though the program cannot diagnose conditions, it can
bring awareness or inspire someone to seek treatment if possible or
necessary. Education also teaches them how to handle foods received in
their food packages to improve their health, e.g. rinsing salt off of canned
vegetables for a lower sodium diet.
2. Volunteers are next in terms of responsibility for sorting and packing food
appropriately. If someone has a dietary need that they need help with, it is
essential that the people who are setting out the food for them be
educated in what kinds of food are ideal for the given health condition.
Once again, however, they are limited by the types of food that the meal
program receives.
3. Finally, managers are responsible for obtaining food, and they do have
some choice in what kinds of food to order. Therefore, education for
managers is also very influential, as they can decide on obtaining food that
better suits specific dietary needs within their community.
This education is done through handouts and packets for each group of people is a
helpful way to introduce nutrition education into the community. The handouts are used
as training material for managers and volunteers, and are added as pamphlets to the
food packages to be sent to clients.
This reduces the need to have organized meetings for education, since people have
limited time and a high volunteer turnover rate would mean frequent education classes
would be needed. Handouts are designed to educate each group as needed and would
include information about the health condition, foods that are optimal, foods that a
good for alternatives, basic meal planning, and food preparation. Handouts can be
printed as needed to reduce budget size.

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