Continuing to Grow our Bluegrass Partnership — Building Kentucky's Food is Medicine Pathway
Continuing to Grow our Bluegrass Partnership — Building Kentucky's Food is Medicine Pathway
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Featuring Dr. Betsy Anderson Steeves, CNHI Senior Research Scientist
Building a smarter Food is Medicine pathway in Kentucky.
A food insecurity screening can uncover a need that may be difficult to name. But asking the question is only the beginning. A patient must feel safe saying yes for help, and the support offered must fit their life.
That gap between identifying a need and delivering support people can use is what a long-standing partnership between Dr. Betsy Anderson Steeves, Senior Research Scientist at the Center for Nutrition & Health Impact (CNHI) and Dr. Alison Gustafson, Director of the University of Kentucky’s (UK) Food as Health Program is working to close.
The Food as Health Program has built a referral hub that helps care teams connect patients with programs across Kentucky. Rather than offer the same support to everyone, the referral hub considers practical realities such as transportation and kitchen access, along with health needs and food preferences. Patients may then be matched with medically tailored meals, grocery prescriptions, or meal kits.
The idea is simple: a program can only help if a patient can realistically use it. As Dr. Steeves explains, finding that fit begins with understanding that every participant’s needs are different.
“Like all shoppers, individuals with unmet food needs are unique; some may prefer to shop in person and select their own foods, others may need to shop online or have ready-to-eat meals delivered to their homes. The most effective programs are those that patients can actually use, and that are feasible for providers to administer. Valuing the experiences and perspectives of food is medicine participants and providers, listening to their needs and designing projects with the program users in mind is a real strength of the work being done in Kentucky.”
Listening at Every Step
CNHI’s role is to understand what happens from the perspective of people moving through this pathway. Interviews CNHI conducted captured the experiences of both patients and providers, including people who chose not to enroll. Their accounts show where trust strengthens the connection and where the pathway falls short.
A recent paper that CNHI co-authored with UK colleagues revealed an important tension. Among eligible patients who agreed to be referred, 73% enrolled. Yet only about one-third of those who initially screened positive expressed interest in being referred to Food is Medicine services.
Low rates of take-up of food supports are not uncommon in the literature. Interviews helped explain the gap. Some people felt embarrassed discussing food insecurity or accepting assistance. Others were unsure what food they would receive or worried that accepting a referral might take resources from someone else.
The way screening happens can help close that gap. Patients responded more positively when questions about their status came from a trusted provider and were asked with a clear intention to help. As one participant explained, “There was not a feeling of judgment, and it felt they were asking to help instead of judging.”
What Becomes Possible After the Referral
The partnership is also learning what happens after a patient says yes. In a recent feasibility study co-authored by CNHI and UK colleagues, a decision tool matched rural and urban adults with hypertension to either medically tailored meals or grocery prescriptions. Ninety-five percent completed the three-month program, and participants rated their likelihood of recommending it, 9.4 out of 10. There was also an encouraging improvement in dietary intake and broader health measures, including blood pressure.
The work is now expanding from individuals to households. The Feeding the Family study is comparing medically tailored meals and grocery prescriptions, both separately and together, for caregivers and children. Early findings show how closely caregiver and child health can be connected, which also suggests that Food is Medicine may need to support the whole household rather than one patient at a time.
The partnership will continue refining the screening and referral experience while testing which program models best fit different patients and families. That work can help the Food as Health team build the evidence needed to strengthen its Food is Medicine infrastructure and expand it responsibly.
Moving from evidence to impact begins before the first meal or grocery benefit is delivered. It begins by interacting with patients in a meaningful way and ensuring the patient (who is also a person) feels heard. By bringing patient and provider experiences into the research, CNHI is helping the UK Food as Health team build a pathway that responds to real lives and continues learning from them.
The future of Food is Medicine will be shaped not only by what programs offer, but by whether people will trust and use them.