Background: The project team’s Community Advisory Board (CAB) expressed an overwhelming interest in promoting food accessibility and improving maternal and child health (MCH) outcomes for Tennesseans during a community mapping exercise conducted in 2021-2022. In 2021, nearly one in three Tennessee families battled food insecurity. In addition, Tennessee has some of the worst outcomes in the United States for infant mortality, low birth weight, and maternal mortality. Efforts to address the food insecurity in MCH are hampered by a lack of communication, coordination, and multidisciplinary patient-centered outcomes research (PCOR) to develop long-term, sustainable solutions. The proposed convening will identify best methods and approaches for understanding the impact of food insecurity on MCH.

Proposed Solution to the Problem: This convening will identify potential interventions surrounding food insecurity and MCH to inform future PCOR.

Objectives: The proposed convening aims to gather stakeholders from all regions of Tennessee (West Tennessee - Mississippi Delta region, Middle Tennessee, and East Tennessee - Appalachia) to develop long-term PCOR surrounding food insecurity and MCH, which will be accomplished with the following objectives.

• Build on the current CAB’s strengths, interests, and passions by identifying additional stakeholders throughout Tennessee to participate in the convening event and to plan the stakeholder convening event
• Convene a diverse group to collaboratively examine and gather different perspectives regarding food insecurity’s impact on MCH
• Develop and disseminate a roadmap for PCOR/CER for food insecurity and MCH

Activities: The CAB will meet, plan, and evaluate the convening event in September 2023. A hybrid format will allow participation virtually or in a socially distanced, in-person setting. Stakeholders will be asked to identify barriers related to food security within the populations they serve or how they have directly been impacted by food insecurity and come up with potential solutions through small-group breakouts and report-backs. Stakeholders will then develop a roadmap regarding the next steps for PCOR/comparative clinical effectiveness research (CER) on MCH and food insecurity. The CAB will meet at least one time after the convening event to finalize the roadmap and evaluate the process and convening event.

Projected Outcomes and Outputs: The proposed convening will result in the following outcomes:

Short-term (during the project period) —Stakeholders will create a roadmap for future PCOR/CER studies based on the innovative solutions proposed at the convening surrounding food insecurity and maternal and child health. A final report and lay summary will be shared with stakeholders by November 2023.

Medium-term (0-2 years after project period) — This event will result in further building capacity for PCOR/CER as well as developing innovative pilot programs to address food insecurity in mothers and children. Ideally, stakeholders would want to continue to be research partners and develop a PCOR grant proposal. The CAB members have identified several agencies to submit for future funding after the end of the project period:

• Centers for Disease Control and Prevention Community Health Funding
• Robert Wood Johnson Foundation
• United States Department of Agriculture Delta Health Care Services
• Blue Cross Blue Shield Foundation of Tennessee
• Health Resources and Services Administration

Long-term (3+ years after the project period) — Conduct a PCOR/CER research project with community partners and stakeholders.

These outcomes are significant; they will illuminate food insecurity and its effects on MCH. The roadmap (the output/deliverable) will ideally consist of a list of stakeholders and their expertise, CAB members, identified resources, barriers and facilitators in communities, future collaborative research projects, and a graphic representation of the research roadmap.

Patient and Stakeholder Engagement Plan: The CAB consists of 12 members with interests and expertise in areas such as rural and urban food insecurity, public policy, child development, community engagement, and lived experience of food insecurity. The CAB will identify additional stakeholders, evaluate the convening, and finalize the roadmap. Additional stakeholders include government and nonprofit agencies; experts in rural health, community development, and food insecurity; healthcare partners; mothers who have experienced food insecurity; and lay members directly impacted by food insecurity. By engaging community stakeholders from diverse backgrounds and contexts, the project team will discover perspectives that inform methods to reduce food insecurity for mothers, children, and pregnant women.

Project Collaborators: Le Bonheur Children’s Hospital Community Services, Regional One Health Midwifery Service, The Works Inc., Rural Health Association of Tennessee, United Way, and Tennessee Government Agencies.