Enhanced Meal Program for Quality of Life

Overseen By Brie Tyler, MPH

Age: 18+

Sex: Any

Trial Phase: Academic

Sponsor: University of Connecticut

Disqualifiers: Cognitive, physical limitations, others

No Placebo Group All trial participants will receive the active study treatment (no placebo)

Compensation: Varies

Number of Visits: Unknown

Duration: 12 weeks

What You Need to Know Before You Apply

What is the purpose of this trial?

This trial aims to determine if adding community health worker support and extra grocery bags to regular home-delivered meals can improve the health and well-being of older adults. The goal is to address issues like poor diet, loneliness, and food insecurity. Participants will either continue with the regular meal service or receive the enhanced service with additional support. The trial seeks older adults in Rhode Island who are already part of the Meals on Wheels program and are at risk of poor nutrition. As an unphased trial, it provides a unique opportunity to contribute to research that could enhance support services for older adults.

Will I have to stop taking my current medications?

The trial information does not specify whether you need to stop taking your current medications. It seems focused on meal delivery and nutrition, so it's unlikely that medication changes are required.

What prior data suggests that this enhanced meal program is safe for older adults?

Research shows that adding phone calls from community health workers and providing healthy grocery bags with home-delivered meals is safe and appreciated by participants. Studies have found that these additions do not cause health issues. Participants often share positive feedback about the extra support. The goal is to improve diet quality and reduce feelings of loneliness without adding risks. So far, no major negative effects have been reported. This makes the enhanced meal program a promising and safe way to improve the quality of life for older adults. ^{1 2 3 4 5}

Why are researchers excited about this trial?

Researchers are excited about the Enhanced Meal Program because it goes beyond the usual care of just home-delivered meals. This program adds Community Health Worker calls and supplemental grocery bags to the mix, creating a more comprehensive support system. This approach not only ensures that nutritional needs are met but also fosters a personal connection and offers additional resources, potentially leading to improved quality of life. By integrating these elements, the program aims to address both physical and social aspects of health, which standard meal delivery services might overlook.

What evidence suggests that this enhanced meal program is effective for improving quality of life?

Research has shown that adding visits from community health workers and providing extra healthy groceries to meal delivery programs can benefit older adults. In this trial, participants in the "Enhanced" arm will receive home-delivered meals, Community Health Worker calls, and supplemental grocery bags. Studies have found that these additions can address issues like diet quality, access to nutritious food, and feelings of loneliness. This approach offers more than just meals by ensuring social interaction and access to healthy food. Early results suggest that these extra services can improve health-related quality of life. Participants receiving these enhanced services often feel better overall compared to those in the "Usual care" arm, who only receive standard home-delivered meals. ^{1 2 3 4 5}

Who Is on the Research Team?

Caitlin Caspi, ScD

Principal Investigator

University of Connecticut

Kim Gans, PhD

Principal Investigator

University of Connecticut

Are You a Good Fit for This Trial?

This trial is for older adults in Rhode Island who are at nutritional risk, eligible for Meals on Wheels assistance, and can communicate in Spanish or English. It's not specified who cannot join the trial.

Inclusion Criteria

I am considered at nutritional risk according to a recent assessment.

I live in Rhode Island.

I am eligible for Meals on Wheels assistance.

Timeline for a Trial Participant

Screening

Participants are screened for eligibility to participate in the trial

2-4 weeks

Treatment

Participants receive enhanced home-delivered meals with community health worker interactions and supplemental grocery bags

12 weeks

Regular interactions with community health workers

Follow-up

Participants are monitored for improvements in diet quality, food security, nutrition security, loneliness, and health-related quality of life

4 weeks

What Are the Treatments Tested in This Trial?

Interventions

• Community Health Worker calls
• Home-delivered meals
• Supplemental grocery bag
• Wellness check and socialization visit

Trial Overview The study tests an enhanced Home-Delivered Meals Program by Meals on Wheels with added community health worker calls, wellness visits, and extra grocery bags to improve diet quality, food security, loneliness, and life quality of older adults.

How Is the Trial Designed?

Group I: Enhanced Experimental Treatment 4 Interventions

Home-delivered meals plus Community Health Worker Calls and supplemental grocery bags

Group II: Usual care Active Control 2 Interventions

Home-delivered meals

Who Is Running the Clinical Trial?

University of Connecticut

Lead Sponsor

Trials

194

Recruited

162,000+

Department of Health and Human Services (DHHS) Administration for Community Living (ACL)

Collaborator

Trials

1

Recruited

1,600+

Meals on Wheels Rhode Island (MOWRI)

Collaborator

Trials

1

Recruited

1,600+

Department of Health and Human Services

Collaborator

Trials

240

Recruited

944,000+

Published Research Related to This Trial

Providing performance feedback to community health workers (CHWs) significantly improved their counseling duration, with a large effect size (Glass's delta=0.97) during the initial 6 weeks, and this improvement was sustained even after the intervention ended (Glass's delta=1.69).

While the feedback did not lead to significant improvements in case activity or form submissions, the supportive supervision aspect of the calls helped maintain CHW motivation, indicating that regular feedback can enhance overall performance in health programs.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effect of Performance Feedback on Community Health Workers' Motivation and Performance in Madhya Pradesh, India: A Randomized Controlled Trial. Kaphle, S., Matheke-Fischer, M., Lesh, N.[2019]

Home-delivered meal programs can significantly support the health and independence of older adults, particularly those facing food insecurity or transitioning from care settings to home, as highlighted by a systematic review of 80 studies.

Most studies reviewed were descriptive and lacked rigorous outcomes, indicating a need for more comprehensive research to understand barriers to access and to optimize meal delivery models for older adults.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Does Participation in Home-Delivered Meals Programs Improve Outcomes for Older Adults? Results of a Systematic Review. Campbell, AD., Godfryd, A., Buys, DR., et al.[2022]

Older adults receiving home-delivered meals are at a high risk of undernutrition, highlighting a significant nutritional concern for this population.

Improving home-delivered meal services, such as by adding dietetic counseling or enriched food options, can enhance nutritional status and intake, but even these improvements may not fully meet the recommended nutritional needs of all recipients.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

The Nutritional Issue of Older People Receiving Home-Delivered Meals: A Systematic Review. Fleury, S., Tronchon, P., Rota, J., et al.[2021]

In a study involving 1310 mother-infant pairs in rural Eastern Cape, home visits by community health workers (CHWs) led to important improvements in maternal health behaviors, such as increased antenatal visits and exclusive breastfeeding for 6 months (OR: 1.8).

Children of mothers who received CHW support were less likely to experience wasting (OR: 0.5) and had fewer symptoms of common childhood illnesses, indicating that while the effects were limited compared to urban settings, CHWs still play a beneficial role in rural health outcomes.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Community health workers impact on maternal and child health outcomes in rural South Africa - a non-randomized two-group comparison study. le Roux, KW., Almirol, E., Rezvan, PH., et al.[2023]

Community health workers play a crucial role in bridging the gap between health providers and the community by offering various services such as health education, outreach, and case management, which enhances access to healthcare.

The study of community health worker programs across seven sites provides valuable insights and lessons that can help improve the effectiveness and implementation of similar programs in other communities.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Impact of community health workers on access, use of services, and patient knowledge and behavior. Zuvekas, A., Nolan, L., Tumaylle, C., et al.[2019]

The Visiting Nurse Service HIV/Home Delivered Meals Program provided 50 clients with HIV/AIDS energy-enhanced meals and nutrition support over 6 months, leading to improved food consumption and weight management for many participants.

Out of 35 participants assessed, 13 gained weight on average by 6 pounds, and the program helped increase the number of participants considered to be 'doing well' from 14 to 19, demonstrating the effectiveness of dietitian-led medical nutrition therapy.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

A community-based, interagency approach by dietitians to provide meals, medical nutrition therapy, and education to clients with HIV/AIDS. Topping, CM., Humm, DC., Fischer, RB., et al.[2006]

Home-delivered meal services, like Meals on Wheels, can enhance energy and protein intake for older adults by including protein-enriched options and providing full-day meal plans, according to a systematic review of 19 studies.

Despite the positive outcomes, none of the studies were rated as high quality, highlighting the need for further research to optimize these meal services for better nutritional care at home.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

Effective elements of home-delivered meal services to improve energy and protein intake: A systematic review. IJmker-Hemink, VE., Dijxhoorn, DN., Briseno Ozumbilla, CM., et al.[2020]

A pilot study involving 12 Meals on Wheels clients showed that providing high protein, high energy snacks significantly improved nutritional status, with a notable increase in energy and protein intake, and a reduction in the number of clients categorized as malnourished.

The study found that while the additional snacks led to increased body weight and BMI, only half of the participants expressed interest in continuing the program, indicating that not all clients recognized the benefits of the snacks for their health.

NCBI (Pubmed)

pubmed.ncbi.nlm.nih.gov

"It could probably help someone else but not me": a feasibility study of a snack programme offered to meals on wheels clients. Charlton, KE., Walton, K., Moon, L., et al.[2021]

Citations

1. pmc.ncbi.nlm.nih.gov pmc.ncbi.nlm.nih.gov/articles/PMC12487516/

A study protocol for a randomized controlled trial ... A study protocol for a randomized controlled trial evaluating the impact of adding community health worker coaching calls and healthy ...

2. pubmed.ncbi.nlm.nih.gov pubmed.ncbi.nlm.nih.gov/41034808/

A study protocol for a randomized controlled trial ... A study protocol for a randomized controlled trial evaluating the impact of adding community health worker coaching calls and healthy grocery bag deliveries ...

3. clinicaltrials.gov clinicaltrials.gov/study/NCT06401694

Evaluating an Enhanced Home-delivered Meal Program ... The enhanced approach includes community health worker (CHW) interactions and supplemental healthy grocery bags to address diet quality, food and nutrition ...

4. researchgate.net researchgate.net/publication/396047073_A_study_protocol_for_a_randomized_controlled_trial_evaluating_the_impact_of_adding_community_health_worker_coaching_calls_and_healthy_grocery_bag_deliveries_to_a_Meals_on_Wheels_home-delivered_meal_pr

(PDF) A study protocol for a randomized controlled trial ... Discussion Enhancements such as CHW calls and grocery bags can help HDMP target food access, social and health interventions for older adults.

5. withpower.com withpower.com/trial/phase-food-insecurity-4-2024-de545

Enhanced Meal Program for Quality of Life The enhanced approach includes community health worker (CHW) interactions and supplemental healthy grocery bags to address diet quality, food and nutrition ...