Community as Medicine: A Novel Approach to Improve Health Behaviors and Mental Well-Being for Vulnerable Populations.

Purpose: Evaluate a group-based, trauma-informed health coaching model based on Lifestyle Medicine pillars, delivered by community health coaches, to improve health behaviors and mental well-being for vulnerable populations. Methods: This program evaluation analyzed quantitative longitudinal data with linear mixed models and qualitative data with reflexive thematic analysis. Participants (n = 720) were low-income adults referred through Federally Qualified Health Centers (FQHCs), who participated in weekly 90-120 minute groups for 3 months. Data were collected via monthly surveys, including the PHQ-9, GAD-7, UCLA 3-item loneliness, exercise as a vital sign, a 2-item dietary screener, and 3 qualitative questions. Results: Participants saw significant reductions in depression, anxiety, and isolation, and significant increases in daily servings of fruits and vegetables, and weekly minutes of exercise. The qualitative analysis identified 4 themes related to the drivers and reinforcers of positive behavior change and improved mental well-being. Conclusions: Initial data suggest this model helps reduce depression, anxiety, and isolation, and promotes positive behavior change within populations most impacted by health inequity. Qualitative results identified drivers of positive change, such as creating a sense of belonging and mutual support. Future research should consider how to continue to scale this program to a variety of populations and across different settings.