Medically Used Tailored Traditional Food to Optimize Nutrition in Heart Failure

Hospitalization or Visit to Emergency Department (All-cause)

The investigators will measure cultural connectedness utilizing a 6-question modified version of the validated Cultural Connectedness Scale-California (CCS-CA) at baseline and at 60 days. This is a validated score, developed by Indigenous scholars to measure cultural connectiveness in Indigenous populations, and has been shown to correlate with physical health and be a social determinant of health. This scale has previously been modified for use in Diné populations specifically by the investigators. The investigators will evaluate total score, as well as subcomponents of identity, traditions, and spirituality.

This is a validated score for evaluating quality of life and symptom measures in heart failure patients. Score ranges from 0-100, with 0 meaning very poor quality of life/symptoms and health status, 100 meaning excellent quality of life/symptom burden/health status.

Subset of this is a validated score for evaluating quality of life measures in heart failure patients. Score ranges from 0-100, with 0 meaning very poor quality of life/symptoms and health status, 100 meaning excellent quality of life/symptom burden/health status.

The investigators will evaluate baseline and 60-day rates of food insecurity utilizing the USDA Adult Food Security: Six Item short Form survey (USDA FSSM 6-Item).[12] At the 60-day evaluation, the investigators will adapt the USDA FSSM 6-Item questionnaire to evaluate food insecurity within the last 2 (rather than 12 months).

albumin, prealbumin, creatinine, NT-proBNP, HbA1c, Total cholesterol, LDL-C, HDL-C, Triglycerides, CRP

Weight (kilograms). Weight and height will be combined to report BMI in kg/m^2

All cause

All cause

ER visit for volume overload or HF symptoms

The investigators will assess diet quality using the 10-item DSQ [11] with an addition question to assess traditional Diné food intake (During the past month, how often did the participant eat traditional Diné foods (such as blue corn mush, steamed, roasted or dried corn, sumac berries, mutton, local varieties of squash or beans) at baseline and at the end of the intervention.

The investigators will measure Financial Stress Scale at baseline and at 60 days using two questions:[16] How worried was the participant over the last 2 months about paying for housing (rent, mortgage, etc.)? How worried was the participant over the last 2 months about paying monthly bills?

§ All questions will be answered on a 4-point scale, where 1 = "not worried at all", 2 = "not too worried", 3 = "moderately worried", and 4 = "very worried"

The investigators will evaluate the following:

• % of meals that include locally sourced ingredients
• % of food supply sourced by Diné producers/suppliers/farmers
• % of meals sourced by Native suppliers/farmers

The investigators will evaluate the percentage of meals delivered successfully to the patient (or percentage of meals that were successfully picked up by the patient if picked up from the food pantry or other location).

The investigators will assess baseline dietary patterns through 3-day food diaries during week 1 and week 8 after enrollment. The investigators will also survey participants on the % of meals consumed at 60 days. Additionally at 90 days, the investigators will perform a survey to evaluate dietary patterns post intervention and adoption of any of the recipes/behavioral changes.

The investigators will evaluate patient satisfaction by evaluating the Net Promoter Score (i.e. how likely is it that the patient would recommend this program to a community member?") post-intervention.

The investigators will perform semi-structured interviews of non-patient stakeholders (i.e. farmers that supplied produce, livestock farmers, food pantry) to assess acceptability and feasibility of providing produce for the meals, as well as the degree to which the program contributed to strengthening the local food system. The investigators will also perform semi-structured interviews of primary care providers and a subset of patients. Semi-structured interviews will be guided by the Consolidated Framework for Implementation Research (CFIR), and the investigators will explore multiple constructs within each CFIR domain that are hypothesized by the study team and based on existing literature to be relevant to acceptability and feasibility of the program.

The investigators will evaluate how much physical activity/exercise patients are participating in weekly at baseline, and at 60 days by asking patients to estimate the number of minutes weekly that they are participating in formal exercise or physical activity.

The investigators will evaluate patients' general health status using a single general health status question (would the patient that in general their health is excellent, very good, good, fair, or poor) at baseline and post-intervention

Subsection of KCCQ-12 Score

Subsection of KCCQ12 Score

Subsection of KCCQ-12 Score

The investigators will evaluate the Indigenous Nourishment Scale (Measure A), which is a scale developed through community-based methods in Indigenous communities to encompass multiple dimensions of nourishment. The investigators will assign score of 0-6 for each response (0 for never-6 for always), for a total score 0-54 (with 0 meaning low levels of nourishment and 54 high levels of nourishment.

Height (cm). Weight and height will be combined to report BMI in kg/m^2.

Urine albumin:creatinine ratio