Client preferences and diabetes management guidelines inform the design and elements of a therapeutic food box intervention

Authors: SHORT, ELIZA - University Of Arizona; SHARMA, JAYATI - University Of Arizona; Thompson, Deborah - Debbe; GONZALEZ, RHONDA - Community Food Bank Of Southern Arizona; SHEAVA, JESSI - Community Food Bank Of Southern Arizona; TAREN, DOUGLAS - University Of Arizona; HINGLE, MELANIE - University Of Arizona

Submitted to: Annals of Behavioral Medicine
Publication Type: Abstract Only
Publication Acceptance Date: 1/15/2020
Publication Date: 5/1/2020
Citation: Short, E., Sharma, J., Thompson, D.J., Gonzalez, R., Sheava, J., Taren, D., Hingle, M. 2020. Client preferences and diabetes management guidelines inform the design and elements of a therapeutic food box intervention. Annals of Behavioral Medicine. 54(Suppl 1):S38. https://doi.org/10.1093/abm/kaaa009.
DOI: https://doi.org/10.1093/abm/kaaa009

Interpretive Summary:

Technical Abstract: Type 2 diabetes (T2D) affects >30 million U.S. adults and disproportionately burdens food insecure households. Associations between food insecurity, poor diet quality, and T2D are well established and have prompted medical nutrition therapy (MNT) recommendations designed to prevent complications. Limited food access and low diet quality in food insecure households make these goals difficult to achieve. Food bank assistance often lacks cultural responsiveness and alignment with MNT goals. Incorporating MNT recommendations and food bank client preferences with food assistance efforts will help improve diet quality and mitigate T2D burden among food insecure households. Our purpose was to assess food bank clients’ preferences related to a typical food assistance box and determine if alternative foods or resources would help clients with T2D improve diet quality and disease management. Twenty participants self-reporting T2D or T2D in their household were recruited from the Community Food Bank of Southern Arizona in June/July 2019. Participants completed a demographic questionnaire and semi-structured interview. Participants viewed a food assistance package of 7 items (e.g., canned/dried legumes, vegetables, grains). Participants described food use and foods they would replace/add from 6 T2D-suitable items. Interviews, conducted in English (n=10) and Spanish (n=10), were digitally recorded, transcribed, and independently verified by two researchers. A script-based codebook was developed and confirmed by a third, senior researcher. All coding was conducted in NVIVO 12 using thematic analysis. Participants were 45 to 83 years, majority female (n=15, 75%), Hispanic (n=16, 80%), and food insecure (n=18, 90%). Participants used all foods received from the food bank or redistributed undesired items to friends and family members. Emerging themes from ongoing analysis center around existing food use and desired replacement foods. Food assistance use was driven by cultural relevance, household food preferences, and ability to pair foods with other household foods. Desired foods included fresh fruits and vegetables, meat, oats, oil, and herbs; desired resources included recipes, cooking demonstrations, and online support groups. Participants desired culturally relevant, cost-effective, and healthy foods and recipes in accordance with MNT guidelines. This feedback can inform tailored food assistance supporting diabetes management in food bank clients.