Feasibility of a food-based diabetes self-management education intervention for food insecure patients with type 2 diabetes: A convergent mixed methods study

Authors: SHORT, ELIZA - University Of Arizona; Thompson, Deborah - Debbe; TAREN, DOUGLAS - University Of Colorado; BRYANT, HOLLY - El Rio Community Health Center; GONZALEZ, RHONDA - Community Food Bank Of Southern Arizona; SHEAVA, JESSI - Community Food Bank Of Southern Arizona; HINGLE, MELANIE - University Of Arizona

Submitted to: Public Health Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 9/18/2023
Publication Date: 9/28/2023
Citation: Short, E., Thompson, D.J., Taren, D., Bryant, H., Gonzalez, R., Sheava, J., Hingle, M. 2023. Feasibility of a food-based diabetes self-management education intervention for food insecure patients with type 2 diabetes: A convergent mixed methods study. Public Health Nutrition. https://doi.org/10.1017/S1368980023002082.
DOI: https://doi.org/10.1017/S1368980023002082

Interpretive Summary: Recent shifts to prioritize food and nutrition security in the U.S. have resulted in the incorporation of food-based nutrition programs into healthcare settings. These 'Food is Medicine' programs aim to use food as a foundational approach to prevent and/or treat chronic diet-related diseases like type 2 diabetes. This study assessed the feasibility of the FRESH (Food and Resources Expanded to Support Health) intervention, a food-based diabetes self-management intervention delivered by a food bank and Federally Qualified Health Center to patients with type 2 diabetes who were experiencing food insecurity. The program was found to be feasible with this population. This research offers an innovative method for addressing an important public health issue, with the potential for substantial public health significance.

Technical Abstract: The purpose of this study was to assess the feasibility of a food-based diabetes self-management education and support (DSMES) intervention delivered by a food bank and Federally Qualified Health Center to English- or Spanish-speaking adults with type 2 diabetes (T2DM) and food insecurity. This single arm pre-/post convergent mixed methods study tested the feasibility of a 3-month intervention using food boxes, recipes, DSMES, and dietitian visits. Feasibility benchmarks assessed were: acceptability (>50% participants satisfied), demand (>50% used program components), and implementation (75% adherence, 80% retention). Assessments included: self-reported food security, health-related quality of life, diabetes self-efficacy, sociodemographic, and dietary intake, height, weight, and HbA1c; and one in-depth interview with participants and key staff. Enrollment, recruitment, and retention rates were summarized; qualitative data were analyzed using structured thematic analysis (participant interviews) and key point summaries (staff interviews). Quantitative/qualitative data integration was conducted using a joint display. 247 patients with T2DM and food insecurity were recruited, 71 expressed interest, 25 consented. 21 participants completed study measurements. 71% (n=15) received 6 home food deliveries and >=1 dietitian visit. A priori benchmarks were approached or met within each feasibility criterion – most participants found the intervention to be acceptable, used most or all intervention components, and reported some challenges within intervention implementation (e.g., timing of food deliveries). Data integration provided deeper understanding of reported intervention implementation challenges, yet high adherence to the intervention. We concluded the intervention was feasible. Next steps include a clinical trial to establish intervention efficacy.