Complex, Varied and Evolving Manifestations of Food Agency in Daily Life Among Diabetes Prevention Program Participants in Baltimore, Maryland

Abstract

ObjectiveTo characterize food agency (one's capacity to procure and prepare food in particular contexts) among Diabetes Prevention Program (DPP) participants and gather perspectives about experiences with DPP. DesignPhotograph-elicitation in-depth interviews and survey measures. SettingBaltimore, Maryland (June–August 2021). ParticipantsBlack women (n = 13) who participated in DPP. Phenomenon of InterestFood agency and strategies used to procure and prepare food and the influence of DPP on daily food behaviors. Surveys measured food agency using the Cooking and Food Provisioning Action Scale and cooking behaviors. AnalysisThematic analysis of qualitative in-depth interviews and descriptive statistics for quantitative measures. ResultsAs quantitative and qualitative data revealed, participants were frequent and confident cooks with high food agency. Participants viewed cooking as a key strategy for healthy eating and desired more hands-on cooking instruction within DPP to develop new healthy cooking skills. The primary barriers identified were related to lack of time or energy. Food procurement and preparation practices shifted over time, and DPP was a key influence on current behaviors. Conclusions and ImplicationsFood agency is complex and manifests heterogeneously in daily life. A life course, contextual, and food agency-based approach could be considered for future diabetes prevention interventions.