Abstract
BackgroundThe prevalence of poor diet quality and type 2 diabetes are exceedingly high in many rural American Indian (AI) communities. Because of limited resources and infrastructure in some communities, implementation of interventions to promote a healthy diet is challenging—which may exacerbate health disparities by region (urban/rural) and ethnicity (AIs/other populations). It is critical to adapt existing evidence-based healthy food budgeting, purchasing, and cooking programs to be relevant to underserved populations with a high burden of diabetes and related complications. The Cooking for Health Study will work in partnership with an AI community in South Dakota to develop a culturally-adapted 12-month distance-learning-based healthy food budgeting, purchasing, and cooking intervention to improve diet among AI adults with type 2 diabetes.MethodsThe study will enroll 165 AIs with physician-diagnosed type 2 diabetes who reside on the reservation. Participants will be randomized to an intervention or control arm. The intervention arm will receive a 12-month distance-learning curriculum adapted from Cooking Matters® that focuses on healthy food budgeting, purchasing, and cooking skills. In-person assessments at baseline, month 6 and month 12 will include completion of the Nutrition Assessment Shared Resources Food Frequency Questionnaire and a survey to assess frequency of healthy and unhealthy food purchases. Primary outcomes of interest are: (1) change in self-reported intake of sugar-sweetened beverages (SSBs); and (2) change in the frequency of healthy and unhealthy food purchases. Secondary outcomes include: (1) change in self-reported food budgeting skills; (2) change in self-reported cooking skills; and (3) a mixed-methods process evaluation to assess intervention reach, fidelity, satisfaction, and dose delivered/received.DiscussionTargeted and sustainable interventions are needed to promote optimal health in rural AI communities. If effective, this intervention will reduce intake of SSBs and the purchase of unhealthy foods; increase the purchase of healthy foods; and improve healthy food budgeting and cooking skills among AIs with type 2 diabetes – a population at high risk of poor health outcomes. This work will help inform future health promotion efforts in resource-limited settings.Trial registrationThis study was registered on ClinicalTrials.gov on October 9, 2018 with Identifier NCT03699709.
Highlights
IntroductionGetting healthy foodTargeted BehaviorsIntroduce MyPlate; Essential nutrients; Basic food safety (Clean, Separate, Cook, Chill); Using a food thermometer; Knife skills; Kitchen tools; Cooking terms; Measuring terms/common units; Reading and doubling/adjusting/reducing recipes; Recipes and cooking tipsStocking a pantry with staples and commodity foods; Comparing prices and using unit prices; Pros and cons of buying in bulk; Reading Nutrition Facts labels and ingredient lists; Developing and using a shopping list; Recipes and cooking tips Vegetables Fruits DairyWhy eating vegetables is important; Diabetes hints; Nutrients and impacts on health; Vegetables by Color; Daily recommendations for consumption; Common portions; Ways to eat more vegetables; Diabetes tips; Buying and storing fresh vegetables; Weighing and calculating; Seasonality; Food safety; Cooking vegetables in 3 ways; Vegetable substitutions; Recipes and cooking tips; $10.00 Cooking ChallengeWhy eating fruits is important; Diabetes hints; Fruits by color; Nutrients and impacts on health; Ways to eat more fruits; Daily recommendations for consumption; Common portions; Diabetes tips; Buying and storing fresh fruits; Weighing and calculating; Seasonality; Food safety; Fruit substitutions; Recipes and cooking tipsWhy eating dairy foods is important; Diabetes hints; Choosing healthy dairy products; Daily recommendations for consumption; Common portions; Lactose intolerance and substitutions; Tips for maximizing food dollars; Food safety; Cooking dairy; Recipes and cooking tips Protein/Meat
While numerous obesity, type 2 diabetes, and cardiovascular disease (CVD) prevention interventions for adults have been implemented in clinical settings in American Indian (AI) communities [28, 33,34,35,36,37,38], most focus on diet education or structured physical activity [33,34,35, 37, 38] in AIs without type 2 diabetes
These curricula do not address the unique challenges of consuming a diet in line with American Diabetes Association (ADA) recommendations [39,40,41] or underlying contextual factors that inhibit individuals’ ability to consume whole foods—including limited budgeting and cooking skills and low literacy and numeracy when purchasing foods
Summary
Getting healthy foodTargeted BehaviorsIntroduce MyPlate; Essential nutrients; Basic food safety (Clean, Separate, Cook, Chill); Using a food thermometer; Knife skills; Kitchen tools; Cooking terms; Measuring terms/common units; Reading and doubling/adjusting/reducing recipes; Recipes and cooking tipsStocking a pantry with staples and commodity foods; Comparing prices and using unit prices; Pros and cons of buying in bulk; Reading Nutrition Facts labels and ingredient lists; Developing and using a shopping list; Recipes and cooking tips Vegetables Fruits DairyWhy eating vegetables is important; Diabetes hints; Nutrients and impacts on health; Vegetables by Color; Daily recommendations for consumption; Common portions; Ways to eat more vegetables; Diabetes tips; Buying and storing fresh vegetables; Weighing and calculating; Seasonality; Food safety; Cooking vegetables in 3 ways; Vegetable substitutions; Recipes and cooking tips; $10.00 Cooking ChallengeWhy eating fruits is important; Diabetes hints; Fruits by color; Nutrients and impacts on health; Ways to eat more fruits; Daily recommendations for consumption; Common portions; Diabetes tips; Buying and storing fresh fruits; Weighing and calculating; Seasonality; Food safety; Fruit substitutions; Recipes and cooking tipsWhy eating dairy foods is important; Diabetes hints; Choosing healthy dairy products; Daily recommendations for consumption; Common portions; Lactose intolerance and substitutions; Tips for maximizing food dollars; Food safety; Cooking dairy; Recipes and cooking tips Protein/Meat. Why eating vegetables is important; Diabetes hints; Nutrients and impacts on health; Vegetables by Color; Daily recommendations for consumption; Common portions; Ways to eat more vegetables; Diabetes tips; Buying and storing fresh vegetables; Weighing and calculating; Seasonality; Food safety; Cooking vegetables in 3 ways; Vegetable substitutions; Recipes and cooking tips; $10.00 Cooking Challenge. Why eating fruits is important; Diabetes hints; Fruits by color; Nutrients and impacts on health; Ways to eat more fruits; Daily recommendations for consumption; Common portions; Diabetes tips; Buying and storing fresh fruits; Weighing and calculating; Seasonality; Food safety; Fruit substitutions; Recipes and cooking tips. The Cooking for Health Study will work in partnership with an AI community in South Dakota to develop a culturally-adapted 12-month distance-learning-based healthy food budgeting, purchasing, and cooking intervention to improve diet among AI adults with type 2 diabetes. AIs with type 2 diabetes in Montana are three times as likely to have CVD than those without diabetes [5]
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have