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

OBJECTIVE: To assess the feasibility of a food-based diabetes self-management education and support (DSMES) intervention delivered to persons with type 2 diabetes (T2DM) and food insecurity. DESIGN: 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, socio-demographic and dietary intake, height, weight, and HbA1c and one in-depth interview with participants and key staff. Enrollment, recruitment and retention rates were summarised; qualitative data were analysed using structured thematic analysis (participant interviews) and key point summaries (staff interviews). Quantitative/qualitative data integration was conducted using a joint display. SETTING: Food bank and Federally Qualified Health Center in the Southwestern U.S. PARTICIPANTS: English- or Spanish-speaking adults with T2DM and food insecurity. RESULTS: In total, 247 patients with T2DM and food insecurity were recruited, seventy-one expressed interest and twenty-five consented. Twenty-one participants completed study measurements. 71 % (n 15) received six 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. CONCLUSIONS: The intervention was feasible. Next steps include a clinical trial to establish intervention efficacy.

Diet Quality Following Food Pantry Visit Differs by Ethnicity.

Food insecurity is associated with poor diet quality and increased diet-related disease risk. Food pantry clients (n=194) completed one 24-hour dietary recall and the Healthy Eating Index-2015 was used to evaluate diet quality. Differences in diet quality relative to participants' last food pantry visit and self-reported ethnicity were evaluated using two-way ANOVA. Food pantry visits within 1-4 days compared to ≥5 days were associated with higher diet quality in non-Hispanics (p=0.01) but diet quality remained the same in Hispanics. Interventions to improve diet quality in food pantry users must consider potential ethnic differences when program planning.

Food Assistance Use Among Food Bank Clients Affected by Type 2 Diabetes.

OBJECTIVE: To understand the perspectives of food bank clients affected by type 2 diabetes (T2DM). DESIGN: Semi-structured in-depth interviews conducted with food bank clients. SETTING: Arizona regional food bank. PARTICIPANTS: Twenty English- and Spanish-speaking food bank clients with T2DM or living with a person with T2DM, aged 45-83 years, majority female, Hispanic, and food insecure. PHENOMENON OF INTEREST: Food bank use and preferences, and how these related to T2DM management. ANALYSIS: A hybrid thematic analysis combining inductive and deductive reasoning. RESULTS: Three organizing themes emerged from the analysis. First, food assistance was influenced by food preferences and the ability to pair with existing household foods. Second, desired support included fresh fruits and vegetables, meat, oats, oil, and herbs; recipes; cooking demonstrations; and social support. Third, factors influencing T2DM management were lack of financial resources, low motivation, insufficient nutrition knowledge, low medication adherence, and multiple comorbidities. Participants also expressed resilience and interest in improving T2DM management. CONCLUSIONS AND IMPLICATIONS: Among a predominantly Hispanic food bank sample, produce and protein-rich foods, nutrition and culinary education, and social support were components of a supportive food bank experience and should be considered when designing food-based interventions for T2DM management for food insecure persons.