ABSTRACT
Objective: To estimate the association between food needs and diabetes outcomes. Research design and methods: Longitudinal cohort study, using a target trial emulation approach. 96,792 adults with type 2 diabetes mellitus who underwent food need assessment in a network of community-based health centers were followed up to 36 months after initial assessment. We used targeted minimum loss estimation to estimate the association between not experiencing food needs, compared with experiencing food needs, and hemoglobin a1c (HbA1c), systolic and diastolic blood pressure (SBP and DBP), and LDL cholesterol. The study period was June 24th, 2016 to April 30th, 2023. Results: We estimated that not experiencing food needs, compared with experiencing food needs, would be associated with 0.12 percentage points lower (95% Confidence Interval [CI] -0.16% to -0.09%, p = < 0.0001) mean HbA1c at 12 months. We further estimated that not experiencing food needs would be associated with a 12-month SBP that was 0.67 mm Hg lower (95%CI -0.97 to -0.38 mm Hg, p < .0001), DBP 0.21 mm Hg lower (95%CI -0.38 to -0.04 mm Hg, p = .01). There was no association with lower LDL cholesterol. Results were similar at other timepoints, with associations for HbA1c, SBP, and DBP of similar magnitude, and no difference in LDL cholesterol. Conclusions: We estimated that not experiencing food needs may be associated with modestly better diabetes outcomes. These findings support testing interventions that address food needs as part of their mechanism of action.
ABSTRACT
CONTEXT: North Carolina's Healthy Opportunities Pilots (HOP) is a Medicaid 1115 Waiver program that seeks to address nonmedical risks to health for Medicaid beneficiaries through multisector collaboration. Among other stakeholders, HOP involves collaboration between human services organizations that deliver interventions, network leads, which establish and oversee the human services organizations within a region of the state. OBJECTIVE: To understand how employees at human services organizations and network leads prepared to deliver HOP services. DESIGN: Qualitative analysis of semistructured interviews. Interviews were conducted between April and June 2022. Interviews were recorded, transcribed verbatim, coded thematically, and analyzed using a conceptual model derived from the consolidated framework for implementation research. SETTING: Organizations within North Carolina counties participating in HOP. PARTICIPANTS: Employees of human services and network lead organizations across all 3 HOP regions of North Carolina. RESULTS: The researchers interviewed 37 participants. Overall, organizations experienced benefits from HOP participation, including capacity-building resources, flexibility in allocating resources, and creating community-wide enthusiasm for addressing nonmedical risks to health. There were also key challenges. These included the time needed to build capacity, adjustments to the work processes and regulations inherent to multisector collaboration, geographic variation in availability of services to offer, and the difficulty of addressing different needs. Finally, participants recognized substantial opportunities that HOP presented, including membership in a more extensive network, exposure to a learning community, and a more sustainable funding source. CONCLUSIONS: The perspectives of individuals preparing to deliver HOP services offer important lessons for those developing and implementing large-scale programs that can address nonmedical threats to health.