Cooking for Health: a healthy food budgeting, purchasing, and cooking skills randomized controlled trial to improve diet among American Indians with type 2 diabetes

Abstract Background The 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. Methods The 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. Discussion Targeted 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 registration This study was registered on ClinicalTrials.gov on October 9, 2018 with Identifier NCT03699709.

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Development of a Cooking, Food Budgeting, and Nutrition intervention for American Indians with Type 2 Diabetes: Rationale and Study Protocol for the Cooking for Healthy Study

Current Developments in Nutrition ◽

10.1093/cdn/nzaa059_018 ◽

2020 ◽

Vol 4 (Supplement_2) ◽

pp. 1301-1301

Author(s):

Amanda Fretts ◽

Caitie Hawley ◽

Meagan Brown ◽

India Ornelas ◽

Lyle Best ◽

...

Keyword(s):

Type 2 Diabetes ◽

American Indians ◽

Diabetes Management ◽

Food Resource ◽

Healthy Food ◽

Healthy Diet ◽

Health Study ◽

Cooking Skills ◽

Written Materials

Abstract Objectives Type 2 diabetes is a leading cause of morbidity among American Indians (AIs). Although healthy diet is a key component of diabetes management, many AIs face barriers to adopting a healthy diet. Preliminary work in an AI community in the north-central USA indicated that the most salient factors that influence healthy diet are: difficulty budgeting for food, low literacy/numeracy when purchasing food, and limited cooking skills. The Cooking for Health Study is a randomized controlled trial developed in partnership with the community that will evaluate the efficacy of a culturally-tailored healthy food budgeting, purchasing, and cooking program on: (1) intake of sugar-sweetened beverages and processed foods; and (2) healthy food budgeting and cooking skills, among AIs with diabetes. Methods The curriculum was informed by focus groups and meetings with community members and in partnership with the tribal diabetes program. The curriculum comprises a 12-month online/distance-learning program delivered through video and written materials. Over one year, we will recruit 165 AI participants with diabetes who are members of the community and reside on the reservation. Individuals will be randomized (using a 1:1 ratio) to intervention or control arm (i.e., delayed intervention). Participants in the intervention arm will receive the curriculum over a year. At baseline, month 6, and month 12, all participants will complete in-person study visits that include food frequency questionnaires, and assessments of food resource management and cooking confidence. Results The curriculum focuses on cooking and budgeting skills, and optimal diet for diabetes management. Lessons include: getting healthy foods; vegetables; fruits; dairy; protein and meats; grains; food budgeting and meal planning; empty calories; snacking; traditional foods; and celebrations. Each lesson comprises 3–8 videos paired with written materials. Enrollment will commence in early 2020. Conclusions Poorly controlled diabetes disproportionately affects the health of AIs compared to other racial/ethnic groups, and has profound effects on healthcare costs. Improving healthy food budgeting, purchasing, and cooking skills among AIs with diabetes should improve diet/diabetes management. Funding Sources NIH/NIMHD R01MD011596.

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Food choices and distress in reservation-based American Indians and Alaska Natives with type 2 diabetes

Public Health Nutrition ◽

10.1017/s1368980018000897 ◽

2018 ◽

Vol 21 (13) ◽

pp. 2367-2375

Author(s):

Nicolette I Teufel-Shone ◽

Luohua Jiang ◽

Jennifer Rockell ◽

Jennifer Chang ◽

Janette Beals ◽

...

Keyword(s):

Type 2 Diabetes ◽

American Indians ◽

Food Choice ◽

Alaska Natives ◽

Healthy Food ◽

Bivariate Analysis ◽

Unhealthy Food ◽

Linear Regression Models ◽

Distress Scale

AbstractObjectiveTo examine the association between food choice and distress in a large national sample of American Indians/Alaska Natives (AI/AN) with type 2 diabetes.DesignParticipants completed a sociodemographic survey, an FFQ and the Kessler-6 Distress Scale. Foods were identified as ‘healthy’ or ‘unhealthy’ using a classification grounded in the health education provided by the programme case managers; healthy and unhealthy food scores were calculated using reported intake frequencies. Pearson’s correlation coefficients for distress and food scores were calculated for all participants and by gender. Multiple linear regression models stratified by gender assessed the association between distress and food scores, controlling for sociodemographics and duration of type 2 diabetes.SettingRural AI reservations and AN villages.SubjectsAI/AN (n 2484) with type 2 diabetes.ResultsBoth males (34·9 %) and females (65·1 %) had higher healthy food scores than unhealthy scores. In bivariate analysis, distress level had a significant negative correlation with healthy food scores among female participants, but the association was not significant among males. Significant positive correlations between distress and unhealthy food scores were found in both genders. In the final multivariate models, healthy food scores were not significantly related to distress; however, unhealthy food scores showed significant positive relationships with distress for both genders (females: β=0·078, P=0·0007; males: β=0·139, P<0·0001).ConclusionsHealth professionals working with AI/AN diagnosed with type 2 diabetes should offer food choice strategies during difficult times and recognize that males may be more likely than females to select unhealthy foods when distressed.

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Food Insecurity and Associated Challenges to Healthy Eating Among American Indians and Alaska Natives With Type 2 Diabetes: Multiple Stakeholder Perspectives

Journal of Aging and Health ◽

10.1177/08982643211013232 ◽

2021 ◽

Vol 33 (7-8_suppl) ◽

pp. 31S-39S

Author(s):

Sarah Stotz ◽

Angela G. Brega ◽

J. Neil Henderson ◽

Steven Lockhart ◽

Kelly Moore ◽

...

Keyword(s):

Type 2 Diabetes ◽

Food Insecurity ◽

American Indians ◽

Healthy Eating ◽

Alaska Native ◽

Fruits And Vegetables ◽

Healthy Food ◽

Stakeholder Perspectives ◽

Healthcare Administrators

Objective: To examine stakeholder perspectives on food insecurity and associated challenges to healthy eating among American Indian and Alaska Native (AI/AN) adults with type 2 diabetes (T2D). Methods: Focus groups and interviews were conducted with purposively selected stakeholders: AI/ANs with T2D, their family members, healthcare administrators, nutrition and diabetes educators, and national content experts on AI/AN health. Two coders analyzed transcripts using the constant-comparison method. Results: Key themes included (1) rural- and urban-dwelling AI/ANs experience different primary food security and associated challenges; (2) factors contributing to food insecurity extend beyond cost of healthy food; and (3) barriers to consuming fresh, healthy food include cost, preparation time, limited cooking knowledge, and challenges with gardening. Discussion: Resources for AI/ANs with T2D who experience food insecurity and associated challenges to healthy eating should be tailored based on urban versus rural location and should address cost and other barriers to consumption of fresh fruits and vegetables.

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