Optimizing interventions to improve nutrition security and reduce diabetes risk among food pantry clients

About This Grant

PROJECT SUMMARY Food insecurity is associated with insufficient nutrient intake, 2-3 times greater risk for diabetes, and suboptimal glycemic control. Over 50 million people in the US rely on food banks and pantries to prevent or alleviate food insecurity. To address disparities in diet-related diseases, some organizations have implemented healthier donation policies and nutrition interventions to provide clients healthier foods and encourage them to select those options. However, there is a need to develop evidence-based interventions that address multiple barriers to healthy eating that are also feasible for organizations to implement. We will use the Multiphase Optimization Strategy (MOST) to identify optimized interventions that can be implemented through the charitable food system to increase food security and reduce diabetes risk among clients. We have previously conducted extensive preliminary research to complete the preparation phase of MOST. In the NOURISH study (Nutrition intervention Optimization to better Utilize Resources and Support Health), we will complete the optimization phase. We will test four intervention components: meal kits, nutritious no-prep meals, culinary nutrition education, and text messages. Combining these evidence-based components may optimize intervention effectiveness for diabetes prevention and self-management by concurrently targeting multiple factors associated with healthy eating. The specific aims of this proposal are: Aim 1) To execute a randomized 24 factorial experiment to identify which combinations of candidate components lead to the greatest improvement in primary outcome: 1) diet (Healthy eating index) and exploratory outcomes: 2) household food security 3) percent weight change 4) Hemoglobin A1C. Clients (N=400) will be randomized to one of 16 groups that receive a combination of the candidate intervention components for 6 months. Outcomes will be measured at baseline, 3-, 6-, and 9-months (follow-up) to assess changes over time. Aim 2) To identify the cost of implementing each candidate component and the combination of components that optimally balance cost and effect (optimized interventions). Aim 3) To develop an open-source dissemination and implementation toolkit that includes detailed instructions and decision tools to guide organizations’ intervention planning. In collaboration with food assistance leaders, we will employ a mixed-methods user-centered design approach to develop a toolkit that describes how to implement intervention components, and the corresponding cost and effect of each combination of effective components. This menu of options will allow organizations to select the intervention that aligns best with their resources and goals. Our team has a 14-year community partnership that affords a unique opportunity to address noted barriers to nutrition security and health and empirically test the effectiveness of providing evidence-based intervention components in the charitable food system. The NOURISH study will provide critical data to inform the development of optimized dietary approaches to reduce diabetes risk in food assistance clients. A future study will test the effectiveness of an optimized intervention in pantries across the US through an Evaluation Phase RCT.