Development and Pilot Evaluation of a Novel Cooking Skills Intervention to Prevent Diabetes

摘要 糖尿病影响12.2%的美国成年人，不成比例地影响低收入人群和成本 每年2450亿美元。饮食行为是2型糖尿病的一个重要危险因素，烹饪技能可以 成为健康饮食的障碍。到目前为止，烹饪技能一直没有得到充分的研究和理解。 烹饪技能，包括驾驭个人，家庭和结构性障碍的能力，商店，预算， 膳食计划和厨师，可能是特别重要的低收入个人谁有有限的财政 和获得健康的预制食品。糖尿病预防计划（DPP），一个广泛的 传播行为减肥计划，重点是营养知识，并规定新的或 限制饮食，难以维持，需要更多或新的烹饪技能。但民进党 课程不包括任何烹饪技能的发展。K01指导的研究科学家 发展奖将支持博士的职业发展朱莉娅沃尔夫森，助理教授在 密歇根大学公共卫生学院通过这个奖项，沃尔夫森博士将开发新的技能， 糖尿病预防的营养，基于社区的前瞻性研究（CBPR），视频分析 和摄影数据，以评估烹饪技能和饮食质量，以及干预设计和评估。 在这些领域的培训将支持她的职业目标，成为一个独立的研究人员和专家， 烹饪技巧对改善饮食质量和预防饮食相关疾病的作用。拟议 研究将采用CBPR原则（例如，积极的社区参与和合作）， 设计一种新的烹饪技能干预，以补充DPP。在目标1中，我们将深入开展 对20名符合DPP条件的低收入成年人的烹饪实践进行了研究（通过深入访谈，视频 参与者做饭，和调查），了解促进者和障碍，在家里做饭， 低收入成年人的基线烹饪技能和知识， 糖尿病这些发现将为DPP厨师的发展提供信息，这是一种新的烹饪技能干预， 补充DPP，我们将在目标2中使用CBPR方法与社区共同开发DPP 密歇根国家肾脏基金会（National Kidney Foundation of Michigan）在目标3中，我们将进行一项随机试点试验， 测试的可行性，可接受性和初步有效性的DPP厨师干预相比， 48名患有糖尿病前期的低收入成年人的标准DPP。试验的主要结果是体重减轻。 次要结果包括HbA1c、腰围、饮食摄入量和饮食质量（通过 远程食物摄影方法），烹饪信心，态度和行为（通过 调查），以及干预措施的可行性和可接受性（通过重点小组进行评估）。这 该研究将对DPP课程进行潜在修改，并将为R01提供试点数据 向NIDDK申请进行DPP厨师的全功率RCT/实施研究。

ABSTRACT Diabetes effects 12.2% of American adults, disproportionately effects low-income populations, and costs $245 billion annually. Eating behavior is an important risk factor for type-2 diabetes, and cooking skills can be a barrier to healthy eating. To date, cooking skills have been understudied and not well understood. Cooking skills, including the ability to navigate individual, family, and structural barriers to shop, budget, meal plan, and cook, may be particularly important for low-income individuals who have limited financial and physical access to healthy pre-prepared food. The Diabetes Prevention Program (DPP), a widely disseminated behavioral weight loss program, focuses on nutritional knowledge and prescribes new or restricted diets that are difficult to sustain, and require more or new cooking skills. However, the DPP curriculum does not include any cooking skill development. This K01 Mentored Research Scientist Development award will support the career development of Dr. Julia Wolfson, an Assistant Professor at the University of Michigan School of Public Health. Through this award, Dr. Wolfson will develop new skills in nutrition for diabetes prevention, Community Based Participatory Research (CBPR), analysis of video and photographic data to assess cooking skills and diet quality, and intervention design and evaluation. Training in these areas will support her career goal of becoming an independent researcher and expert in the role of cooking skills for improving diet quality and preventing diet-related diseases. The proposed research will employ CBPR principles (e.g. active community engagement and collaboration) to inform the design of a novel cooking skills intervention to supplement the DPP. In Aim 1 we will conduct in-depth study of the cooking practices of 20 low-income adults eligible for the DPP (via in depth interviews, videos of participants cooking meals, and surveys), to understand facilitators and barriers to cooking at home, and baseline cooking skills and knowledge among low-income adults at risk for developing type-2 diabetes. These findings will inform the development of DPP Cooks, a new cooking skills intervention to supplement the DPP, which we will co-develop in Aim 2 using a CBPR approach with our community partner, the National Kidney Foundation of Michigan. In Aim 3 we will conduct a randomized pilot trial to test the feasibility, acceptability and preliminary effectiveness of the DPP Cooks intervention compared to standard DPP with 48 low-income adults with pre-diabetes. The primary outcome of the trial is weight loss. Secondary outcomes include HbA1c, waist circumference, dietary intake and diet quality (as measured by the Remote Food Photography Method), cooking confidence, attitudes and behaviors (assessed through surveys), and the feasibility and acceptability of the intervention (assessed through focus groups). This study will generate potential modifications to the DPP curriculum and will provide pilot data for an R01 application to NIDDK for a fully powered RCT/implementation study of DPP Cooks.