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

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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.