Delivering Food Resources & Kitchen Skills (FoRKS) to Adults with Food Insecurity and Hypertension: An RCT

摘要 粮食不安全，联合国将其定义为不一致地获得足够的负担得起的粮食， 营养食品，是安全网初级保健患者中普遍存在的SDOH。在有食物的成年人中 缺乏安全感，高血压(HTN)和2型糖尿病(DM2)等疾病的发病率要高出两倍 很流行。广泛提供的慢性病自我管理教育和支持(SME)计划 非常重视营养教育，但没有显著解决获得负担得起的、有营养的食物或 一顿饭。值得注意的是，模拟表明，为缺乏食物安全的成年人量身定做的医疗用餐可能是 与一些常用的处方药一样，性价比高。 利用我们在系统工程和以用户为中心的设计方面的知识，我们的团队创建了 成功地试行了一种由营养师领导的名为Forks：Food Resources&Kitchen的新型社会技术干预 技能。安全网初级保健患者-参与者(两名飞行员中N=20人)接受了基本的家庭烹饪 工具，家常便饭，低钠，低碳水化合物的地中海式食物和配料，以及两次- 每周一次的家庭烹饪实践课。平均出席率为87%，平均满意度为4.7/5.0 送餐和动手烹饪课分别为4.9/5.0和4.9/5.0。WebEx视频会议课程允许参与者 在他们自己的家庭厨房里，在一个支持社会的“空间”里一起学习和烹饪。 我们在这里提出了一项随机对照试验，以评估Forks与增强型日常护理(EUC)的对比。安全- 35岁或以上有食物不安全和收缩压≥120 mm Hg的初级保健净额患者 (约40%也将有DM2)将被邀请、同意、评估并随机进行。EUC由SDOH组成 筛查、转诊到食品储藏室，以及帮助登记参加食品计划(例如，SNAP)。EUC还 由CDC批准的为期5周的中小企业计划组成。除了EUC，那些被随机分配到Forks的人还将 到第16周，接受家庭送来的食物和配料工具包，以及每周两次的Webex烹饪课程。 第17周，参与者将从用叉子送来的食物过渡到购买负担得起的、有营养的食物。 福克斯课程将继续，以保持学习和社会支持，这可能是关键的长期 获取和准备营养食物的参与度和自我效能。 主要的假设是，相对于EUC，Forks参与者将经历更低的平均收缩压血 干预后即刻压力(基线后16周)。对基线后24周的维护将 也要接受评估。还将评估食品安全、营养和糖化血红蛋白，以及成本效益和 行为机制，如学习投入、自我效能和食物资源管理技能。

ABSTRACT Food insecurity, defined by the United Nations as inconsistent access to a sufficient quantity of affordable, nutritious food, is a prevalent SDOH among safety-net primary care patients. Among adults with food insecurity, conditions like hypertension (HTN) and type 2 diabetes (DM2) are as much as two times more prevalent. Widely available chronic disease self-management education and support (SMES) programs place much emphasis on nutrition education but do not significantly address access to affordable, nutritious food or meals. Notably, simulations have shown that medically-tailored meals for food-insecure adults could be as cost-effective as some commonly prescribed medications. Drawing upon our knowledge of systems engineering and user-centered design, our team created and successfully piloted a novel, dietitian-led sociotechnical intervention called FoRKS: Food Resources & Kitchen Skills. Safety-net primary care patient-participants (N=20 across two pilots) received essential home cooking tools, home delivered lower sodium, lower-carbohydrate Mediterranean-style meals and ingredients, and twice- weekly hands-on home cooking classes. Mean attendance was 87% and mean satisfaction was 4.7/5.0 for delivered foods and 4.9/5.0 for hands-on cooking class. Webex videoconference classes allowed participants to learn and cook together in a socially supportive “space” from their own home kitchen. We here propose a randomized controlled trial to evaluate FoRKS versus enhanced usual care (EUC). Safety- net primary care patients aged 35 years or over with food insecurity and systolic blood pressure ≥120 mm Hg (~40% will also have DM2) will be invited, consented, assessed, and randomized. EUC consists of SDOH screening, referrals to food pantries, and assistance enrolling in food programs (e.g., SNAP). EUC also consists of our CDC-approved 5-week SMES program. Those randomized to FoRKS will, in addition to EUC, receive home-delivered meals and ingredient kits, and twice-weekly Webex cooking classes to week 16. In week 17, participants will transition from FoRKS-delivered foods to shopping for affordable, nutritious foods. FoRKS classes will continue in order to maintain learning and social support that may be critical to longer-term engagement and self-efficacy for obtaining and preparing nutritious food. The primary hypothesis is that, relative to EUC, FoRKS participants will experience lower mean systolic blood pressure immediately post-intervention (16 weeks post-baseline). Maintenance to 24-weeks post-baseline will also be assessed. Food security, nutrition, and HbA1c will also be evaluated as will cost-effectiveness and behavioral mechanisms such as learning engagement, self-efficacy, and food resource management skills.