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

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基本信息

批准号：
10708818
负责人：
DANIEL O CLARK
金额：
$ 59.5万
依托单位：
INDIANA UNIV-PURDUE UNIV AT INDIANAPOLIS
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-22 至 2027-05-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10708818
关键词：
Address Adult Antihypertensive Agents Behavioral Behavioral Mechanisms Black race Blood Pressure Budgets Carbohydrates Chronic Disease Communities Consent Dietitian Disease Management Drug Prescriptions Education Effectiveness Eligibility Determination Engineering Enrollment Food Glycosylated hemoglobin A Health Health system Healthcare Home Hour Household Hypertension Intervention Knowledge Learning Link Maintenance Medicaid Medical Non-Insulin-Dependent Diabetes Mellitus Not Hispanic or Latino Nutritional Outcome Participant Persons Preparation Primary Care Process Race Randomized Randomized, Controlled Trials Recipe Reporting Resources Sampling Self Efficacy Self Management Social support Sodium System Testing Training Transportation United Nations United States National Institutes of Health aged behavior change cooking cost cost effective cost effectiveness delivered meals economic evaluation effectiveness evaluation experience follow-up food insecurity food resource food security health disparity improved innovation intervention cost learning engagement novel nutrition nutrition education pandemic disease pilot test post intervention primary care patient programs safety net satisfaction screening sex simulation skills social social health determinants tool treatment as usual user centered design videoconference

项目摘要

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.

摘要