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

提供食物资源

• 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
• 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

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 粮食不安全，联合国将其定义为无法持续获得足够数量的负担得起的粮食， 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 不安全感，高血压（HTN）和2型糖尿病（DM 2）等疾病的发病率是其他疾病的两倍。 普遍存在。广泛提供慢性病自我管理教育和支持（SMES）计划 强调营养教育，但没有大力解决获得负担得起的营养食品的问题， 吃饭。值得注意的是，模拟实验表明，为食物不安全的成年人量身定制的医疗餐可能会 成本效益作为一些常用的处方药。 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 成功地试行了一种新的，营养师主导的社会技术干预称为FoRKS：食品资源和厨房 Skills.安全网初级保健患者参与者（两个试点中的N=20）接受了基本的家庭烹饪 工具，家庭提供的低钠，低碳水化合物的地中海式膳食和配料，两次- 每周一次的家庭烹饪课平均出勤率为87%，平均满意度为4.7/5.0， 送餐和4.9/5.0动手烹饪课。Webex视频会议课程允许参与者 在一个社会支持的“空间”里，从他们自己的家庭厨房一起学习和烹饪。 我们在这里提出了一个随机对照试验，以评估FoRKS与加强常规护理（EUC）。安全- 35岁或以上的净初级保健患者，食物不安全且收缩压≥120 mm Hg （约40%也患有DM 2）将被邀请、知情同意、评估和随机化。EUC由SDOH组成 筛查、转介到食品储藏室，以及帮助参加食品计划（例如，SNAP）。EUC还 包括我们CDC批准的5周SMES计划。除EUC外，随机分配至FoRKS的患者还将 接收送货上门的膳食和配料包，以及每周两次的Webex烹饪课程，直至第16周。在 第17周，参与者将从FoRKS提供的食品过渡到购买负担得起的营养食品。 FoRKS课程将继续，以保持学习和社会支持，这可能是至关重要的长期 获得和准备营养食物的参与和自我效能。 主要假设是，相对于EUC，FoRKS参与者将经历较低的平均收缩血 干预后即刻的压力（基线后16周）。维持至基线后24周将 也要评估。还将评估粮食安全、营养和HbA 1c，以及成本效益和 行为机制，如学习参与，自我效能和食物资源管理技能。