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.

抽象的 联合国将粮食不安全定义为无法获得足够数量、负担得起的食物 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 (DM2) 等疾病的发病率高达两倍 流行。广泛开展慢性病自我管理教育和支持 (SMES) 计划 非常重视营养教育，但没有大力解决获得负担得起的营养食品或 膳食。值得注意的是，模拟表明，为粮食不安全的成年人量身定制的膳食可能与 与一些常用处方药一样具有成本效益。 凭借我们在系统工程和以用户为中心的设计方面的知识，我们的团队创建并 成功试点了一种由营养师主导的新型社会技术干预措施，名为“FORKS：食物资源和厨房” 技能。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、送货上门的低钠、低碳水化合物地中海式餐食和配料，以及两次- 每周实践家庭烹饪课程。平均出勤率为 87%，平均满意度为 4.7/5.0 外卖食品和动手烹饪课 4.9/5.0。 Webex 视频会议课程允许参与者 在自己家庭厨房的社交支持“空间”中一起学习和烹饪。 我们在此提出一项随机对照试验来评估 FoRKS 与强化常规护理 (EUC) 的比较。安全- 年龄 35 岁或以上、粮食不安全且收缩压≥120 mm Hg 的净初级保健患者 （约 40% 也有 DM2）将被邀请、同意、评估和随机化。 EUC 由 SDOH 组成 筛查、转介至食品储藏室以及协助参加食品计划（例如 SNAP）。欧盟委员会还 包括我们经 CDC 批准的为期 5 周的 SMES 计划。除了 EUC 之外，那些被随机分配到 FoRKS 的人还将： 收到送货上门的餐食和配料包，以及每周两次的 Webex 烹饪课程，直至第 16 周。 第 17 周，参与者将从 FoRKS 提供的食品过渡到购买价格实惠、营养丰富的食品。 FoRKS 课程将继续进行，以维持学习和社会支持，这对于长期发展可能至关重要 获取和准备营养食物的参与度和自我效能感。 主要假设是，相对于 EUC，FoRKS 参与者的平均收缩压较低 干预后立即施加压力（基线后 16 周）。维持至基线后 24 周将 也进行评估。还将评估粮食安全、营养和 HbA1c，以及成本效益和 行为机制，例如学习投入、自我效能和食物资源管理技能。