Exploring Food Insecurity and Pilot Testing a Diabetes Nutrition Education Program and Healthy Food Access Service for American Indian and Alaska Native Adults with Type 2 Diabetes

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PROJECT SUMMARY / ABSTRACT Healthy nutrition habits are key to managing type 2 diabetes (T2D). However, American Indian and Alaska Natives (AI/ANs) often lack access to healthy food and disproportionately experience food insecurity. Food insecurity, defined as lack of consistent access to enough food for an active, healthy life, negatively impacts one’s ability to manage blood sugar and body weight. I am pursuing a K01 Mentored Research Scientist Development Award to fill critical training gaps in the areas of quantitative data analysis of intervention studies and effectiveness and pragmatic study design. In order to effectively bridge my prior training and research experience to obtain my first R01, I have carefully developed a mentored training plan that strategically supports my research aims for this K01 award. I am currently Co-Investigator on a study team that developed a culturally responsive diabetes nutrition education curriculum for AI/AN adults with T2D, entitled “What Can I Eat? Healthy Choices for AI/ANs with T2D” (WCIE). WCIE includes interactive, hands-on nutrition education learning activities, including portion control, decreasing sugary beverages and saturated fat, and problem solving for barriers to healthful eating. In January 2020 we launched a tribally-supported, 6-site, waitlist control design test of WCIE. In June 2021, we will complete data collection with 150 AI/AN adults who have T2D. Data will include 3 timepoints for immediate intervention and 5 for waitlist intervention participants over 6 months with surveys (nutrition knowledge, behavior, self-efficacy) and clinical outcomes (BMI, blood pressure, and HbA1c). Though WCIE does not include a specific food insecurity intervention, we included a household food insecurity measure at all data collection timepoints. In Aim #1 of this proposed K01 I will examine the relationship between food insecurity and clinical WCIE outcomes in the existing dataset through secondary analysis to utilize my new intervention quantitative data analysis skills and advance understanding of the moderating effect of food insecurity on diabetes nutrition education and T2D outcomes among AI/ANs. In Aim #2 I will design/pilot test WCIE with added service to improve healthy food access and evaluate its feasibility/impact on T2D outcomes at an urban AI/AN- serving clinic in Oklahoma City, OK. We will work with the Oklahoma City clinic to identify their need for a healthy food access service in the following domains: transportation, availability of healthy food, or affordability of healthy food. Aim #2 will provide me the opportunity to utilize my new training in effectiveness and pragmatic trials study design and quantitative data analysis of intervention studies. My detailed training plan includes formal coursework at the University of Colorado Anschutz Medical Campus, seminars, workshops/conferences on AI/AN health research, and support from my mentors who are experts and leaders in the area of AI/AN diabetes health, AI/AN health interventions, T2D and food insecurity interventions, and quantitative/study design methodology. The proposed training plan and aims will provide me with a set of skills and expertise needed to successfully obtain R01 funding and become a leader in diabetes health disparities intervention science.