1
|
Raber M, Brozovich J, Le T, Brown A, Saenz T, Caracostis A, Basen-Engquist K. The Bite of HOPE Small Food Business Development Program: a clinic-based culinary medicine program targeting local business owners. Transl Behav Med 2023; 13:845-850. [PMID: 37210084 DOI: 10.1093/tbm/ibad030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2023] Open
Abstract
Culinary medicine is a popular approach to health promotion, but most programs focus on patient or provider-facing education. While laudable, these efforts do not represent the full potential for culinary medicine to impact community health. We describe a novel approach to culinary medicine at a federally qualified health center (FQHC), the HOPE Clinic: Bite of HOPE Small Food Business Development (SFBD) program. Describe the design and implementation of the Bite of HOPE SFBD program and examine initial response to the program through interviews and focus groups with past participants. The SFBD program aims to create healthy food outlets by supporting local small businesses with education, resources, and mentorship support. Former participants in the SFBD program were invited to participate in focus groups and interviews exploring their experience and perceived program impact. Three focus groups (n = 10) and nine in-depth interviews were conducted. Most participants were Black or Hispanic and all operated their businesses in the community surrounding HOPE Clinic. Five themes emerged from the data including perceived program purpose, program discovery, motivating factors to participation, perceived program impact, and suggestions for improvement. Participants expressed high satisfaction with the program and positive changes in both business development and personal eating habits. There is an opportunity to leverage the culinary medicine model to support local small food business and improve community health. The Bite of HOPE SFBD program offers an example of how clinic-based resources can expand into the surrounding environment.
Collapse
Affiliation(s)
- Margaret Raber
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030, USA
| | - Joseph Brozovich
- HOPE Clinic-Aldine Community Health Center, 3000 Aldine Mail Route Rd, Houston TX 77039, USA
| | - Thuan Le
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030, USA
| | - Asyjia Brown
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030, USA
| | - Tabbie Saenz
- HOPE Clinic-Aldine Community Health Center, 3000 Aldine Mail Route Rd, Houston TX 77039, USA
| | - Andrea Caracostis
- HOPE Clinic-Aldine Community Health Center, 3000 Aldine Mail Route Rd, Houston TX 77039, USA
| | - Karen Basen-Engquist
- Department of Health Disparities Research, University of Texas MD Anderson Cancer Center, 1400 Pressler St, Houston, TX 77030, USA
| |
Collapse
|
2
|
Marrero DG, Blew RM, Palmer KNB, James K, Roe DJ, Hingle MD. Rationale and design of a type 2 diabetes prevention intervention for at-risk mothers and children at a Federally Qualified Healthcare Center: EPIC El Rio Families Study Protocol. BMC Public Health 2021; 21:346. [PMID: 33579240 PMCID: PMC7881686 DOI: 10.1186/s12889-021-10392-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 02/05/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Exposure to gestational diabetes mellitus (GDM) is associated with increased risk for type 2 diabetes (T2DM) in mothers, and poor cardiovascular health among offspring. Identifying effective methods to mitigate T2DM risk has the potential to improve health outcomes for mothers with a history of GDM and their children. The goal of the EPIC El Rio Families Study is to implement and evaluate the effects of a 13-week behavioral lifestyle intervention on T2DM risk factors in at-risk mothers and their 8- to 12-year-old children. We describe herein the rationale for our specific approach, the adaption of the DPP-based curriculum for delivery to patients of a Federally Qualified Health Center (FQHC), and the study design and methodology. METHODS The effects of the intervention on reduction in excess body weight (primary outcome), hemoglobin A1c, blood pressure, and changes in lifestyle behaviors associated with weight trajectory and T2DM risk in mother-child dyads will be evaluated during a 13-week, group randomized trial wherein 60 mothers and their children will be recruited to the intervention or wait-listed control conditions at one of two FQHC locations. Intervention participants (n = 30) will begin the group program immediately, whereas the wait-listed controls (n = 30) will receive a booklet describing self-guided strategies for behavior change. Associated program delivery costs, acceptability of the program to participants and FQHC staff, and potential for long-term sustainability will also be evaluated. DISCUSSION Successful completion in our aims will produce a scalable program with high potential for replication and dissemination, and estimated intervention effects to inform T2DM prevention efforts on families who use the FQHC system. The results from this study will be critical in developing a T2DM prevention model that can be implemented and scaled across FQHCs serving populations disproportionately burdened by T2DM. TRIAL REGISTRATION ClinicalTrials.gov NCT03781102 ; Date of registration: 19 December 2018.
Collapse
Affiliation(s)
- David G Marrero
- University of Arizona Health Sciences Center for Border Health Disparities, 1295 North Martin Ave., P.O. Box 210202, Tucson, AZ, 85721, USA
| | - Robert M Blew
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, The University of Arizona, 1177 E. 4th Street, Shantz Building, Room 328, Tucson, AZ, 85721, USA
- University of Arizona Collaboratory for Metabolic Disease and Prevention, Abrams Public Health Center, 3950 S. Country Club Rd, Tucson, AZ, 85714, USA
| | - Kelly N B Palmer
- University of Arizona Health Sciences Center for Border Health Disparities, 1295 North Martin Ave., P.O. Box 210202, Tucson, AZ, 85721, USA
| | - Kyla James
- Family and Child Wellness at El Rio Community Health Center, 450 W Paseo Redondo, Tucson, AZ, 85701, USA
| | - Denise J Roe
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, 1295 N. Martin Ave., P.O. Box 245210, Tucson, AZ, 85724, USA
| | - Melanie D Hingle
- Department of Nutritional Sciences, College of Agriculture & Life Sciences, The University of Arizona, 1177 E. 4th Street, Shantz Building, Room 328, Tucson, AZ, 85721, USA.
- University of Arizona Collaboratory for Metabolic Disease and Prevention, Abrams Public Health Center, 3950 S. Country Club Rd, Tucson, AZ, 85714, USA.
| |
Collapse
|
3
|
Hingle M, Blew R, James K, Mockbee J, Palmer KN, Roe DJ, Saboda K, Shaibi GQ, Whitlatch S, Marrero D. Feasibility and Acceptability of a Type 2 Diabetes Prevention Intervention for Mothers and Children at a Federally Qualified Healthcare Center. J Prim Care Community Health 2021; 12:21501327211057643. [PMID: 34866483 PMCID: PMC8652912 DOI: 10.1177/21501327211057643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 10/15/2021] [Accepted: 10/18/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Maternal obesity and gestational diabetes mellitus (GDM) contribute to increased risk for type 2 diabetes mellitus (T2DM) among both mothers and their offspring. Randomized trials demonstrated T2DM risk reduction in adults following lifestyle behavior change and modest weight loss; the evidence base for at-risk children remains limited. PURPOSE Evaluate the feasibility, acceptability, and preliminary efficacy of a T2DM prevention intervention for mother-child dyads delivered by Federally Qualified Health Center staff. METHODS A group randomized design tested the effects of a behavioral lifestyle intervention on T2DM risk factors in women with a history of GDM and their 8- to 12-year-old children. Mother-child dyads were recruited and randomized to intervention or wait-listed control conditions. Intervention participants completed the 13-week intervention; control participants received standard of care. Baseline and 13-week measures assessed program acceptability and feasibility, and explored effects on body weight, waist circumference, hemoglobin A1c, and lifestyle behaviors. RESULTS Forty-two dyads were randomized and 35 (83%) completed pre-/post-measurements. Participants and program leaders positively rated content and engagement. Nearly all strongly agreed that activities were enjoyable (97%), applicable (96%), useful (97%), and motivational (96%). Attendance averaged 65% across 2 cohorts; delivery costs were approximately $225/dyad. There were no significant differences in body weight, BMI (or BMI z-score), waist circumference, hemoglobin A1c, diet quality, physical activity, sleep, or home environment changes between intervention and control groups. CONCLUSIONS A family T2DM prevention program was feasibly delivered by FQHC staff, and acceptable to mothers and children. Program efficacy will be evaluated in an adequately powered clinical trial.
Collapse
Affiliation(s)
| | | | - Kyla James
- El Rio Community Health Center, Tucson,
AZ, USA
| | - Joy Mockbee
- El Rio Community Health Center, Tucson,
AZ, USA
| | | | | | | | | | | | | |
Collapse
|
4
|
Joachim-Célestin M, Gamboa-Maldonado T, Dos Santos H, Montgomery SB. Delivering the Same Intervention to Hispanic/Latinos With Pre-diabetes and Diabetes. Early Evidence of Success in a Longitudinal Mixed Method Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2021; 58:469580211055595. [PMID: 34825596 PMCID: PMC8673885 DOI: 10.1177/00469580211055595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite nationwide efforts to address the diabetes epidemic and reduce prevalence disparities, higher rates persist among the poor, especially those with limited literacy. Currently, individuals with abnormal glycemia who have pre-diabetes and diabetes qualify for different programs. However, evidence suggests that, for low-income Hispanic/Latinos, offering a single intervention to all those with abnormal glycemia may provide a more culturally acceptable and effective approach. Our objective was to explore the feasibility of such an intervention led by community health workers (CHWs) among low-income Hispanic/Latinos with diabetes and at risk for diabetes. METHODS Using a quasi-experimental mixed method design, we assessed weight, glycosylated hemoglobin, diabetes knowledge, and behavior changes of Hispanic/Latinos participants with pre-diabetes and diabetes living in Southern California. Biometric measurements, blood tests, and surveys were collected at baseline and 3 months post-intervention. Interviews and focus group discussions provided qualitative data. RESULTS Although the program was less costly, results exceeded those reported for low-income H/L attending the National Diabetes Prevention Program and did not differ between pre-diabetes and diabetes groups. Instead, including individuals at different stages of the dysglycemic spectrum seemed to have enhanced the intervention. Physician referral and attendance of family/friends were associated with better outcomes. CONCLUSION Our findings indicate that a joint prevention/self-management intervention led by CHWs for low-income Hispanic/Latinos with diabetes and with pre-diabetes is feasible and cost-effective, providing results that could help reduce the success gap. Incorporating suggestions and replicating this study on a larger scale could help determine whether or not results are reproducible.
Collapse
Affiliation(s)
- Maud Joachim-Célestin
- Loma Linda University School of Behavioral Health, Loma Linda, CA, USA
- Loma Linda University School of Medicine, Loma Linda, CA, USA
| | | | | | | |
Collapse
|