Feasibility of a food-based diabetes self-management education intervention for food insecure patients with type 2 diabetes: A convergent mixed methods study

Objective: To assess the feasibility of a food-based diabetes self-management education and support (DSMES) intervention delivered to persons with type 2 diabetes (T2DM) and food insecurity. Design: This single arm pre-/post convergent mixed methods study tested the feasibility of a 3-month intervention using food boxes, recipes, DSMES and dietitian visits. Feasibility benchmarks assessed were acceptability (> 50 % participants satisfied), demand (> 50 % used program components) and implementation (75 % adherence, 80 % retention). Assessments included: self-reported food security, health-related quality of life, diabetes self-efficacy, socio-demographic and dietary intake, height, weight, and HbA1c and one in-depth interview with participants and key staff. Enrollment, recruitment and retention rates were summarised; qualitative data were analysed using structured thematic analysis (participant interviews) and key point summaries (staff interviews). Quantitative/qualitative data integration was conducted using a joint display. Setting: Food bank and Federally Qualified Health Center in the Southwestern U.S. Participants: English- or Spanish-speaking adults with T2DM and food insecurity. Results: In total, 247 patients with T2DM and food insecurity were recruited, seventy-one expressed interest and twenty-five consented. Twenty-one participants completed study measurements. 71 % (n 15) received six home food deliveries and ≥ 1 dietitian visit. A priori benchmarks were approached or met within each feasibility criterion - most participants found the intervention to be acceptable, used most or all intervention components, and reported some challenges within intervention implementation (e.g. timing of food deliveries). Data integration provided deeper understanding of reported intervention implementation challenges, yet high adherence to the intervention. Conclusions: The intervention was feasible. Next steps include a clinical trial to establish intervention efficacy.