Barriers and Facilitators of Implementing a Clinic-Integrated Food Prescription Plus Culinary Medicine Program in a Low-Income Food Insecure Population: A Qualitative Study

ABSTRACT Background Food prescription and CM programs are gaining popularity as tools for (1) decreasing food insecurity; (2) increasing personal agency; (3) promoting healthy eating; and (4) reducing the risk of chronic diseases. However, there is a gap in understanding of how healthcare professionals can deliver evidence-based “how to” nutrition information that is tailored for culturally diverse, low-income populations. Objective To understand the barriers and facilitators for healthy eating among a low-income, diverse population with diabetes, and the gaps in knowledge and training needed for Registered Dietitian Nutritionists (RDN) to address patient barriers when implementing a food prescription and CM program in a healthcare setting. Design A series of nine focus groups were conducted: six focus groups with patients with diabetes (n=40): three in English and three in Spanish and three focus groups with RDN employees (n=17). Participant/setting A convenience sample of forty low-income food insecure patients with diabetes receiving care at a diverse, integrated, safety net healthcare system in an urban setting in Texas and convenience sample of seventeen RDN employees. Analysis All focus group transcripts were examined by independent reviewers and blind catalogued and organized into common themes and subthemes based on constant comparative methodology. Investigator group consensus was reached on emergent themes and subthemes for the respective focus groups. Results Patients reported frustration with mixed dietary messages from different healthcare providers, lack of culturally inclusive recommendations, and a desire for skills to prepare tasty and healthy food. RDNs desired more training and education in cultural humility, culinary nutrition skills, and behavioral change theory. Conclusion Our study describes how cultural humility, practical culinary nutrition skills, and consistent and coordinated messaging can help to improve patient nutrition care. Prior to implementation of a food prescription and CM program, efforts should promote training of RDN staff in culinary nutrition and related areas to increase acceptability and adherence of the program for patients.