Date of Award

Spring 5-2020

Degree Name

Doctor of Public Health (DrPH)

Advisor(s)

CASEY DURAND, PhD

Second Advisor

DEANNA M. HOELSCHER, PHD, RDN, LD, CNS, FISBNPA

Third Advisor

SHREELA V SHARMA PHD RDN LD CNS FISBNPA

Abstract

Substantial evidence demonstrates the relations between a healthy dietary pattern rich in fruits, vegetables, and whole grains and a lower risk of chronic diseases including type 2 diabetes. Despite well supported studies, programs, and public health campaigns presenting the health benefits of consuming a healthy dietary pattern, most Americans fall far short of the recommendations. Further, the compounding effects of food insecurity and the consumption of energy-dense and nutrient-deficient foods disproportionately affect low income minority populations. Culinary medicine (CM) and food prescription 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 critical gap in the education and training of healthcare professionals including Registered Dietitian Nutritionists (RDN) to deliver CM programs that are specifically designed for low income minority patients with diabetes participating in a food prescription program. The purpose of this dissertation project was three-fold (1) to perform a formal needs assessment among the target population of low-income, minority patients with diabetes and practicing RDNs; (2) to utilize concepts of intervention mapping to develop a comprehensive CM curriculum; and (3) to develop a subsequent training curriculum for practicing RDNs to level-set culinary nutrition skills and knowledge. Intervention Mapping (IM) was utilized to systematically develop a Social Cognitive Theory (SCT)-based framework for a CM curriculum tailored to the needs of a culturally diverse, food insecure, and low-income minority population. Secondarily, a train-the-trainer capacity-building curriculum was developed to fill the identified gaps among practicing RDNs. Our IM process was informed by key informant interviews, six patient focus groups (n=40), and three RDN focus groups (n=17). The qualitative data analysis identified themes and subthemes to understand the (1) diverse dietary habits and barriers and facilitators to healthy eating; and (2) the gaps in education and knowledge in culinary nutrition between practicing RDNs and the needs of their respective patients. The resulting CM curriculum includes a three step method for each session, (1) taste – provides participants the opportunity to consume delicious “healthy food” in order to change negative outcome expectations of “healthy food” tasting bad; (2) see – demonstration of recipes (cooking techniques) involves modeling and observational learning of skills; and (3) do – provides participants the ability to increase behavioral capacity and self-efficacy through hands-on experiential preparation recipe(s) (cooking techniques). Lastly, holding the series of classes in a group setting with self-efficacy discussions and goal setting promote modeling through peers, group learning, changes in social norms, and continued reinforcement of positive behaviors. The RDN training curriculum consists of level-setting of basic cooking skills (e.g., knife skills, vegetable roasting), counseling strategies, diversity training, and mock session delivery. Results from the pilot testing and evaluation of patient curriculum and practitioner training will inform and provide an evidence-based foundation for future culinary nutrition programming among a diverse low-income minority population.

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