Delivering Health: Addressing Diabetes and Food Insecurity

A Siemens analyzer was utilized to measure HbA1c (%) via finger stick blood collection.

Total skin carotenoid level was measured using a Veggie Meter optical skin scanner using Raman Spectroscopy. The Veggie Meter produces a score from 0 to 800, with higher scores indicating greater skin carotenoid levels, which suggest a greater intake of fruits and vegetables.

24 hour dietary recalls was collected using the Nutrition Data System for Research (NDSR). NDSR was used to calculate Healthy Eating Index-2015 (HEI) scores. HEI is a metric used to assess the quality of a person's diet by comparing their food intake to the Dietary Guidelines for Americans, with a higher score indicating a diet that more closely aligns with recommended nutritional guidelines. HEI scores range from 0 to 100, where a higher score is better.

Weight and height was used to compute a continuous measure of BMI (kilograms per square meter).

Self-report items from the Behavioral Risk Factor Surveillance System (BRFSS) survey assessed lifetime prevalence of chronic diseases.

Self-efficacy for self-management of type 2 diabetes was assessed using the eight item Diabetes Self-Efficacy Scale (DSES). The DSES assesses confidence in a person's perceived capability to perform necessary type 2 diabetes self-care activities including, maintaining healthy diet, engaging in exercise, and performing blood sugar monitoring (0, Not at all confident to 10, Totally confident). The score for the scale is the mean of the eight items, producing a range of scores of 0-10, with higher scores indicating higher levels of confidence to perform diabetes self-management activities.

Oral health was assessed by a single self-report item from the BRFSS, asking length of time since a dental cleaning ("Within the past year=1; Within the past 2 years=2; Within the past 5 years=3; 5 or more years ago=4; Never=5"). A lower score indicates a better outcome (more recent dental cleaning).

Psychological distress related to type 2 diabetes was assessed using the Problem Areas in Diabetes 5-item scale (PAID-5) scale. The PAID-5 is used to assess the emotional distress related to living with type 2 diabetes, consisting of five questions that focus on feelings like fear, depression, worry about future complications, feeling overwhelmed by diabetes management, and coping with diabetes complications; essentially measuring the psychological impact of managing diabetes on a person's daily life (0, Not a problem to 4, Serious problem). The sum of the items produces a total score that ranges from 0-20, with lower scores indicating less distress.

Food security was assessed using the Hunger Vital Sign two-question screening tool. Food security was not assessed at post-intervention, therefore no data can be reported for this measure.

Food pantry utilization was assessed through a single survey item adapted from Feeding America's Hunger in America survey. The item asked how many times the participant got food from a food pantry in the past 30 days.

Type 2 diabetes medication adherence was collected using responses to six items (0, No; 1, Yes) from the National Health Interview Survey (NHIS). The survey items assess how well individuals with diabetes adhered to their prescribed medication regimen, specifically by measuring whether they are taking medications correctly and refilling prescriptions as directed versus using non-adherence strategies to lower the cost of their medications (e.g., skipping doses, taking less medicine than prescribed, delaying filling prescriptions). Scores ranged from 0-6, with lower scores on the scale indicating a better outcome (e.g., better adherence to medication regimens).

Cooking skills and knowledge were assessed using two items. The first item asks "How confident do you feel being able to cook from raw or basic ingredients?" Response options include "Not confident at all; Somewhat confident; and Completely confident". Cooking skills and knowledge were not assessed at post-intervention, therefore no data can be reported for this measure.

Cooking skills and knowledge were assessed using two items. The second item asks "How confident do you feel about following a simple recipe?" Response options include "Not confident at all; Somewhat confident; and Completely confident". Cooking skills and knowledge were not assessed at post-intervention, therefore no data can be reported for this measure.

The Summary of Diabetes Self-Care Activities (SDSCA) was used to assess self-management behaviors. The SDSCA is used to assess how well individuals with diabetes manage their condition by measuring the frequency (number of days) of their self-care practices like diet, exercise, blood glucose monitoring, and foot care over the past seven days.

The General Diet subscale is 2 items assessing how many days participants adhered to a diet plan (0-7 days per week).

The Summary of Diabetes Self-Care Activities (SDSCA) was used to assess self-management behaviors. The SDSCA is used to assess how well individuals with diabetes manage their condition by measuring the frequency (number of days) of their self-care practices like diet, exercise, blood glucose monitoring, and foot care over the past seven days.

The Specific Diet subscale is 2 items assessing how many days participants ate certain types of foods (0-7 days per week).

The Summary of Diabetes Self-Care Activities (SDSCA) was used to assess self-management behaviors. The SDSCA is used to assess how well individuals with diabetes manage their condition by measuring the frequency (number of days) of their self-care practices like diet, exercise, blood glucose monitoring, and foot care over the past seven days.

The Exercise subscale is 2 items assessing how many days participants engaged in exercise (0-7 days per week).

The Summary of Diabetes Self-Care Activities (SDSCA) was used to assess self-management behaviors. The SDSCA is used to assess how well individuals with diabetes manage their condition by measuring the frequency (number of days) of their self-care practices like diet, exercise, blood glucose monitoring, and foot care over the past seven days.

The Blood Glucose Testing subscale is 2 items assessing how many days participants tested their blood sugar (0-7 days per week).

The Summary of Diabetes Self-Care Activities (SDSCA) was used to assess self-management behaviors. The SDSCA is used to assess how well individuals with diabetes manage their condition by measuring the frequency (number of days) of their self-care practices like diet, exercise, blood glucose monitoring, and foot care over the past seven days.

The Foot Care subscale is 2 items assessing how many days participants performed a foot check and inspected the inside of their shoes (0-7 days per week).

The Summary of Diabetes Self-Care Activities (SDSCA) was used to assess self-management behaviors. The SDSCA is used to assess how well individuals with diabetes manage their condition by measuring the frequency (number of days) of their self-care practices like diet, exercise, blood glucose monitoring, and foot care over the past seven days. Smoking was assessed using a single yes/no item.

The Summary of Diabetes Self-Care Activities (SDSCA) was used to assess self-management behaviors. The SDSCA is used to assess how well individuals with diabetes manage their condition by measuring the frequency (number of days) of their self-care practices like diet, exercise, blood glucose monitoring, and foot care over the past seven days.

The Medication Adherence subscale is 2 items assessing how many days participants adhered to taking recommended diabetes medications (0-7 days per week).