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

Published:November 24, 2021DOI:



      Food prescription and culinary medicine programs are gaining popularity as tools for decreasing food insecurity, increasing personal agency, promoting healthy eating, and reducing the risk of chronic diseases. However, there is a gap in understanding of how health care professionals can deliver evidence-based how-to nutrition information that is tailored for culturally diverse, low-income populations.


      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.


      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).


      A convenience sample of 40 low-income food insecure patients with diabetes receiving care at a diverse, integrated, safety net health care system in an urban setting in Texas and convenience sample of 17 RDN employees.

      Statistical 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.


      Patients reported frustration with mixed dietary messages from different health care 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.


      Our study describes how cultural humility, practical culinary nutrition skills, and consistent and coordinated messaging can help to improve patient nutrition care. Before implementation of a food prescription and culinary medicine program, efforts should promote training of RDN staff in culinary nutrition and related areas to increase acceptability and adherence of the program for patients.


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      J. W. McWhorter is an assistant professor Department of Health Promotion and Behavioral Sciences, and director of culinary nutrition, Nourish Program, UTHealth School of Public Health, Houston, TX.


      L. Moore is a faculty member, Department of Health Promotion and Behavioral Sciences, and director, Nourish Program, UTHealth School of Public Health, Houston, TX.


      S. R. Weston is director of outreach, Nourish Program, UTHealth School of Public Health, Houston, TX.


      C. Durand is an assistant professor, Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX.


      M. P. Danho is program manager, Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, TX.


      S. Sharma is a professor, Department of Epidemiology, Human Genetics and Environmental Sciences, UTHealth School of Public Health, Houston, TX.


      D. M. Hoelscher is John P. McGovern Professor in Health Promotion, and director, Michael and Susan Dell Center for Healthy Living, and regional dean, UTHealth School of Public Health, Houston, TX.


      D. M. LaRue is director of care integration, Population Health Transformation, Harris Health System, Houston, TX.


      K. C. Tseng is senior vice president and chief integration officer, Population Health Transformation, Harris Health System, Houston, TX.