1. Introduction
Type 2 Diabetes, T2D, CM, diabetes
TYPE 2 DIABETES, RECRUITMENT, DIABETES
In-person culinary medicine (CM) can improve health behaviors, but its translation to virtual platforms and impact on diabetes outcomes are not well described. We designed a pragmatic trial comparing the effectiveness of virtual CM (eCM) to Medical Nutrition Therapy on diabetes outcomes among patients with uncontrolled diabetes within a safety-net healthcare system. All participants were provided cooking equipment and food from a food pantry. Due to low initial eCM participation, recruitment was paused, and eight semi-structured interviews were conducted to solicit feedback on study appeal, operations, and barriers to participation. Rapid thematic analysis was used to modify study operations. We found that participants were interested in the study and motivated by health concerns. While they valued food distribution and cooking equipment, they highlighted transportation barriers and conflicts with the pick-up time/location. Some eCM participants expressed discomfort with the virtual platform or preferred to observe rather than cook along. Study operations were modified by (1) moving supply pick-up to a familiar community clinic and diversifying food pick-up locations; (2) offering an in-person orientation to the program to increase comfort with the virtual platform; (3) emphasizing the credibility and relatability of the eCM instructor and encouraging participation of family members. This redesign led to the recruitment of 79 participants, of whom 75% attended at least one class. In conclusion, participant feedback informed pragmatic changes in study operations that increased engagement in this ongoing trial and may inform future eCM program design.People with Type 2 Diabetes (T2D) face daily challenges in diabetes self-management, including healthy eating, being active, glucose monitoring, and medication management [Culinary Medicine delivered using an RD offers an alternative approach to MNT that provides both nutrition education and experiential cooking. By learning nutritional principles in a “hands-on” manner, participants can improve diet variety and healthy cooking practices and build confidence toward food-related behavior change and kitchen self-efficacy [While initial studies of culinary medicine have promising findings, randomized studies in food-insecure patients with diabetes [We designed a pragmatic trial comparing the effectiveness of virtual culinary medicine and clinic-based medical nutrition therapy on T2D outcomes. Patients with uncontrolled T2D were recruited from a local safety-net clinic system with high rates of food insecurity among the patient population. This paper describes the initial recruitment and engagement challenges within the randomized trial of virtual culinary medicine and medical nutrition therapy, the implementation of redesign strategies based on participant and stakeholder feedback, and the impact of these changes on recruitment and engagement in an ongoing RCT.