Healthy food prescription incentive programme for adults with type 2 diabetes who are experiencing food insecurity: protocol for a randomised controlled trial, modelling and implementation studies

Dana Lee Olstad, Reed Beall, Eldon Spackman, Sharlette Dunn, Lorraine L Lipscombe, Kienan Williams, Richard Oster, Sara Scott, Gabrielle L Zimmermann, Kerry A McBrien, Kieran J D Steer, Catherine B Chan, Sheila Tyminski, Seth Berkowitz, Alun L Edwards, Terry Saunders-Smith, Saania Tariq, Naomi Popeski, Laura White, Tyler Williamson, Mary L'Abbé, Kim D Raine, Sara Nejatinamini, Aruba Naser, Carlota Basualdo-Hammond, Colleen Norris, Petra O'Connell, Judy Seidel, Richard Lewanczuk, Jason Cabaj, David J T Campbell, Dana Lee Olstad, Reed Beall, Eldon Spackman, Sharlette Dunn, Lorraine L Lipscombe, Kienan Williams, Richard Oster, Sara Scott, Gabrielle L Zimmermann, Kerry A McBrien, Kieran J D Steer, Catherine B Chan, Sheila Tyminski, Seth Berkowitz, Alun L Edwards, Terry Saunders-Smith, Saania Tariq, Naomi Popeski, Laura White, Tyler Williamson, Mary L'Abbé, Kim D Raine, Sara Nejatinamini, Aruba Naser, Carlota Basualdo-Hammond, Colleen Norris, Petra O'Connell, Judy Seidel, Richard Lewanczuk, Jason Cabaj, David J T Campbell

Abstract

Introduction: The high cost of many healthy foods poses a challenge to maintaining optimal blood glucose levels for adults with type 2 diabetes mellitus who are experiencing food insecurity, leading to diabetes complications and excess acute care usage and costs. Healthy food prescription programmes may reduce food insecurity and support patients to improve their diet quality, prevent diabetes complications and avoid acute care use. We will use a type 2 hybrid-effectiveness design to examine the reach, effectiveness, adoption, implementation and maintenance (RE-AIM) of a healthy food prescription incentive programme for adults experiencing food insecurity and persistent hyperglycaemia. A randomised controlled trial (RCT) will investigate programme effectiveness via impact on glycosylated haemoglobin (primary outcome), food insecurity, diet quality and other clinical and patient-reported outcomes. A modelling study will estimate longer-term programme effectiveness in reducing diabetes-related complications, resource use and costs. An implementation study will examine all RE-AIM domains to understand determinants of effective implementation and reasons behind programme successes and failures.

Methods and analysis: 594 adults who are experiencing food insecurity and persistent hyperglycaemia will be randomised to a healthy food prescription incentive (n=297) or a healthy food prescription comparison group (n=297). Both groups will receive a healthy food prescription. The incentive group will additionally receive a weekly incentive (CDN$10.50/household member) to purchase healthy foods in supermarkets for 6 months. Outcomes will be assessed at baseline and follow-up (6 months) in the RCT and analysed using mixed-effects regression. Longer-term outcomes will be modelled using the UK Prospective Diabetes Study outcomes simulation model-2. Implementation processes and outcomes will be continuously measured via quantitative and qualitative data.

Ethics and dissemination: Ethical approval was obtained from the University of Calgary and the University of Alberta. Findings will be disseminated through reports, lay summaries, policy briefs, academic publications and conference presentations.

Trial registration number: NCT04725630.

Protocol version: Version 1.1; February 2022.

Keywords: diabetes & endocrinology; general diabetes; health economics; nutrition & dietetics; preventive medicine; primary care.

Conflict of interest statement

Competing interests: DLO and DJTC have received funding from a Petro-Canada Young Innovator Award in Community Health. The remaining authors declare that they have no competing interests.

© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1
Figure 1
Healthy food prescription programme logic model. A1C an indicator of average blood glucose levels over the previous 3 months. A1C, glycosylated haemoglobin.
Figure 2
Figure 2
Healthy food prescription programme care pathway.

References

    1. American Diabetes Association . Economic costs of diabetes in the U.S. in 2017. Diabetes Care 2018;41:917–28. 10.2337/dci18-0007
    1. Health care system cost of people with diabetes, 2013. Available:
    1. New diabetes rates released with urgent plea for governments to implement national diabetes strategy, 2019. Available:
    1. Quantitative Economic Decisions Inc: Canadian Diabetes Cost Model. The Canadian Diabetes Cost Model was developed for diabetes Canada by quantitative economic decisions, Inc. (formerly Informetrica Limited) and publicly released in 2009. The forecasting model provides projections about the prevalence, incidence and economic burden of diabetes for Canadian society based on national surveillance data from the Canadian chronic disease surveillance system 2009.
    1. O'Reilly DJ, Xie F, Pullenayegum E, et al. . Estimation of the impact of diabetes-related complications on health utilities for patients with type 2 diabetes in Ontario, Canada. Qual Life Res 2011;20:939–43. 10.1007/s11136-010-9828-9
    1. Bradley C, Speight J. Patient perceptions of diabetes and diabetes therapy: assessing quality of life. Diabetes Metab Res Rev 2002;18:S64–9. 10.1002/dmrr.279
    1. Sievenpiper JL, Chan CB, Dworatzek PD, et al. . Nutrition therapy. Canadian J Diabetes 2018;42:S64–79. 10.1016/j.jcjd.2017.10.009
    1. Evert AB, Dennison M, Gardner CD, et al. . Nutrition therapy for adults with diabetes or prediabetes: a consensus report. Diabetes Care 2019;42:731–54. 10.2337/dci19-0014
    1. Neuenschwander M, Ballon A, Weber KS, et al. . Role of diet in type 2 diabetes incidence: umbrella review of meta-analyses of prospective observational studies. BMJ 2019;366:l2368. 10.1136/bmj.l2368
    1. American Diabetes Association . Improving care and promoting health in populations: standards of medical care in diabetes-2019. Diabetes Care 2019;42:S7–12. 10.2337/dc19-S001
    1. Stratton IM, Adler AI, Neil HA, et al. . Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ 2000;321:405–12. 10.1136/bmj.321.7258.405
    1. UK Prospective Diabetes Study (UKPDS) Group . Effect of intensive blood-glucose control with metformin on complications in overweight patients with type 2 diabetes (UKPDS 34). UK prospective diabetes study (UKPDS) group. Lancet 1998;352:854–65.
    1. UK Prospective Diabetes Study (UKPDS) Group . Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). UK prospective diabetes study (UKPDS) group. Lancet 1998;352:837–53.
    1. Zhu C-H, Zhang S-S, Kong Y, et al. . Effects of intensive control of blood glucose and blood pressure on microvascular complications in patients with type II diabetes mellitus. Int J Ophthalmol 2013;6:141–5. 10.3980/j.issn.2222-3959.2013.02.06
    1. Antonio JP, Sarmento RA, de Almeida JC. Diet quality and glycemic control in patients with type 2 diabetes. J Acad Nutr Diet 2019;119:652–8. 10.1016/j.jand.2018.11.006
    1. Nathan DM, Kuenen J, Borg R, et al. . Translating the A1C assay into estimated average glucose values. Diabetes Care 2008;31:1473–8. 10.2337/dc08-0545
    1. Little RR, Rohlfing CL, Sacks DB, et al. . Status of hemoglobin A1c measurement and goals for improvement: from chaos to order for improving diabetes care. Clin Chem 2011;57:205–14. 10.1373/clinchem.2010.148841
    1. Rao M, Afshin A, Singh G, et al. . Do healthier foods and diet patterns cost more than less healthy options? A systematic review and meta-analysis. BMJ Open 2013;3:e004277. 10.1136/bmjopen-2013-004277
    1. Canada’s Food Price Report 10th edition 2020, 2020. Available:
    1. Campbell DJT, Ronksley PE, Hemmelgarn BR, et al. . Association of enrolment in primary care networks with diabetes care and outcomes among first nations and low-income Albertans. Open Med 2012;6:e155–65.
    1. McBrien KA, Manns BJ, Hemmelgarn BR, et al. . The association between sociodemographic and clinical characteristics and poor glycaemic control: a longitudinal cohort study. Diabet Med 2016;33:1499–507. 10.1111/dme.13023
    1. Deved V, Jette N, Quan H, et al. . Quality of care for first nations and non-First nations people with diabetes. Clin J Am Soc Nephrol 2013;8:1188–94. 10.2215/CJN.10461012
    1. Dyck RF, Sidhu N, Klomp H, et al. . Differences in glycemic control and survival predict higher ESRD rates in diabetic first nations adults. Clin Invest Med 2010;33:E390–7. 10.25011/cim.v33i6.14590
    1. McBrien KA, Manns BJ, Chui B, et al. . Health care costs in people with diabetes and their association with glycemic control and kidney function. Diabetes Care 2013;36:1172–80. 10.2337/dc12-0862
    1. Household food insecurity by Province and Territory, 2014, 2014. Available:
    1. Fitzpatrick T, Rosella LC, Calzavara A, et al. . Looking beyond income and education: socioeconomic status gradients among future high-cost users of health care. Am J Prev Med 2015;49:161–71. 10.1016/j.amepre.2015.02.018
    1. Mayer VL, McDonough K, Seligman H, et al. . Food insecurity, coping strategies and glucose control in low-income patients with diabetes. Public Health Nutr 2016;19:1103–11. 10.1017/S1368980015002323
    1. Berkowitz SA, Baggett TP, Wexler DJ, et al. . Food insecurity and metabolic control among U.S. adults with diabetes. Diabetes Care 2013;36:3093–9. 10.2337/dc13-0570
    1. Seligman HK, Davis TC, Schillinger D, et al. . Food insecurity is associated with hypoglycemia and poor diabetes self-management in a low-income sample with diabetes. J Health Care Poor Underserved 2010;21:1227–33. 10.1353/hpu.2010.0921
    1. Seligman HK, Jacobs EA, Lopez A, et al. . Food insecurity and hypoglycemia among safety net patients with diabetes. Arch Intern Med 2011;171:1204–6. 10.1001/archinternmed.2011.287
    1. Berkowitz SA, Gao X, Tucker KL. Food-insecure dietary patterns are associated with poor longitudinal glycemic control in diabetes: results from the Boston Puerto Rican health study. Diabetes Care 2014;37:2587–92. 10.2337/dc14-0753
    1. Berkowitz SA, Meigs JB, DeWalt D, et al. . Material need insecurities, control of diabetes mellitus, and use of health care resources: results of the measuring economic insecurity in diabetes study. JAMA Intern Med 2015;175:257–65. 10.1001/jamainternmed.2014.6888
    1. Silverman J, Krieger J, Kiefer M, et al. . The relationship between food insecurity and depression, diabetes distress and medication adherence among low-income patients with poorly-controlled diabetes. J Gen Intern Med 2015;30:1476–80. 10.1007/s11606-015-3351-1
    1. Heerman WJ, Wallston KA, Osborn CY, et al. . Food insecurity is associated with diabetes self-care behaviours and glycaemic control. Diabet Med 2016;33:844–50. 10.1111/dme.12896
    1. Gucciardi E, Vahabi M, Norris N, et al. . The intersection between food insecurity and diabetes: a review. Curr Nutr Rep 2014;3:324–32. 10.1007/s13668-014-0104-4
    1. Nelson K, Cunningham W, Andersen R, et al. . Is food insufficiency associated with health status and health care utilization among adults with diabetes? J Gen Intern Med 2001;16:404–11. 10.1046/j.1525-1497.2001.016006404.x
    1. Seligman HK, Bolger AF, Guzman D, et al. . Exhaustion of food budgets at month’s end and hospital admissions for hypoglycemia. Health Aff 2014;33:116–23. 10.1377/hlthaff.2013.0096
    1. Gucciardi E, Vogt JA, DeMelo M, et al. . Exploration of the relationship between household food insecurity and diabetes in Canada. Diabetes Care 2009;32:2218–24. 10.2337/dc09-0823
    1. Diabetes Canada Clinical Practice Guidelines Expert Committee, Imran SA, Agarwal G, et al. . Targets for glycemic control. Can J Diabetes 2018;42:S42–6. 10.1016/j.jcjd.2017.10.030
    1. Diabetes incidence among first nations in Alberta, 2017. Available:
    1. The first nations regional health survey. Phase 3: Volume 2, 2018. Available:
    1. Household food insecurity in Canada, 2017–2018, 2020. Available:
    1. Aiyer JN, Raber M, Bello RS, et al. . A pilot food prescription program promotes produce intake and decreases food insecurity. Transl Behav Med 2019;9:922–30. 10.1093/tbm/ibz112
    1. Forbes JM, Forbes CR, Lehman E, et al. . "Prevention produce": integrating medical student mentorship into a fruit and vegetable prescription program for at-risk patients. Perm J 2019;23. 10.7812/TPP/18-238
    1. Wetherill MS, Chancellor McIntosh H, Beachy C, et al. . Design and implementation of a clinic-based food pharmacy for food insecure, uninsured patients to support chronic disease self-management. J Nutr Educ Behav 2018;50:947–9. 10.1016/j.jneb.2018.05.014
    1. Impacts of the fruit and vegetable prescription program, 2015. Available:
    1. Ridberg RA, Bell JF, Merritt KE, et al. . A pediatric fruit and vegetable prescription program increases food security in low-income households. J Nutr Educ Behav 2019;51:e221:224–30. 10.1016/j.jneb.2018.08.003
    1. Trapl ES, Smith S, Joshi K, et al. . Dietary impact of produce prescriptions for patients with hypertension. Prev Chronic Dis 2018;15:E138. 10.5888/pcd15.180301
    1. Cavanagh M, Jurkowski J, Bozlak C, et al. . Veggie Rx: an outcome evaluation of a healthy food incentive programme. Public Health Nutr 2017;20:2636–41. 10.1017/S1368980016002081
    1. Wholesome Wave’s fruit and vegetable prescription program, New York City 2013 outcomes, 2013. Available:
    1. Wholesome Wave’s fruit and vegetable prescription program, New York City 2014 outcomes, 2014. Available:
    1. Wholesome wave’s fruit and vegetable prescription program 2013 report, 2014. Available:
    1. Wholesome wave’s fruit and vegetable prescription program 2012 program report, 2012. Available:
    1. Black AP, Vally H, Morris P, et al. . Nutritional impacts of a fruit and vegetable subsidy programme for disadvantaged Australian Aboriginal children. Br J Nutr 2013;110:2309–17. 10.1017/S0007114513001700
    1. Black AP, Vally H, Morris PS, et al. . Health outcomes of a subsidised fruit and vegetable program for Aboriginal children in northern New South Wales. Med J Aust 2013;199:46–50. 10.5694/mja13.10445
    1. Bryce R, Guajardo C, Ilarraza D, et al. . Participation in a farmers' market fruit and vegetable prescription program at a federally qualified health center improves hemoglobin A1C in low income uncontrolled diabetics. Prev Med Rep 2017;7:176–9. 10.1016/j.pmedr.2017.06.006
    1. Jones LJ, VanWassenhove-Paetzold J, Thomas K, et al. . Impact of a fruit and vegetable prescription program on health outcomes and behaviors in young Navajo children. Curr Dev Nutr 2020;4:nzaa109. 10.1093/cdn/nzaa109
    1. Veldheer S, Scartozzi C, Bordner CR, et al. . Impact of a prescription produce program on diabetes and cardiovascular risk outcomes. J Nutr Educ Behav 2021;53:1008–17. 10.1016/j.jneb.2021.07.005
    1. Kerr D, Barua S, Glantz N, et al. . Farming for life: impact of medical prescriptions for fresh vegetables on cardiometabolic health for adults with or at risk of type 2 diabetes in a predominantly Mexican-American population. BMJ Nutr Prev Health 2020;3:239–46. 10.1136/bmjnph-2020-000133
    1. Bhat S, Coyle DH, Trieu K, et al. . Healthy food prescription programs and their impact on dietary behavior and cardiometabolic risk factors: a systematic review and meta-analysis. Adv Nutr 2021;12:1944–56. 10.1093/advances/nmab039
    1. Friedman DB, Freedman DA, Choi SK, et al. . Provider communication and role modeling related to patients' perceptions and use of a federally qualified health Center-Based farmers' market. Health Promot Pract 2014;15:288–97. 10.1177/1524839913500050
    1. Trapl ES, Joshi K, Taggart M, et al. . Mixed methods evaluation of a produce prescription program for pregnant women. J Hunger Environ Nutr 2017;12:529–43. 10.1080/19320248.2016.1227749
    1. Buyuktuncer Z, Kearney M, Ryan CL, et al. . Fruit and vegetables on prescription: a brief intervention in primary care. J Hum Nutr Diet 2014;27:186–93. 10.1111/jhn.12109
    1. Lee Y, Mozaffarian D, Sy S, et al. . Cost-effectiveness of financial incentives for improving diet and health through Medicare and Medicaid: a microsimulation study. PLoS Med 2019;16:e1002761. 10.1371/journal.pmed.1002761
    1. Freedman DA, Choi SK, Hurley T, et al. . A farmers' market at a federally qualified health center improves fruit and vegetable intake among low-income diabetics. Prev Med 2013;56:288–92. 10.1016/j.ypmed.2013.01.018
    1. Zhou X, Siegel KR, Ng BP, et al. . Cost-effectiveness of diabetes prevention interventions targeting high-risk individuals and whole populations: a systematic review. Diabetes Care 2020;43:1593–616. 10.2337/dci20-0018
    1. Curran GM, Bauer M, Mittman B, et al. . Effectiveness-implementation hybrid designs: combining elements of clinical effectiveness and implementation research to enhance public health impact. Med Care 2012;50:217–26. 10.1097/MLR.0b013e3182408812
    1. Glasgow RE, Nelson CC, Strycker LA, et al. . Using RE-AIM metrics to evaluate diabetes self-management support interventions. Am J Prev Med 2006;30:67–73. 10.1016/j.amepre.2005.08.037
    1. Glasgow RE, Vogt TM, Boles SM. Evaluating the public health impact of health promotion interventions: the RE-AIM framework. Am J Public Health 1999;89:1322–7. 10.2105/ajph.89.9.1322
    1. The First Nations Principles of OCAP , 2019. Available:
    1. Tri-Council policy statement: ethical conduct for research involving humans – TCPS 2 (2018), 2018. Available:
    1. Indigenous health transformational roadmap 2018-2020, 2018. Available:
    1. Campbell DJT, Manns BJ, Hemmelgarn BR, et al. . Understanding financial barriers to care in patients with diabetes. Diabetes Educ 2017;43:78–86. 10.1177/0145721716679276
    1. Campbell DJT, Manns BJ, Leblanc P, et al. . Finding resiliency in the face of financial barriers: development of a conceptual framework for people with cardiovascular-related chronic disease. Medicine 2016;95:e5561. 10.1097/MD.0000000000005561
    1. Kulhawy-Wibe S, King-Shier KM, Barnabe C, et al. . Exploring structural barriers to diabetes self-management in Alberta first nations communities. Diabetol Metab Syndr 2018;10:87. 10.1186/s13098-018-0385-7
    1. Campbell D, Campbell R, Larsen M. Home Sweet Home(less): Giving diabetes a voice from the street – Images and stories from a community-based photovoice project. In: North American Primary Care Research Group Annual Meeting. Toronto, ON 2019.
    1. Campbell D, Campbell R, Larsen M. Creating together: designing and conducting a community-based participatory research project. In: Canadian alliance to end homelessness annual meeting, Edmonton, AB 2019.
    1. Indigenous food sovereignty. Available:
    1. Barnard LS, Wexler DJ, DeWalt D, et al. . Material need support interventions for diabetes prevention and control: a systematic review. Curr Diab Rep 2015;15:574. 10.1007/s11892-014-0574-1
    1. Hager ER, Quigg AM, Black MM, et al. . Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics 2010;126:e26–32. 10.1542/peds.2009-3146
    1. Gundersen C, Engelhard EE, Crumbaugh AS, et al. . Brief assessment of food insecurity accurately identifies high-risk US adults. Public Health Nutr 2017;20:1367–71. 10.1017/S1368980017000180
    1. Makelarski JA, Abramsohn E, Benjamin JH, et al. . Diagnostic accuracy of two food insecurity screeners recommended for use in health care settings. Am J Public Health 2017;107:1812–7. 10.2105/AJPH.2017.304033
    1. Hagenaars A, de Vos K. The definition and measurement of poverty. J Hum Resour 1988;23:211–21. 10.2307/145776
    1. Litwin H, Sapir EV. Perceived income adequacy among older adults in 12 countries: findings from the survey of health, ageing, and retirement in Europe. Gerontologist 2009;49:397–406. 10.1093/geront/gnp036
    1. Gildner TE, Liebert MA, Capistrant BD, et al. . Perceived income adequacy and well-being among older adults in six low- and middle-income countries. J Gerontol B Psychol Sci Soc Sci 2019;74:516–25. 10.1093/geronb/gbw145
    1. Al Hamarneh YN, Charrois T, Lewanczuk R, et al. . Pharmacist intervention for glycaemic control in the community (the RxING study). BMJ Open 2013;3:e003154. 10.1136/bmjopen-2013-003154
    1. Olsho LE, Klerman JA, Wilde PE, et al. . Financial incentives increase fruit and vegetable intake among supplemental nutrition assistance program participants: a randomized controlled trial of the USDA healthy incentives pilot. Am J Clin Nutr 2016;104:423–35. 10.3945/ajcn.115.129320
    1. Browne AJ, Varcoe C, Ford-Gilboe M, et al. . EQUIP healthcare: an overview of a multi-component intervention to enhance equity-oriented care in primary health care settings. Int J Equity Health 2015;14:152. 10.1186/s12939-015-0271-y
    1. Frut and vegetable prescription program, 2019. Available:
    1. Mayne SL, Auchincloss AH, Michael YL. Impact of policy and built environment changes on obesity-related outcomes: a systematic review of naturally occurring experiments. Obes Rev 2015;16:362–75. 10.1111/obr.12269
    1. McGill R, Anwar E, Orton L, et al. . Are interventions to promote healthy eating equally effective for all? Systematic review of socioeconomic inequalities in impact. BMC Public Health 2015;15:457. 10.1186/s12889-015-1781-7
    1. Ni Mhurchu C, Blakely T, Jiang Y, et al. . Effects of price discounts and tailored nutrition education on supermarket purchases: a randomized controlled trial. Am J Clin Nutr 2010;91:736–47. 10.3945/ajcn.2009.28742
    1. Burr ML, Ashfield-Watt PAL, Dunstan FDJ, et al. . Lack of benefit of dietary advice to men with angina: results of a controlled trial. Eur J Clin Nutr 2003;57:193–200. 10.1038/sj.ejcn.1601539
    1. Burr ML, Trembeth J, Jones KB, et al. . The effects of dietary advice and vouchers on the intake of fruit and fruit juice by pregnant women in a deprived area: a controlled trial. Public Health Nutr 2007;10:559–65. 10.1017/S1368980007249730
    1. Ness AR, Hughes J, Elwood PC, et al. . The long-term effect of dietary advice in men with coronary disease: follow-up of the diet and reinfarction trial (dart). Eur J Clin Nutr 2002;56:512–8. 10.1038/sj.ejcn.1601342
    1. Fafard St-Germain A-A, Tarasuk V. Prioritization of the essentials in the spending patterns of Canadian households experiencing food insecurity. Public Health Nutr 2018;21:2065–78. 10.1017/S1368980018000472
    1. Khan MI, Weinstock RS. Carbohydrates. In: McPherson RA, Pincus MR, eds. Henry’s clinical diagnosis and management by laboratory methods. 22nd edn. Philadephia, PA: Saunders Elsevier, 2011: 210–25.
    1. Goddu AP, Roberson TS, Raffel KE, et al. . Food Rx: a community-university partnership to prescribe healthy eating on the South side of Chicago. J Prev Interv Community 2015;43:148–62. 10.1080/10852352.2014.973251
    1. Nutrition guideline diabetes, 2016. Available:
    1. Canadian Community Health Survey - annual component (CCHS), 2020. Available:
    1. Milton K, Bull FC, Bauman A. Reliability and validity testing of a single-item physical activity measure. Br J Sports Med 2011;45:203–8. 10.1136/bjsm.2009.068395
    1. Topp CW, Østergaard SD, Søndergaard S, et al. . The WHO-5 well-being index: a systematic review of the literature. Psychother Psychosom 2015;84:167–76. 10.1159/000376585
    1. Lorig K, Stewart A, Ritter P. Outcome measures for health education and other health care interventions. Vol. 2019. Thousand Oaks, CA: Sage, 1996.
    1. Self-efficacy for diabetes, 2009. Available:
    1. Schmitt A, Reimer A, Hermanns N, et al. . Assessing diabetes self-management with the diabetes self-management questionnaire (DSMQ) can help analyse behavioural problems related to reduced glycaemic control. PLoS One 2016;11:e0150774. 10.1371/journal.pone.0150774
    1. Schmitt A, Gahr A, Hermanns N, et al. . The diabetes self-management questionnaire (DSMQ): development and evaluation of an instrument to assess diabetes self-care activities associated with glycaemic control. Health Qual Life Outcomes 2013;11:138. 10.1186/1477-7525-11-138
    1. McGuire BE, Morrison TG, Hermanns N, et al. . Short-form measures of diabetes-related emotional distress: the Problem Areas in Diabetes Scale (PAID)-5 and PAID-1. Diabetologia 2010;53:66–9. 10.1007/s00125-009-1559-5
    1. EQ-5D-5L, 2020. Available:
    1. Work productivity and activity impairment questionnaire, 2004. Available:
    1. Household food insecurity in Canada: a guide to measurement and interpretation, 2018. Available:
    1. Determining food security status, 2012. Available:
    1. The household food security survey module (HFSSM), 2012. Available:
    1. Kalichman SC, Amaral CM, Swetzes C, et al. . A simple single-item rating scale to measure medication adherence: further evidence for convergent validity. J Int Assoc Physicians AIDS Care 2009;8:367–74. 10.1177/1545109709352884
    1. Seligman HK, Lyles C, Marshall MB. A pilot food bank intervention featuring diabetes-appropriate food improved glycemic control among clients in three states. Health Aff 2015;34:1956–63. 10.1377/hlthaff.2015.0641
    1. Barriers to care for people with chronic health conditions (BCPCHC), 2011. Available:
    1. Macarthur subjective social status scale, 2019. Available:
    1. Cundiff JM, Smith TW, Uchino BN, et al. . Subjective social status: construct validity and associations with psychosocial vulnerability and self-rated health. Int J Behav Med 2013;20:148–58. 10.1007/s12529-011-9206-1
    1. Subar AF, Kirkpatrick SI, Mittl B, et al. . The automated self-administered 24-hour dietary recall (ASA24): a resource for researchers, clinicians, and educators from the National cancer Institute. J Acad Nutr Diet 2012;112:1134–7. 10.1016/j.jand.2012.04.016
    1. Kirkpatrick SI, Subar AF, Douglass D, et al. . Performance of the automated self-administered 24-hour recall relative to a measure of true intakes and to an interviewer-administered 24-h recall. Am J Clin Nutr 2014;100:233–40. 10.3945/ajcn.114.083238
    1. ASA24-Canada, 2020. Available:
    1. Park Y, Dodd KW, Kipnis V, et al. . Comparison of self-reported dietary intakes from the automated self-administered 24-h recall, 4-d food records, and food-frequency questionnaires against recovery biomarkers. Am J Clin Nutr 2018;107:80–93. 10.1093/ajcn/nqx002
    1. Thompson FE, Subar AF. Dietary assessment methodology. In: Coulston AM, Boushey CJ, Ferruzzi MG, eds. Nutrition in the prevention and treatment of disease. 3rd edn. London: Elsevier, 2013: 5–46.
    1. Krebs-Smith SM, Pannucci TE, Subar AF, et al. . Update of the healthy eating index: HEI-2015. J Acad Nutr Diet 2018;118:1591–602. 10.1016/j.jand.2018.05.021
    1. Kirkpatrick SI, Reedy J, Krebs-Smith SM, et al. . Applications of the healthy eating index for surveillance, epidemiology, and intervention research: considerations and caveats. J Acad Nutr Diet 2018;118:1603–21. 10.1016/j.jand.2018.05.020
    1. American Diabetes Association . Standards of medical care in diabetes-2007. Diabetes Care 2007;30:S4–41. 10.2337/dc07-S004
    1. Sacks DB, Arnold M, Bakris GL, et al. . Guidelines and recommendations for laboratory analysis in the diagnosis and management of diabetes mellitus. Clin Chem 2011;57:e1–47. 10.1373/clinchem.2010.161596
    1. American Diabetes Association, European Association for the Study of Diabetes, International Federation of Clinical Chemistry and Laboratory Medicine, et al. . Consensus statement on the worldwide standardisation of the HbA1c measurement. Diabetologia 2007;50:2042–3. 10.1007/s00125-007-0789-7
    1. Berard LD, Siemens R, Woo V. Monitoring glycemic control. Canadian Journal of Diabetes 2018;42:S47–53. 10.1016/j.jcjd.2017.10.007
    1. Baker JR, Johnson RN, Scott DJ. Serum fructosamine concentrations in patients with type II (non-insulin-dependent) diabetes mellitus during changes in management. Br Med J 1984;288:1484–6. 10.1136/bmj.288.6429.1484
    1. Radtke MD, Pitts SJ, Jahns L, et al. . Criterion-related validity of spectroscopy-based skin carotenoid measurements as a proxy for fruit and vegetable intake: a systematic review. Adv Nutr 2020;11:1282–99. 10.1093/advances/nmaa054
    1. Alberta health data asset directory, 2018. Available:
    1. Cheng XH, Jo Y, Kim J. Heterogeneous impact of supplemental nutrition assistance program benefit changes on food security by local prices. Am J Prev Med 2020;58:e97–103. 10.1016/j.amepre.2019.10.013
    1. Brassard D, Elvidge Munene L-A, St Pierre S, et al. . Development of the Healthy Eating Food Index (HEFI)-2019 measuring adherence to Canada's Food Guide 2019 recommendations on healthy food choices. Appl Physiol Nutr Metab 2022. 10.1139/apnm-2021-0415. [Epub ahead of print: 14 Jan 2022].
    1. Diabetes Canada Clinical Practice Guidelines Expert Committee, Lipscombe L, Booth G, et al. . Pharmacologic glycemic management of type 2 diabetes in adults. Can J Diabetes 2018;42:S88–103. 10.1016/j.jcjd.2017.10.034
    1. Dimitri C, Oberholtzer L, Zive M, et al. . Enhancing food security of low-income consumers: an investigation of financial incentives for use at farmers markets. Food Policy 2015;52:64–70. 10.1016/j.foodpol.2014.06.002
    1. An analysis of sample attrition in panel data: the Michigan panel study of income dynamics, 1997. Available:
    1. Testing and adjusting for attrition in household panel data, 2011. Available:
    1. Li P, Stuart EA. Best (but oft-forgotten) practices: missing data methods in randomized controlled nutrition trials. Am J Clin Nutr 2019;109:504–8. 10.1093/ajcn/nqy271
    1. Scharfstein D, McDermott A, Díaz I, et al. . Global sensitivity analysis for repeated measures studies with informative drop-out: a semi-parametric approach. Biometrics 2018;74:207–19. 10.1111/biom.12729
    1. Alberta wage and salary survey, 2017. Available:
    1. Hayes AJ, Leal J, Gray AM, et al. . UKPDS outcomes model 2: a new version of a model to simulate lifetime health outcomes of patients with type 2 diabetes mellitus using data from the 30 year United Kingdom prospective diabetes study: UKPDS 82. Diabetologia 2013;56:1925–33. 10.1007/s00125-013-2940-y
    1. EQ-5D, 2019. Available:
    1. Damschroder LJ, Aron DC, Keith RE, et al. . Fostering implementation of health services research findings into practice: a consolidated framework for advancing implementation science. Implement Sci 2009;4:50. 10.1186/1748-5908-4-50
    1. Meyers DC, Durlak JA, Wandersman A. The quality implementation framework: a synthesis of critical steps in the implementation process. Am J Community Psychol 2012;50:462–80. 10.1007/s10464-012-9522-x
    1. Meyers DC, Katz J, Chien V, et al. . Practical implementation science: developing and piloting the quality implementation tool. Am J Community Psychol 2012;50:481–96. 10.1007/s10464-012-9521-y
    1. Indigenous peoples in Canada video and leaning series, 2019. Available:
    1. Equipping for equity online modules, 2019. Available:
    1. Lewis CC, Scott K, Marriott BR. A methodology for generating a tailored implementation blueprint: an exemplar from a youth residential setting. Implement Sci 2018;13:68. 10.1186/s13012-018-0761-6
    1. CFIR stakeholder survey, 2019. Available:
    1. Powell BJ, Waltz TJ, Chinman MJ, et al. . A refined compilation of implementation strategies: results from the expert recommendations for implementing change (ERIC) project. Implement Sci 2015;10:21. 10.1186/s13012-015-0209-1
    1. Powell BJ, Beidas RS, Lewis CC, et al. . Methods to improve the selection and tailoring of implementation strategies. J Behav Health Serv Res 2017;44:177–94. 10.1007/s11414-015-9475-6
    1. Waltz TJ, Powell BJ, Fernández ME, et al. . Choosing implementation strategies to address contextual barriers: diversity in recommendations and future directions. Implement Sci 2019;14:42. 10.1186/s13012-019-0892-4
    1. Lavis JN, Boyko JA, Gauvin F-P. Evaluating deliberative dialogues focussed on healthy public policy. BMC Public Health 2014;14:1287. 10.1186/1471-2458-14-1287
    1. Lavis JN, Boyko JA, Oxman AD, et al. . Support tools for evidence-informed health Policymaking (STP) 14: organising and using policy dialogues to support evidence-informed policymaking. Health Res Policy Syst 2009;7:S14. 10.1186/1478-4505-7-S1-S14
    1. Hsieh H-F, Shannon SE. Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277–88. 10.1177/1049732305276687
    1. Malterud K, Siersma VD, Guassora AD. Sample size in qualitative interview studies: guided by information power. Qual Health Res 2015.
    1. Palinkas LA, Mendon SJ, Hamilton AB. Innovations in mixed methods evaluations. Annu Rev Public Health 2019;40:423–42. 10.1146/annurev-publhealth-040218-044215
    1. Food security and diabetes: a position statement, 2020. Available:
    1. Morton S. Progressing research impact assessment: a ‘contributions’ approach. Res Eval 2015;24:405–19. 10.1093/reseval/rvv016
    1. Moscrop A, Ziebland S, Roberts N, et al. . A systematic review of reasons for and against asking patients about their socioeconomic contexts. Int J Equity Health 2019;18:112. 10.1186/s12939-019-1014-2
    1. We ask because we care. The Tri-Hospital + TPH health equity data collection research project report, 2018. Available:
    1. Naz A, Rosenberg E, Andersson N, et al. . Health workers who ask about social determinants of health are more likely to report helping patients: mixed-methods study. Can Fam Physician 2016;62:e684–93.
    1. Health Care’s Blind Side . The overlooked connection between social needs and good health, 2011. Available:
    1. Anderson ES, Lippert S, Newberry J, et al. . Addressing social determinants of health from the emergency department through social emergency medicine. West J Emerg Med 2016;17:487–9. 10.5811/westjem.2016.5.30240
    1. Schickedanz A, Hamity C, Rogers A, et al. . Clinician experiences and attitudes regarding screening for social determinants of health in a large integrated health system. Med Care 2019;57:S197–201. 10.1097/MLR.0000000000001051
    1. Pak T-Y, Kim G. Food stamps, food insecurity, and health outcomes among elderly Americans. Prev Med 2020;130:105871. 10.1016/j.ypmed.2019.105871
    1. GBD 2017 Diet Collaborators . Health effects of dietary risks in 195 countries, 1990-2017: a systematic analysis for the global burden of disease study 2017. Lancet 2019;393:1958–72. 10.1016/S0140-6736(19)30041-8
    1. Tarasuk V, Cheng J, de Oliveira C, et al. . Association between household food insecurity and annual health care costs. CMAJ 2015;187:E429–36. 10.1503/cmaj.150234
    1. Fitzpatrick C, Datta GD, Henderson M, et al. . School food environments associated with adiposity in Canadian children. Int J Obes 2017;41:1005–10. 10.1038/ijo.2017.39
    1. Campbell DJT, Manns BJ, Weaver RG, et al. . Financial barriers and adverse clinical outcomes among patients with cardiovascular-related chronic diseases: a cohort study. BMC Med 2017;15:33. 10.1186/s12916-017-0788-6
    1. Canadian community health survey public use Microdata files, 2015-16. Available:
    1. Tonelli M, Wiebe N, Richard J-F, et al. . Characteristics of adults with type 2 diabetes mellitus by category of chronic kidney disease and presence of cardiovascular disease in Alberta Canada: a cross-sectional study. Can J Kidney Health Dis 2019;6:2054358119854113. 10.1177/2054358119854113
    1. First nations food, nutrition & environment study, 2019. Available:
    1. Galesloot S, McIntyre L, Fenton T, et al. . Food insecurity in Canadian adults receiving diabetes care. Can J Diet Pract Res 2012;73:e261–6. 10.3148/73.3.2012.e261
    1. Juarez D, Goo R, Tokumaru S, et al. . Association between sustained glycated hemoglobin control and healthcare costs. Am J Pharm Benefits 2013;5:59–64.

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera