June 2017 // Volume 55 // Number 3 // Tools of the Trade // 3TOT4
A Conversation Tool for Assessing a Food Pantry's Readiness to Address Diet-Related Chronic Diseases
Food insecurity is associated with diabetes and other chronic diseases. Individuals who experience food insecurity may use coping skills to avoid hunger, including eating unhealthful foods and binging when food is abundant, two practices that are often detrimental to prevention or management of chronic diseases. Food pantries, especially those using the Rainbow of Colors Choice Food Pantry System, are potential settings for providing nutrition education, healthful foods, and screenings to help individuals prevent or manage their chronic diseases. This article describes a conversation guide Extension professionals can use to assist food pantry personnel in identifying and implementing strategies for addressing chronic diseases.
Food insecurity is associated with diabetes and other diet-related chronic diseases (Seligman, Bindman, Vittinghoff, Kanaya, & Kushel, 2007). Those who are food insecure have more emotional and financial challenges related to managing diabetes, low self-efficacy for managing diabetes, more emergency room visits for hypoglycemia (Seligman & Schillinger, 2010), poorer glucose control, and increased risk of health complications (Seligman et al., 2007; Seligman, Jacobs, López, Tschann, & Fernandez, 2012; Seligman & Schillinger, 2010). People who experience food insecurity often use coping strategies to avoid hunger, potentially compromising the ability to manage blood sugars. Coping strategies may include consuming low-cost and energy-dense foods, eating a small variety of foods, practicing food waste avoidance, and binging when food is abundant (Seligman & Schillinger, 2010). Extension professionals can help combat diet-related chronic diseases in food-insecure groups through education of food pantry personnel.
Addressing Chronic Disease via Food Pantries
Food pantries were originally designed to meet emergency food needs. However, many households rely on them to access food year round. A majority of food pantry clients reported using a pantry at least six times per year, and one third reported using a pantry every month (Echevarria-Cruz & Santos, 2010). Recent interventions have focused on food pantries' providing healthful options and nutrition education as a way to address diet-sensitive chronic diseases. Strategies that can be implemented within food pantries include providing food boxes for those with diabetes, offering screenings and referrals, and providing diabetes education (Seligman et al., 2015). Additionally, some food pantries have converted to the Rainbow of Colors Choice Food Pantry System; such pantries are organized according to U.S. Department of Agriculture Myplate food groups and offer clients healthful choices and nutrition education (Remley et al., 2006; Remley, Kaiser, & Osso, 2013).
Still, many pantries operate using a traditional approach by distributing preselected items. Assessing the diabetes status of clients and addressing associated needs might be an afterthought. The foods distributed might not be the most healthful or desirable, depending on community resources and the procurement skills of the food pantry personnel. Furthermore, clients may not know how to use certain foods, especially in the context of a diabetic meal plan. Interaction with volunteers may be limited, possibly hindering dialogue around needs and preferences. Extension educators can assess readiness and provide coaching and training related to the Rainbow of Colors Choice Food Pantry System, thereby assisting food pantries in addressing diet-sensitive chronic diseases such as diabetes.
Conversation Tool for Assessing Readiness
Here, I present a conversation tool Extension educators can use with food pantry directors and staff to assess a pantry's readiness to convert to the Rainbow of Colors Choice Food Pantry System and to provide strategies for addressing diabetes and other chronic diseases. The questions were drawn from my experiences in food pantry assistance, community coaching (Hubbel & Emory, 2009), and community readiness (Oetting et al., 2014). The tool, shown in Figure 1, has been field-tested in several Ohio pantries.
Application of Results of the Readiness Conversation
Following the conversation, Extension educators can guide a food pantry's director and staff to resources or training. Several tools and resources, such as Making the Switch: A Guide to Converting to A Choice Food Pantry by the Ohio Association of Second Harvest Foodbanks, can address perceived barriers to converting to a choice pantry (e.g., lack of space, concerns about operations). Other tools, such as Feeding America's Healthy Foodbank Hub, can help food pantry personnel make organizational changes related to procuring and offering more healthful foods, use "behavioral nudges" to encourage healthful food choices, or implement other strategies to help clients learn how to use foods (Feeding America, 2014). For assessing chronic disease, the Centers for Disease Control and Prevention offers a prediabetes screening tool (Centers for Disease Control and Prevention, 2016). Additionally, some researchers have offered guidance on how to help diabetic clients, such as by creating "diabetes only" selections or developing key partnerships with health care providers (Seligman et al., 2015). Finally, Ohio State University Extension has developed a choice pantry volunteer training that equips choice pantry volunteers and staff with cultural competency and nutrition education skills. The training promotes motivational interviewing to facilitate dialogue between food pantry clients and volunteers around food preferences and needs. Motivational interviewing has been shown to be effective in food pantries in terms of promoting nutrition (Martin, Wu, Wolff, Colontonia, & Grady, 2016).
Centers for Disease Control and Prevention. (2016). CDC prediabetes screening test. Retrieved from https://www.cdc.gov/diabetes/prevention/pdf/prediabetestest.pdf
Echevarria-Cruz, S., & Santos, R. (2010). Hunger's new staple (Vol. 9). Retrieved from http://www.feedingamerica.org/hunger-in-america/our-research/hungers-new-staple/hungers-new-staple-full-report.pdf
Feeding America. (2014). Healthy foodbank hub. Retrieved from http://healthyfoodbankhub.feedingamerica.org/
Hubbel, K., & Emory, M. (2009). Engaging in sustainable community change: A community guide to working with a coach. Retrieved from http://kenhubbell.com/pdfs/Engaging.pdf
Martin, K., Wu, R., Wolff, M., Colontonia, A., & Grady, J. (2016). A novel food pantry program. American Journal of Public Health, 45(5), 569–575.
Oetting, E. R., Plested, B. A., Edwards, R. W., Thurman, P. J., Kelly, K., & Beauvais, F. (2014). Community readiness for community changes. Retrieved from http://triethniccenter.colostate.edu/docs/CR_Handbook_8-3-15.pdf
Remley, D., Gallagher, T., McDowell, J., Kershaw, M., Lambea, M. C., & Melgar-Quinonez, H. (2006). Extension's role in developing "Choice" food pantries in Southwest Ohio. Journal of Extension, 44(6), Article 6IAW5. Available at http://www.joe.org/joe/2006december/iw5.php
Remley, D. T., Kaiser, M. L., & Osso, T. (2013). A case study of promoting nutrition and long-term food security through choice pantry development. Journal of Hunger and Environmental Nutrition, 8(3), 324–336.
Seligman, H. K., Bindman, A. B., Vittinghoff, E., Kanaya, A. M., & Kushel, M. B. (2007). Food insecurity is associated with diabetes mellitus: Results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999–2002. Journal of General Internal Medicine, 22(7), 1018–1023.
Seligman, H. K., Jacobs, E. A., López, A., Tschann, J., & Fernandez, A. (2012). Food insecurity and glycemic control among low-income patients with type 2 diabetes. Diabetes Care, 35(2), 233–238.
Seligman, H. K., Lyles, C., Marshall, M. B., Prendergast, K., Smith, M. C., Headings, A., . . . Waxman, E. (2015). A pilot food bank intervention featuring diabetes-appropriate food improved glycemic control among clients in three states. Health Affairs, 34(11), 1956–1963.
Seligman, H. K., & Schillinger, D. (2010). Hunger and socioeconomic disparities in chronic disease. The New England Journal of Medicine, 363(1), 6–9.