The goal of this observational study is to learn about dietary quality and barriers to healthy eating among older adults who participate in the Los Angeles County Food Rx Produce Distribution Program. The study will also evaluate whether a newer dietary assessment tool, the Global Diet Quality Questionnaire (GDQQ), performs similarly to an established dietary assessment tool, the Mediterranean Diet Scale (PREDIMED MDS), in measuring diet quality among adults aged 60 years and older. The main questions it aims to answer are: * Is the GDQQ associated with diet quality scores measured by the PREDIMED Mediterranean Diet Scale? * Does the GDQQ predict self-reported body mass index (BMI) as well as or better than the PREDIMED Mediterranean Diet Scale? * What barriers and facilitators influence healthy eating and participation in produce distribution programs among older adults? Participants will: * Complete questionnaires about their dietary habits, demographic characteristics, and food access experiences. * Complete two dietary quality assessment tools: the PREDIMED Mediterranean Diet Scale and the Global Diet Quality Questionnaire. * If randomly selected, participate in a one-time semi-structured interview to discuss healthy eating, food access, experiences with produce distribution events, and challenges to improving dietary quality.
Poor dietary quality is a major contributor to chronic disease risk among older adults and is associated with age-related conditions including obesity, cardiovascular disease, type 2 diabetes, cognitive decline, and chronic inflammation. Older adults experiencing food insecurity often face additional barriers to healthy eating, including limited access to nutritious foods, language and literacy challenges, unfamiliarity with available produce, and logistical barriers to participating in food assistance programs. Understanding these barriers is critical for developing culturally relevant and sustainable nutrition interventions that can improve dietary quality and health outcomes in vulnerable populations. This mixed-methods study will evaluate dietary quality among older adults participating in the Los Angeles County Food Rx Produce Distribution Program and explore participant perspectives regarding healthy eating, food access, and produce distribution services. The study has two primary aims. Aim 1: Validation and Comparison of Dietary Quality Assessment Tools The first aim is to assess dietary quality among adults aged 60 years and older who regularly participate in Food Rx produce distribution events. Participants will complete two dietary assessment instruments: The Mediterranean Diet Adherence Screener (PREDIMED Mediterranean Diet Scale \[MDS\]), a widely used and validated measure of adherence to a Mediterranean dietary pattern. The Global Diet Quality Questionnaire (GDQQ), a country-specific dietary quality assessment tool developed to rapidly evaluate alignment with global dietary recommendations across diverse cultural populations. The GDQQ generates a Global Dietary Recommendations (GDR) score based on dietary factors associated with protection from and risk for noncommunicable diseases. The study will examine the relationship between GDQQ-GDR scores and PREDIMED MDS scores and evaluate whether the GDQQ performs comparably to or better than the PREDIMED MDS in predicting self-reported body mass index (BMI). Approximately 125 older adults will complete dietary quality assessments and demographic questionnaires. Survey data will be collected electronically using REDCap and analyzed using descriptive statistics, correlation analyses, and multivariable regression models. Analyses will evaluate associations among dietary quality, demographic characteristics, food security status, comorbidities, and participation in produce distribution programs. Aim 2: Qualitative Assessment of Barriers and Facilitators to Healthy Eating The second aim will explore participant experiences, perceptions, and barriers related to healthy eating and participation in produce distribution programs. A randomly selected subset of participants from Aim 1 will be invited to participate in semi-structured qualitative interviews. The qualitative component is informed by a Community Advisory Board (CAB) consisting of Food Rx stakeholders and community members with expertise in food access and nutrition programming. Interview questions were developed collaboratively with CAB input to ensure cultural relevance and responsiveness to participant experiences. Interviews will examine: Understanding of dietary quality and healthy eating Knowledge of the relationship between diet and chronic disease Experiences accessing nutritious foods Perceived barriers to improving dietary quality Experiences with produce distribution events Perceived benefits and challenges of Food Rx participation Attitudes toward unfamiliar or culturally relevant produce items Recommendations for improving food distribution services and nutrition interventions A minimum of 20 and up to 30 interviews will be conducted, with recruitment continuing until thematic saturation is achieved. Interviews will be conducted by trained bilingual interviewers in English or Spanish. Interview data will undergo thematic analysis using a grounded theory approach, with coding performed independently by multiple researchers and reviewed for consensus. Community-Engaged Research Approach This study utilizes a community-based participatory research framework through collaboration with the National Health Foundation and the Food Rx Community Advisory Board. Community stakeholders contribute to study design, development of interview guides, interpretation of findings, and dissemination of results. This approach is intended to enhance cultural appropriateness, participant engagement, and the practical relevance of study findings. Significance This study addresses an important gap in understanding dietary quality assessment among diverse older adult populations experiencing food insecurity. Findings will provide evidence regarding the validity and feasibility of using the GDQQ in community-based nutrition programs and will identify barriers and facilitators that influence healthy eating among older adults. Results are expected to inform future culturally tailored nutrition interventions, improve produce prescription programs, and support strategies aimed at reducing nutrition-related chronic disease risk in underserved populations.
Study Type
OBSERVATIONAL
Enrollment
125
Hubert H. Humphrey Comprehensive Health Center
Los Angeles, California, United States
RECRUITINGGlobal Diet Quality Questionnaire-Global Dietary Recommendations (GDQQ-GDR)
The Global Diet Quality Questionnaire (GDQQ) can be used to generate a Global Dietary Recommendations (GDR) score that ranges from 0 to 18 and is associated with meeting World Health Organization (WHO) global dietary recommendations. The GDR Score is calculated by combining indicators of dietary factors protective against noncommunicable diseases (NCD-Protect) and indicators of dietary factors that are promotive of noncommunicable disease (NCD-Risk).16 The NCD-Protect score (range 0-9) is based on consumption of nine food groups that are associated with meeting WHO recommendations on fruits, vegetables, whole grains, pulses, nuts and seeds, and fiber. The NCD-Risk Score is based on consumption of eight food groups that are negatively associated with meeting WHO recommendations on free sugar, salt, total and saturated fat, and red and processed meat.
Time frame: Participants will be asked the GDQQ surveyed once during the study period. Assessed once at enrollment during completion of baseline dietary quality questionnaires (approximately 15-20 minutes)
Validation of GDQQ-GDR Against the PREDIMED Mediterranean Diet Scale and Self-Reported Body Mass Index
Validation of the GDQQ-GDR through (1) assessment of the correlation between GDQQ-GDR scores and PREDIMED Mediterranean Diet Scale (MDS) scores, and (2) evaluation of the ability of GDQQ-GDR scores to predict self-reported body mass index (BMI) compared with PREDIMED MDS scores. These analyses will determine whether the GDQQ performs as well as or better than the established PREDIMED MDS in this population of older adults.
Time frame: Assessed once at enrollment using data collected during completion of dietary quality questionnaires and demographic survey (approximately 15-20 minutes)
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