The goal of this clinical trial is to evaluate the feasibility, acceptability, and effectiveness of a culturally tailored nutrition education intervention designed to improve diet quality and reduce nutrition-related cardiometabolic disease risk among low-income adults participating in the Los Angeles County Food Rx Fresh Produce Distribution Program. Participants are adults aged 18 years and older who experience food insecurity and receive services through Food Rx produce distribution sites. The main questions it aims to answer are: Does participation in the Diet Quality Matters intervention reduce food neophobia (reluctance to try unfamiliar foods)? Does participation improve overall dietary quality as measured by validated diet quality assessment tools? Does participation improve food resource management skills, nutrition-related self-efficacy, and food security? Does participation lead to improvements in cardiometabolic risk indicators, including body mass index (BMI) and blood pressure? Is the intervention acceptable, feasible, and culturally relevant to participants and program staff? Participants will: Complete baseline surveys assessing food neophobia, diet quality, food security, food resource management skills, and self-efficacy. Attend three monthly nutrition education sessions that include: Guided group motivational interviewing discussions. Live culturally tailored cooking demonstrations. Taste-testing of featured foods. Group discussions about adapting recipes to participants' cultural and household preferences. Undergo height, weight, and blood pressure measurements. Complete follow-up surveys approximately 3 months after the final intervention session. Participate in optional feedback interviews regarding their experiences with the program.
Background Food insecurity disproportionately affects low-income households and communities of color and is associated with reduced dietary quality and increased risk of chronic cardiometabolic conditions, including obesity, hypertension, diabetes, chronic kidney disease, and cardiovascular disease. Although fresh produce distribution programs improve access to fruits and vegetables, evidence demonstrating sustained improvements in overall dietary quality and chronic disease risk reduction remains limited. The Los Angeles County Food Rx Collaborative operates produce distribution programs throughout Los Angeles County to address food insecurity and improve health outcomes among underserved populations. Prior evaluations of Food Rx programs demonstrated adequate fruit and vegetable consumption among participants; however, measurable improvements in dietary quality and cardiometabolic risk have not yet been established. One potential barrier to improving dietary quality is food neophobia, defined as reluctance to try unfamiliar foods. Food neophobia may limit dietary diversity and reduce consumption of minimally processed plant foods that contribute to healthy dietary patterns. Repeated exposure to novel plant foods, coupled with nutrition education and behavioral support, may increase acceptance of these foods and improve overall dietary quality. Study Purpose The purpose of this pilot study is to evaluate a community-partnered nutrition education intervention called Diet Quality Matters, designed to improve dietary quality among Food Rx participants by increasing consumption of diverse minimally processed plant foods and reducing barriers related to food neophobia. The intervention integrates evidence-based nutrition education, motivational interviewing, culturally tailored cooking demonstrations, taste-testing experiences, and community discussion to support sustainable dietary behavior change. The study also seeks to assess the feasibility and acceptability of implementing this intervention within Food Rx produce distribution programs and to generate preliminary data to inform future larger-scale randomized controlled trials. Study Design This is a prospective, single-arm behavioral intervention pilot study using a pre-post evaluation design. Approximately 240 participants will be enrolled from a Los Angeles County Food Rx produce distribution site. Recruitment will occur through community outreach, referrals, flyers, word-of-mouth communication, and re-contact of individuals who previously consented to future research participation. The study uses a Community-Partnered Participatory Research (CPPR) framework involving collaboration among researchers, Food Rx leadership, community advisory board members, community health workers (promotores), and partner organizations. Intervention Participants will attend three nutrition education sessions delivered over a three-month period during regularly scheduled Food Rx produce distribution events. Each session includes: Guided Group Motivational Interviewing (\~15 minutes) Facilitated discussions designed to enhance motivation, identify personal goals, and strengthen commitment to dietary behavior change. Live Recipe Demonstration and Taste Testing (\~30 minutes) Nutrition educators prepare culturally relevant recipes featuring foods distributed through the Food Rx program. Participants observe preparation techniques, receive nutrition education, and sample featured foods. Community Cultural Adaptation Discussion (\~15 minutes) Participants discuss how recipes and dietary recommendations can be adapted to their cultural traditions, food preferences, family practices, and household resources. Data Collection Baseline Assessments Prior to participation, participants will complete: Demographic questionnaire Food Neophobia Scale Global Dietary Quality Questionnaire (GDQQ) PREDIMED Mediterranean Diet Score Food insecurity screening measures Food resource management skills assessments Nutrition self-efficacy assessments Participants will also undergo: Height measurement Weight measurement Body Mass Index calculation Blood pressure assessment Follow-Up Assessments Approximately three months after completion of the intervention, participants will repeat all outcome assessments to evaluate changes from baseline. Primary Outcomes Food Neophobia Change in Food Neophobia Scale scores from baseline to follow-up. Diet Quality Change in: Global Dietary Quality Questionnaire (GDQQ) scores PREDIMED Mediterranean Diet Score Secondary Outcomes Food resource management skills Nutrition-related self-efficacy Food security status Body Mass Index (BMI) Blood pressure Implementation and Acceptability Evaluation Semi-structured interviews will be conducted with participants and intervention staff to assess: Acceptability of the intervention Feasibility of implementation Cultural relevance Participant satisfaction Barriers and facilitators to participation Recommendations for future program improvement and scale-up Qualitative findings will guide refinement of the intervention and inform future implementation across additional Food Rx sites. Long-Term Goal The long-term objective of this pilot study is to develop and evaluate scalable, culturally responsive "Food Is Medicine" interventions that improve dietary quality, reduce nutrition-related chronic disease risk, and address food insecurity among underserved populations in Los Angeles County. Findings from this study will inform the design of a future multi-site randomized controlled trial within the Los Angeles County Food Rx Collaborative.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
OTHER
Masking
NONE
Enrollment
240
Diet Quality Matters (DQM) is a culturally tailored behavioral nutrition education intervention designed to improve diet quality and reduce cardiometabolic disease risk among food-insecure adults participating in the Los Angeles County Food Rx Program. Adapted from the evidence-based Cooking Matters curriculum, DQM combines motivational interviewing, nutrition education, cooking demonstrations, taste testing, and culturally relevant group discussions to increase consumption of diverse minimally processed plant foods and reduce food neophobia. Participants attend three monthly in-person group sessions, each lasting approximately 60 minutes and delivered during Food Rx produce distribution events. Sessions include guided motivational interviewing (15 minutes), a live recipe demonstration and taste testing (30 minutes), and a discussion on adapting healthy eating practices to participants' cultural and household preferences (15 minutes).
Martin Luther King, Jr. Center for Public Health
Los Angeles, California, United States
RECRUITINGCurtis R. Tucker Health Center
Los Angeles, California, United States
ACTIVE_NOT_RECRUITINGChange in Diet Quality - GDQQ GDR Score
Change in overall diet quality as measured by the Global Dietary Quality Questionnaire (GDQQ)-Global Dietary Recommendations (GDR) Score. Range 0-18 with higher score indicating better diet quality. Calculated by GDR Score = NCD-Protect Score - NCD-Limit socre + 9
Time frame: Assessed at baseline, prior to study intervention, and again 30 days post last intervention session
Change in Diet Quality - MDS
Change in overall diet quality as measured by the PREDIMED Mediterranean Diet Score. Range 0-9 with higher score indicating increased adherence to mediterranean diet.
Time frame: Assessed at baseline, prior to study intervention, and again 30 days post last intervention session
Change in NCD-Protect Score
Change in consumption of food groups associated with protection against noncommunicable diseases (NCDs) will be assessed using the NCD-Protect score derived from the Global Diet Quality Questionnaire (GDQQ). The score reflects consumption of health-promoting food groups, including fruits, vegetables, whole grains, legumes, nuts and seeds, and other recommended foods represented in the GDQQ. Higher scores indicate greater consumption of NCD-protective foods and a more favorable dietary pattern with a range 0-9
Time frame: Assessed at baseline, prior to study intervention, and again 30 days post last intervention session
Change in NCD-Limit Score
Change in consumption of food groups recommended for limitation for prevention of noncommunicable diseases (NCDs) will be assessed using the NCD-Limit score derived from the Global Diet Quality Questionnaire (GDQQ). The score reflects consumption of foods that dietary recommendations advise limiting, such as highly processed foods and foods high in added sugars, sodium, or unhealthy fats, as represented in the GDQQ. Lower scores indicate lower consumption of foods recommended for limitation and a more favorable dietary pattern with a range 0-9.
Time frame: Assessed at baseline, prior to study intervention, and again 30 days post last intervention session
Change in Food Neophobia
Change in willingness to try new or unfamiliar foods as measured by the Food Neophobia Scale (FNS). The Food Neophobia Scale (FNS) is a 10-item questionnaire to measure an individual's reluctance to eat unfamiliar or novel foods. It uses a 7-point Likert scale (1 = strongly disagree to 7 = strongly agree), yielding total scores from 10 to 70, where higher scores show greater food neophobia
Time frame: Assessed at baseline, prior to study intervention, and again 30 days post last intervention session.
Change in Cardiometabolic Risk Indicators - BMI
Change in body mass index (BMI). Weight and height will be combined to report BMI in kg/m\^2
Time frame: Baseline, prior to study intervention, and again 30 days post last intervention session.
Change in Cardiometabolic Risk Indicators - Grip Strength
Change in grip strength (kg) using dynamometer.
Time frame: Baseline, prior to study intervention, and again 30 days post last intervention session.
Change in Cardiometabolic Risk Indicators - Systolic BP
Change in systolic blood pressure (mmHg) collected using sphygmomanometer.
Time frame: Baseline, prior to study intervention, and again 30 days post last intervention session.
Change in Cardiometabolic Risk Indicators - Diastolic BP
Change in diastolic blood pressure (mmHg). Collected using sphygmomanometer.
Time frame: Baseline, prior to study intervention, and again 30 days post last intervention session.
Change in Food Security
Change in food security status assed using one question, "In the last 12 months, did you or other adults in your household ever cut the size of your meals or skip meals because there wasn't enough money for food?" An answer of "yes" indicates a high risk for very low food security.
Time frame: Baseline to 30 days post last intervention session.
Change in Food Resource Management Skills
Change in food resource management skills. Food resource management will be assessed using 5 questions evaluating participants' food management behaviors. Each item is rated on a 5-point scale ranging from 1 (Never) to 5 (Always). Item responses are summed to generate a total score ranging from 5 to 25, with higher scores indicating greater ability to manage food resources effectively.
Time frame: Baseline, prior to study intervention, and again 30 days post last intervention session.
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Change in Behavior Self Confidence
Self-confidence in food resource management will be assessed using 4 items evaluating participants' confidence in their ability to purchase healthy foods for their family on a budget, select the best-priced forms of fruits and vegetables, make food money last throughout the month, and prepare low-cost meals. Each item is rated on a 5-point scale ranging from 1 (Not at all confident) to 5 (Very confident). Responses are summed to generate a total score ranging from 4 to 20, with higher scores indicating greater self-confidence in managing food resources and preparing affordable meals. Change in total score will be evaluated from baseline to follow-up.
Time frame: Baseline, prior to study intervention, and again 30 days post last intervention session.