Research takes practical approach to diabetes prevention in underserved community

Diabetes is a major risk factor for cardiovascular disease, including heart attacks and strokes. When facing housing insecurity, the risk of developing Type 2 diabetes can be particularly high. 

For people moving from shelters into supportive or transitional housing, establishing new routines and learning to independently prepare healthy meals can be particularly challenging. Limited budgets, equipment and access to healthy food can make it difficult to maintain healthy eating habits.

A research team co-led by clinician-researcher Dr. David Campbell, MD, PhD, an associate professor in the Department of Medicine at the Cumming School of Medicine, is taking a practical approach to addressing that gap.

The team recently received a Canadian Institutes of Health Research (CIHR) Catalyst Grant to co-design a hands-on culinary medicine curriculum for people living in supportive and transitional housing. 

The goal is to help participants build cooking skills, nutrition knowledge and confidence to support healthier eating and, ultimately, inform approaches to Type 2 diabetes prevention.

“Diabetes and obesity are very common in people with low income, and especially those who have experienced homelessness,” says Campbell. “This is due, in part, to the fact that food provided in shelters is of low nutritional value. Unfortunately, after people get housing, it is hard to re-establish routines and cook healthy foods for oneself.”

Rather than developing the curriculum in isolation, the research team is working alongside people with lived experience to ensure it reflects the realities of their lives.

The curriculum is being co-designed with members of the Calgary Diabetes Advocacy Committee (CDAC), a group made up of people with lived experience of diabetes and homelessness. The project also brings together partners from Alberta’s health system, community agencies and social work.

Julia MacLaren, a PhD trainee and registered dietitian supervised by Campbell, is taking a lead role in the study. She is using an evidence-based co-design framework to ensure the curriculum reflects the needs and priorities of the people it is intended to serve.

Through focus groups, hands-on workshops and collaborative development sessions, CDAC members will share their experiences with food and cooking, interactions with the shelter system and the realities of preparing meals with limited budgets, equipment and supplies.

“The voices of our CDAC partners are central to this project to ensure the program is practical, relevant and ready to be used in real-world settings,” says MacLaren.

The group has identified access to healthy food and opportunities to develop healthy eating habits as priorities for improving experiences for people who are experiencing homelessness and who are at risk of, or living with, diabetes, which is linked to cardiovascular disease. 

Once the curriculum has been co-designed and refined, the researchers plan to test it with people living in supportive and transitional housing in Calgary. The longer-term goal is to evaluate the curriculum in a randomized trial and determine whether it can improve dietary intake.

For MacLaren, the project builds on more than a decade of experience working in culinary medicine, a field that combines nutrition science with practical cooking skills. Her work in primary care, diabetes screening and health-system consulting has reinforced the importance of tailoring nutrition interventions to the realities of people's lives.

“I have always been in love with the beautiful science of nutrition,” says MacLaren. “I have learned that if you want to truly make a difference, you have to be able to relate with people to understand the foods they eat and the ways that they live.”

Campbell says the co-design process is an important step toward creating a program that is both evidence-based and practical.

“My hope is that the co-design work creates a curriculum that speaks to people, meets them where they are, and helps them to develop confidence in their cooking skills,” he says. “We will take the refined curriculum that we design together forward to test in a randomized trial with the goal of improving dietary intake.”

Campbell is an associate professor in the Dept. of Medicine at the Cumming School of Medicine. He is a member of the Libin Cardiovascular Institute and the O’Brien Institute for Public Health.