{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,18]],"date-time":"2026-09-18T02:08:03Z","timestamp":1789697283723,"version":"4.0.1"},"reference-count":64,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100000886","name":"Duke Endowment","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000886","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["SAGE Open Medicine"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Diabetes self-management education supports healthy dietary behaviors but often lacks food skill-building education to plan, budget for, select, and prepare (cook) healthier food.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>This study examined the relationship between food skills, diabetes self-management, and stress with medically underinsured patients with type-2 diabetes mellitus within the Fresh Start Food is Medicine (FIM) program. A secondary objective was to examine the impact on diet quality and clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>\n                      Adults (\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009150) with type-2 diabetes mellitus participated in the 20-week Fresh Start FIM intervention, which included nine group education classes, a produce prescription, and telephone-based health coaching. Group education and skill-building centered around food skills and diabetes self-management. Measures included surveys (e.g., food skills confidence, diet quality, and stress) and clinical measures (e.g., weight, HbA1c, and blood pressure). Data analysis included paired\n                      <jats:italic>t<\/jats:italic>\n                      -tests, Wilcoxon signed-rank tests, and linear regression.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Significant improvements were observed in food skills confidence (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), diet quality (e.g., fruit\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.03; vegetable\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001; whole grain\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 consumption), diabetes self-management (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and perceived stress (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.01). Food skills confidence and diabetes self-management were significant predictors of perceived stress (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.05 and 0.009, respectively). Blood pressure significantly declined (systolic: \u22126.7\u2009mmHg,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007; diastolic,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.02).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Integrating food skills education and individualized behavioral support within an FIM intervention improved food skills confidence, diabetes self-management, and diet quality while reducing perceived stress among medically underinsured patients with type-2 diabetes mellitus. Enhanced self-efficacy in diabetes management and food skills were key contributors to stress reduction, emphasizing the importance of skill-oriented education within diabetes self-management education. These findings underscore the critical role of food skills in building capacity to improve dietary behaviors and health with resource-limited populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/20503121251346020","type":"journal-article","created":{"date-parts":[[2025,8,23]],"date-time":"2025-08-23T11:23:28Z","timestamp":1755948208000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":4,"title":["Enhancing diabetes self-management and reducing stress through food skills education with medically under-insured individuals with type-2 diabetes"],"prefix":"10.1177","volume":"13","author":[{"given":"Hannah-Therese","family":"Rayala","sequence":"first","affiliation":[{"name":"Brody School of Medicine, East Carolina University, Greenville, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9623-1353","authenticated-orcid":false,"given":"Brandon J","family":"Stroud","sequence":"additional","affiliation":[{"name":"Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC, USA"},{"name":"Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3035-8447","authenticated-orcid":false,"given":"Lauren R","family":"Sastre","sequence":"additional","affiliation":[{"name":"Department of Nutrition Science, College of Allied Health Sciences, East Carolina University, Greenville, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,8,23]]},"reference":[{"key":"e_1_3_3_2_2","unstructured":"Centers for Disease Control and Prevention. About type 2 diabetes. Atlanta: CDC https:\/\/www.cdc.gov\/diabetes\/about\/about-type-2-diabetes.html (2024 accessed 21 August 2024)."},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.2337\/dci23-0085"},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199309303291401"},{"key":"e_1_3_3_5_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(98)07019-6"},{"issue":"7","key":"e_1_3_3_6_2","article-title":"Self-care practices and their role in the control of diabetes: a narrative review","volume":"15","author":"Ahmad F","year":"2023","unstructured":"Ahmad F, Joshi SH. Self-care practices and their role in the control of diabetes: a narrative review. 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Social determinants, health literacy, and disparities: intersections and controversies. 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