FareShare Medically Tailored Meals Pilot Program for Type 2 Diabetes

Within the scope of this jointly led community-based, non-randomised clinical pilot feasibility study, the 12-week medically tailored meals intervention comprises weekly direct delivery of ready-made meals prepared by chefs at FareShare—the meal provider and research partner in this pilot. Meals are prepared and cooked onsite and stored, and delivered to recipients frozen, ready to be heated by recipients. Meals are prepared according to recipes developed jointly by FareShare chefs and study dietitians in line with evidence-based nutritional recommendations for the management of type 2 diabetes. FareShare will use donated and purchased ingredients and produce grown in their kitchen gardens. The intervention will provide participants—adults living in inner and parts of Greater Melbourne with diagnosed, undermanaged type 2 diabetes and who have trouble accessing nutritious foods with two main meals (lunch and dinner) and two snacks daily, five days a week. Our referral partner site dietitians from community health organisations—cohealth and Holstep Health will identify, pre-screen and refer clients within their networks diagnosed with type 2 diabetes and ongoing hyperglycaemia who face challenges accessing or preparing nutritious food, according to their clinical judgement and will administer the Hunger Vital Signs screening tool. With their client’s verbal permission, the study team will contact the referred client to explain the study requirements, provide the Participant Information and Consent Form, obtain informed consent and complete eligibility screening. Enrolled participants will then be contacted by a member of the FareShare operational project team to provide information about meal ordering and delivery processes. Participants will self-order weekly boxes by calling FareShare via a dedicated phone line coordinated and monitored by FareShare, which will oversee and facilitate meal ordering and coordinate delivery logistics. Participants can order meals weekly or up to two weeks ahead by phone by selecting meals from a menu of four meal set options comprising meals aligned with the Australian Dietary Guidelines and prepared using additional guidelines from the National Diabetes Service and Diabetes Australia - Carbohydrate counting and diabetes 2016. A meal box of 10 frozen meals and 10 snacks (5x30g portions of mixed nuts and 5 pieces of seasonal fruit) will be delivered directly to the participant's home address weekly for 12 weeks in consultation with the participant to ensure they are available within the delivery days and windows to receive the meal box. As part of the intervention, participants will be contacted by phone at Weeks 1 and 4 by the meal provider to review meal satisfaction via three short routine monitoring questions, taking up to 15 minutes. Moreover, participants will be contacted at Weeks 2, 6 and 8 by the study team to review their consumption of meals and provide their feedback regarding meal satisfaction. Calls to participants at Weeks 2 and 8 will be conducted by a study dietitian providing auxiliary dietary support, including an individually tailored dietary consultation as part of the intervention and also to encourage meal uptake and support healthier food choices. The dietary consults aim to ask participants three routine monitoring questions related to consumption and satisfaction with the delivered MTMs. That is, 1) Can you tell me what you thought about the healthy meals provided in the last few weeks (briefly note response, i.e, satisfied or not satisfied); 2) In the last week, of the 10 meals provided, how many healthy meals did you eat? (Write down the number and reason if provided.) If a reason is not provided, participants will be asked a third question, i.e., 3) Can you tell me more about why you did not eat (X number) of meals in the last week? Reasons will be noted by the dietitian, e.g., bad taste or was in hospital for a few days or not delivered, etc. Study dietitians will also consult with participants and provide healthy eating advice and resources as required around their topics of interest or queries. For example, regarding meal timing, other meals, snacks and fluids consumed alongside the MTMs, including on the two non-prescribed meal days as directed by the participant's queries. Examples of available resources include (but are not limited to) Baker Institute Factsheets regarding 'Dietary Fibre', 'Healthy Snacks', as well as an 'Eating Out Guide' by Diabetes Australia, 'Breakfast Ideas' and 'Healthy Snacks and Meal Ideas' developed by the National Diabetes Services Scheme. The duration of this call will be up to 30 minutes. If resources are provided in response to the participant's queries, the relevant information will be either posted or emailed, depending on the needs of the participant. In Weeks 6 and 13, participants will complete a short process evaluation questionnaire, which will take up to 15 minutes.