Food Literacy Program Helps Rural, Uninsured Patients With Diabetes Build Healthy Eating Skills

A recent studyopens in new tab/window in the Journal of Nutrition Education and Behavioropens in new tab/window (JNEB), published by Elsevier, examined the impact of a Food is Medicine (FIM) and food literacy education program on rural, uninsured adults with type 2 diabetes. Findings suggest that even when educational programs are effective overall, additional cultural tailoring may be needed to ensure that all participants benefit equally.

Researchers evaluated changes in participants’ food literacy using a validated assessment tool before and after the intervention. Findings showed that overall food literacy scores improved significantly following participation in the program, suggesting that education focused on building food-related knowledge and practical skills may help individuals better navigate food choices and prepare healthy meals.

The Fresh Start FIM + Food Literacy intervention included nine group classes focused on practical food skills such as meal planning, shopping, budgeting, and food preparation, along with health coaching support and produce prescriptions, which provide patients with monetary vouchers, produce boxes, or deliveries of fresh fruits and vegetables as a form of medical treatment. The study included 150 adults recruited through four safety net clinics in rural eastern North Carolina that are members of the North Carolina Association of Free and Charitable Clinics (NCAFCC), a statewide network serving uninsured and underinsured populations. Participants attended educational sessions held at local community sites and received support designed to help them incorporate healthy foods into their daily routines while managing diabetes.

Despite overall improvements, the study also identified disparities in food literacy across racial and ethnic groups. Hispanic participants had significantly lower food literacy scores than White participants both before and after the intervention, particularly in areas such as meal planning, shopping, and budgeting.

“Food literacy involves more than simply knowing what foods are healthy. It includes the skills needed to plan meals, shop on a budget, prepare food, and navigate complex food environments,” said Brandon J. Stroud, MPH, RDN, CHES, corresponding author of the study, Teaching Instructor, and Co-Director of the Farm2Clinic Initiative at East Carolina University. “Programs that combine nutrition education with practical skill-building may help individuals better manage chronic conditions such as diabetes.”

These findings highlight the potential value of integrating food literacy education into Food is Medicine and produce prescription programs. The authors note that culturally tailored educational approaches may further strengthen these programs and help address persistent disparities in nutrition knowledge and food-related skills among underserved populations.

Notes for editors

The article is "Impact of Food Literacy Education on Rural, Uninsured Patients With Diabetes," by Raven Breinholt, BS; Brandon J. Stroud, MPH, RDN, CHES; Lauren R. Sastre, PhD, RDN, LDN (https://doi-org.ucc.idm.oclc.org/10.1016/j.jneb.2026.01.007opens in new tab/window). It appears in the Journal of Nutrition Education and Behavior, volume 58, issue 4 (April 2026), published by Elsevier.

The article is openly available via a CC BY 4.0 license at https://www.jneb.org/article/S1499-4046(26)00007-2/fulltextopens in new tab/window.

Full text of the article is also available to credentialed journalists upon request; contact Eileen Leahy at +1 732 406 1313 or [email protected]opens in new tab/window to obtain a copy. To schedule an interview with the author(s), please contact Brandon J. Stroud, MPH, RDN, CHES, at [email protected]opens in new tab/window.

An audio podcast featuring an interview with Brandon J. Stroud, MPH, RDN, CHES, and other information for journalists are available at https://www.jneb.org/content/mediaopens in new tab/window. Excerpts from the podcast may be reproduced by the media with permission from Eileen Leahy.

About the Journal of Nutrition Education and Behavior (JNEB)

The Journal of Nutrition Education and Behavior (JNEB), the official journal of the Society for Nutrition Education and Behavior (SNEB), is a refereed, scientific periodical that serves as a resource for all professionals with an interest in nutrition education and dietary/physical activity behaviors. The purpose of JNEB is to document and disseminate original research, emerging issues, and practices relevant to nutrition education and behavior worldwide and to promote healthy, sustainable food choices. It supports the society’s efforts to disseminate innovative nutrition education strategies and communicate information on food, nutrition, and health issues to students, professionals, policy makers, targeted audiences, and the public.

The Journal of Nutrition Education and Behavior features articles that provide new insights and useful findings related to nutrition education research, practice, and policy. The content areas of JNEB reflect the diverse interests of health, nutrition, education, Cooperative Extension, and other professionals working in areas related to nutrition education and behavior. As the Society's official journal, JNEB also includes occasional policy statements, issue perspectives, and member communications. www.jneb.orgopens in new tab/window

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