Abstract B61: A community-engaged approach to promoting adherence to diet-related cancer prevention guidelines
Authors: Smith Selina S. , Whitehead Mary S. , Delmoor Ernestine , Britt Thomas , Harris Cassandra L. , Robinson-Flint Janette , Coughlin Steven S. , Sheats Joyce Q. 
Published: May 2016

Abstract
Background: Supplementing traditional nutrition education with experiential, skills-building activities (e.g., recipe modification, and cookbook development) can enhance awareness of diet-related cancer prevention guidelines (D-RCPGs). The objective of this study was to document the development of a cookbook of healthy recipes with lifestyle tips to promote awareness of D-RCPG in African American communities.
Methods: This mixed-method study was completed in three phases. In Phase 1, community coalitions implementing a cluster randomized control trial were invited to submit recipes. During Phase 2, recipes were transformed, refined, and prepared by a chef with input from a registered dietitian. Using a Likert scale, participants were asked to rate each prepared dish from 1 (unattractive; flavor did not appeal to me; inappropriate texture; unappetizing aroma; unacceptable) to 5 (extremely attractive; tasted great; great texture; smelled good; extremely acceptable). Comments of the raters were considered, recipes were revised and finalized, and nutritional analyses were completed. For the final phase, four focus group discussions in Miami, Chicago, Philadelphia, and Los Angeles were conducted to ensure acceptability of messages related to lifestyle (diet and physical activity). An interview guide, developed for conducting the discussions, was tested for length, clarity, and organization. Discussions were digitally recorded, transcribed verbatim, manually coded, summarized, and coded to determine the degree of agreement/disagreement across themes and calculating inter-rater reliability scores.
Results: Eighteen NBLIC community coalitions submitted 40 recipes reviewed for originality, cultural appropriateness, and acceptability for the cookbook. Acceptable recipes (n=32) were modified to reduce total energy, fat, and saturated fat; increase fiber and micronutrient content; replace refined grains with whole grains; and improve nutritional quality (e.g., limit sugar and salt content). Thirty-six African American men and women, ages 22-86, participated in a 2-hour cooking demonstration and taste-test of eight transformed recipes. Most participants (74%) rated dishes as 5 on appearance (extremely attractive); taste (tasted great); texture (great texture); aroma (smelled good); and overall acceptability (extremely acceptable). Recipes with overall acceptability of 4 or 5 were included in the cookbook. Four focus groups (n = 43; mean age: 57.32 years; standard deviation [SD]: 7.91; range: 35–75 years old) were completed in Miami, Chicago, Philadelphia, and Los Angeles. Themes emerging from content analysis converged into the following categories: 1) practical guidance on measuring ingredients; 2) best ways to prepare healthy meals; 3) health benefits of fruits and vegetables; and 4) recommendations for physical activity. The cookbook with lifestyle tips, “Down Home Healthy Living 2.0,” was distributed in print form to 2,500 trial participants and was shared electronically through websites and social media.
Conclusions/Discussion: Relatively few cookbooks and related dietary resources have been developed using community-based participatory approaches. Resources that are culturally appropriate and tailored to the target audience are more likely to be disseminated and widely used. Consumers are frequently bombarded by the news media, television cooking shows, food blogs, word-of-mouth, and other channels with confusing and contradictory information about nutrition and food choices. Carefully developed cookbooks and related educational resources can serve as useful sources of information for consumers seeking to lower their risk of chronic illness by adopting or maintaining a nutritious diet.
Citation Format: Selina S. Smith, Mary S. Whitehead, Ernestine Delmoor, Thomas Britt, Cassandra L. Harris, Janette Robinson-Flint, Steven S. Coughlin, Joyce Q. Sheats. A community-engaged approach to promoting adherence to diet-related cancer prevention guidelines. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B61.