Patient Engagement

Texting Plays Critical Role in Diabetes Prevention Program at Feeding America Food Banks

We’re really excited about a unique study on diabetes prevention that was recently released by the CDC (Centers for Disease Control and Prevention) led by Feeding America, the nation’s largest hunger-relief organization with a network of 200 food banks providing food assistance to more than 40 million people, in partnership with the University of Pittsburgh and the Alameda County Community Food Bank (ACCFB). Instead of just looking at general effectiveness of a diabetes prevention program (DPP), it focuses on innovative interventions delivered through food banks. 


Food banks are critical resource points in many underserved communities, but few studies have examined their potential role in preventing diabetes. We’ve seen the benefits that food banks provide, especially when working with FQHCs, so we were eager to see the results. 

The Intervention

The program took place between November 2017 and March 2018, enrolling 244 eligible participants. Their demographics broke down as follows: 

  • 90.6% were female

  • 80.1% were Hispanic

  • 49.1% had an income under $20,000

  • 68.8% had low or very low food security (at baseline) 

Concentrated on 12 community food distribution sites in Alameda County, California, the program involved text-based education and engagement along with monthly diabetes-appropriate food packages and referrals to healthcare. The texting component took place on three levels: 

1) Text-Based Health Promotion Education

All selected participants were enrolled in health promotion education delivered through the CareMessage platform

Participants were provided with a 24-week physical activity module that was then followed by a 24-week nutrition program. Each of the modules gave participants 3 to 5 messages per week to educate them and support healthier behavior modifications. 83.2% (203) of patients were interested in text-based education at the start of the program. (We took this high number as an indication of the important role texting plays in communicating with the underserved at scale.)

Food bank staff members were responsible for initiating each participant in the program, which was delivered in the participants’ preferred language (English or Spanish). After completing the physical activity portion, participants were guided into the nutrition module. 

Text-based health promotion programs were not used as a substitute for DPP classes, but instead provided relevant and complementary health information to participants. 

2) Text-Based Engagement and Administrative Messaging

Participants who opted into text messaging also received general administrative messages. These messages were designed to maintain or increase engagement in activities such as picking up project food packages. Messages included:

  • Distribution reminders

  • Date or time changes

  • Survey reminders

These messages were also managed by food bank staff members using the CareMessage platform.

3) Text Alternative to DPPs

As the project was initially designed, it connected food bank clients to an existing community-based DPP to support them in lowering their diabetes risk. However, the initial DPP provider underwent changes and did not have the capacity to provide classes during the project period. Since food bank staff members could not find a replacement DPP partner within the first six months of the study, any participant interested in a community-based DPP was enrolled in the text-based health promotion programs. 

By the time of close of enrollment in March 2018, the text-based program had been initiated for 203 participants. 

The Results

By the midpoint of the program, participants had exhibited significant improvement in:

  • Food security status

  • Physical activity

  • Depression scores

  • Health status

  • Dietary intake

During that period, BMI did not change. 

The Implications

The study highlighted the pivotal role that food banks serve for vulnerable populations that are at high risk for poor health and chronic diseases like diabetes. It underscores the fact that they can be highly effective and accessible for populations such as the underserved who might not have access to these services through traditional healthcare systems or community-based programs. It also illuminates the potential that texting can serve in reaching these goals

“Feeding America is committed to engaging the people we serve and delivering impactful programming,” said Morgan Smith, a Senior Programs Manager at Feeding America. “In addition to distributing nutritious foods to people in need, our network of food banks provides nutrition education and works to connect clients to healthcare and other services.  Text-based programming like CareMessage can extend food banks’ reach, facilitate client engagement, and help increase access to information and resources for the people we serve.”

If you’d like to talk about the opportunity your FQHC has to partner with local food banks in addressing patient health and food security, fill out the form below. 

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