The study, led by William B. Perkison and colleagues at The University of Texas Health Science Center at Houston School of Public Health, tested whether the Sustainable Culturally Adapted Nutrition (SCAN) program could be feasibly incorporated into the National DPP. SCAN consists of four group cooking technique lessons and group motivational interviewing counseling designed to reinforce participants’ ability to adapt and sustain the dietary recommendations discussed in the National DPP. The researchers recruited 37 National DPP participants from a Federally Qualified Health Center in Houston and randomized them to either an intervention arm receiving both SCAN and the National DPP or a control arm receiving only the National DPP.

The technical design of the study was a pragmatic quasi-experimental pilot. The primary outcome was National DPP attendance, and secondary outcomes included weight and body mass index (BMI). Chi-square and Fisher’s exact tests compared baseline characteristics between groups, while linear regression models assessed the association between weight and National DPP attendance. The researchers conducted both intention-to-treat and per-protocol analyses to capture the full range of participant experiences.

At 12 months, the intention-to-treat analysis found no significant difference in attendance between the intervention group, which attended an average of 7.64 National DPP sessions, and the control group, which attended 7.80 sessions. However, the per-protocol analysis revealed a more encouraging pattern. Participants who attended at least one SCAN cooking class attended an average of 9.67 National DPP sessions compared to 6.88 sessions among those who attended zero cooking classes, a difference that trended toward significance. Although not statistically significant, attendance at each additional National DPP session reduced participants’ average weight by 1.3 percent.

Perhaps the most striking finding was the greater dose-response association between National DPP attendance and average weight loss in the intervention group compared to the control group. This pattern suggests that when participants engage with the culturally adapted cooking component, the relationship between class attendance and weight outcomes may be strengthened, potentially amplifying the benefits of the core prevention program.

The SCAN cooking classes themselves were built on a foundation of behavioral theory. Developed with the Nourish Program, a comprehensive nutrition education initiative based at the UTHealth School of Public Health, the curriculum was grounded in Social Cognitive Theory and aimed to increase participants’ outcome expectations of the taste of healthy foods, knowledge of healthy eating, self-efficacy for engaging in healthy eating, culinary skills, and social support. Guided by Intervention Mapping, a systematic process for adapting and evaluating theory-based interventions, the team identified both surface-level and deep-level cultural adaptations needed to ensure the curriculum resonated with participants.

Surface-level adaptations included tailoring recipes, pamphlets, and images to reflect participants’ cultural backgrounds and offering classes in both Spanish and English. Deep-level adaptations involved integrating motivational interviewing throughout course delivery. SCAN coaches received 14 hours of motivational interviewing training and consultation covering the history and theory of the approach, the principal tenets of behavior change counseling, and demonstration and practice of techniques such as asking open questions, affirming participants’ strengths, and using reflective listening to strengthen self-efficacy.

The four cooking sessions covered knife skills, roasting, sautéing, and microwaving, each paired with culturally relevant recipes such as Texas Caviar with dressing, Tajin Spiced Roasted Carrots, Tajin and Oregano Sautéed Winter Vegetables, and Garlic and Herb Butter Broccoli. Participants received recipe ingredients and cooking tools delivered to their homes before each virtual class to eliminate food availability barriers and promote participation. Take-home messages emphasized practical strategies like utilizing the entire vegetable to reduce waste, not peeling vegetables to preserve nutrients, and cutting vegetables to uniform sizes for even cooking.

Beyond the cooking classes, all participants in both study arms were enrolled in a food supplement program run by the Houston Food Bank, which distributes over $200 million of food each year to more than 800,000 recipients with food insecurity. Enrolled participants received a food supplement identification card used to obtain food vouchers twice per month for the duration of the National DPP at local distribution centers. The program was designed to lower barriers to accessing the healthy foods participants were learning about and to reinforce their willingness to make changes.

Satisfaction surveys revealed uniformly positive feedback. Among the SCAN cohort, there were improvements in confidence in assessing personal risk for diabetes and ability to reach healthcare providers. At the 12-month assessment compared to 6 months, there was an increase in participants who felt confident or very confident in their ability to assess their personal risk for diabetes, reaching 84.62 percent from 77 percent, and in their ability to reach their healthcare providers, rising to 76.92 percent from 62 percent. Confidence in cooking healthy foods reached 100 percent at 12 months. One participant summarized the experience as appreciating the information about diabetes, the education, the knowledge, the motivation to move forward, and the inspiration to educate oneself.

Despite these promising signals, the study faced notable limitations. The low number of participants resulted in low statistical power to detect significant differences in adherence. Over 80 percent of participants lacked 12-month biometric data for hemoglobin A1C, HDL, and LDL cholesterol, preventing outcome analysis. The study was conducted largely during the COVID-19 pandemic, forcing virtual delivery of both programs at a time when many participants had never joined a virtual call. Many participants only had a smartphone, limiting their ability to simultaneously visualize instructors while preparing recipes at home. Additionally, the National DPP was delivered by an independent organization, First Mile Care, which limited the researchers’ ability to fully synergize the SCAN program with the prediabetes curriculum.

Barriers to participation also emerged from the survey data. The most frequently reported challenges included work schedule conflicts and personal responsibilities such as childcare obligations. At the 12-month assessment, 30.8 percent of respondents identified work schedules and program timing as the primary barriers. Financial constraints were also reported as obstacles to obtaining healthy foods needed for weight management. Although all participants received access to a food supplement program card, fewer than 15 percent used the benefit, citing the limited quantity of food provided and scheduling difficulties at the food bank.

The researchers concluded that SCAN’s integration into the National DPP has shown potential in improving attendance and was well received by participants. The positive trend in attendance among those who engaged with the cooking classes, combined with the stronger dose-response association between attendance and weight loss in the intervention group, suggests that culturally adapted culinary education may address some of the barriers that have historically undermined diabetes prevention efforts, particularly among racial and ethnic minority groups who prepare foods differently than those suggested in standard American recipes.

Looking forward, the research team outlined several adaptations for future iterations. A larger study over a longer period, evaluating outcomes at 6 and 12 months after completion of the National DPP, will better ascertain whether improvements in biometric measurements are sustainable and perhaps independent of sessions attended. Future versions will examine how the four cooking classes are best spaced throughout the 12-month program to optimize attendance, increase the amount of motivational interviewing training coaches receive with objective scoring methods, incorporate structured group-sharing sessions and participant feedback workflows to enhance cultural appropriateness, and offer the program in a hybrid format at multiple times to maximize accessibility. Larger scale implementation is necessary to understand the long-term impact of SCAN and its potential to enhance protection against the development of diabetes and its devastating health complications.

Subject of Research: Outcomes of the Sustainable Culturally Adapted Nutrition Program (SCAN) and food supplement program to improve engagement with the National Diabetes Prevention Program (NDPP)

Article Title: Outcomes of the Sustainable Culturally Adapted Nutrition Program (SCAN) and food supplement program to improve engagement with the National Diabetes Prevention Program (NDPP)

Article References: Perkison, W. B., Fwelo, P., Heredia, N. I., Garza, E., Yang, J. J., Velasco-Huerta, F., Rodriguez, S. A., Beg, S. S., Pulicken, C., Mathews, P. D., Reininger, B. M., Chenier, R. S., & Fernandez, M. E. (2026). Outcomes of the Sustainable Culturally Adapted Nutrition Program (SCAN) and food supplement program to improve engagement with the National Diabetes Prevention Program (NDPP). Frontiers in Clinical Diabetes and Healthcare, 7, Article 1838175. https://doi.org/10.3389/fcdhc.2026.1838175

Image Credits: AI Generated

DOI: 10.3389/fcdhc.2026.1838175

Keywords: diabetes prevention, prediabetes, nutrition intervention, culturally adapted health program, motivational interviewing, National Diabetes Prevention Program, cooking classes, food supplement, Outcomes, Sustainable, Culturally, Adapted