Co-Creating Solutions: Affordable Healthy Eating for Individuals Living with Cognitive Disabilities

Abstract

Background: Access to safe and nutritious food is a fundamental human right, yet it remains elusive for many, especially those living with cognitive disabilities. Cognitive disabilities affect one's ability to plan, recall information, make decisions, use tools (like recipes), or even stay attentive, making it difficult for them to plan and eat healthy meals. Additionally, this population is also highly vulnerable to poverty and food insecurity, further exacerbating barriers to healthy eating. Therefore, removing barriers impeding affordable healthy eating for individuals living with cognitive disabilities is a pressing need.

Objectives: The goal of this project was to make healthy eating more accessible for individuals living with cognitive disabilities. Our specific objectives were to 1) explore the healthy eating and food preparation barriers faced by individuals with cognitive disabilities; 2) develop recipe selection checklist to select and adapt recipes to easy-to-read language; and 3) evaluate the usability, usefulness and acceptability of recipes adapted into easy-to-read language.

Methods: This three-phase qualitative study uses a Community-Based Participatory Research (CBPR) approach. This project is a collaboration between the academic partners (Fernandez lab and SD), the community partners (Open), and individuals with lived experience of cognitive disabilities to understand and address the community's healthy eating and food preparation needs and challenges. All phases of the study were informed by community insights collected during the interviews and steering committee meetings with advisors with lived experience. Findings from the first phase were used to develop a recipe selection checklist. A website scan was done to collect recipes present on 10 Canadian health organization websites. The checklist was applied to the recipes to evaluate their affordability and healthfulness. An easy-to-read language and an accessible format protocol was also developed to adapt recipes. The adapted recipes were tested by eight participants to evaluate their usability, usefulness and acceptability.

Results: Manuscript one demonstrated that the healthy eating and food preparation barriers faced by individuals living with cognitive disabilities in the current Canadian ecosystem can mainly be categorized into two superordinate themes: 1) personal circumstances influence healthy eating, and 2) food environments lack accessibility.

In the bridging chapter, an eight-item recipe selection checklist was developed to evaluate the affordability and healthfulness of existing recipes. Applying these criteria to 1313 recipes available on 10 Canadian healthy organization websites, showed that only 191 (14.5%) of them were affordable and nutritionally complete meals. From these 191 recipes, eight were adapted into easy-to-read language and an accessible format.

In manuscript two, recipes adapted into easy-to-read language and accessible format received moderately high to high scores (total scores 32-48; median scores 35-44). The usability of recipes was found to be affected by the practical aspects of recipe, visual presentation of information, and the organization of information. The usefulness of information was influenced by the quantity of information and the quality of the written content. Lastly, the acceptability of recipes was determined by the food skills required, cognitive load, and overall appreciation (taste and texture).

Conclusion: This project used a CBPR approach to provide in-depth community insights into the healthy eating, food preparation and recipe accessibility barriers faced by individuals living with cognitive disabilities in the current Canadian society. The project provides a recipe selection checklist and recipe adaptation protocol. These documents can be used as a guide by recipe developers to align their resources with the needs of individuals living with cognitive disabilities. Utilizing these resources can help reduce healthy eating barriers and facilitate independent food preparation for not only individuals living with cognitive disabilities, but for the general population as well.