In rural Georgia, where access to fresh food is limited and traditional diets are central to daily life, patients need support that extends beyond clinic walls, rooted in their homes, families, and communities. Sustained dietary change is most effective when it builds on shared routines and cultural strengths, not when patients are left to navigate it alone. Long-term support must foster collective engagement to prevent complications and promote lasting health.

• Rural diabetes patients and families with low income and limited transportation, often making food decisions collectively
• Households that rely on dollar stores or food pantries as primary food sources
• Patients influenced by informal food networks (social media, family advice, community leaders), rather than formal health education channels

While clinics may offer initial education on diabetes management, patients often receive little to no follow-up once they return home. Applying that guidance can be difficult due to cultural food preferences, financial limitations, and varying levels of health literacy. Without ongoing support, many patients fall back on familiar, less healthy meals or turn to social media for advice, which often provide inaccurate or conflicting information.

Although community resources like food pantries, cooking classes, and local health initiatives exist, they are rarely coordinated with clinical care or structured to support habit-building at home. Programs led by Extension agents, promotoras, or community health workers have shown promise, but these partnerships are underutilized and often operate in isolation from the healthcare system. Community workshops can be effective but are frequently dependent on short-term grant funding.

Without ongoing support, even well-intentioned dietary changes often fail to last, as many patients lack practical tools to apply advice within their daily routines, whether shopping at dollar stores, cooking for families, or honoring cultural food traditions. This absence of culturally relevant, sustained guidance at home creates a gap between clinical recommendations and real-world practice that current care models seldom address. Moreover, existing approaches frequently isolate the patient as the sole agent of change, placing the burden of making drastic adjustments on them alone. A more effective strategy would engage family and community networks, transforming nutrition education into a collective effort that supports not only the patient but also their broader social environment.

NEEDS STATEMENT:

Empower patients with culturally relevant, practical tools and community-based support to sustain healthy eating habits beyond the clinic, rooted in their daily routines, food environments, and social networks.

REQUIREMENTS:

• Tools can include:
• Mobile-friendly, multilingual toolkits featuring meal planning ideas tailored to local grocery and dollar store inventories.
• Culturally relevant recipe cards and video demonstrations that promote healthier adaptations of traditional dishes familiar to the community.
• Highlighting/alerts of existing community resources (food pantries, cooking classes, Extension programs).
• Diabetes-educator facing resources such that trusted community leaders (ex. promotoras, church figures) can easily use recommendations to organize community events.
• Connection with sustainable funding options to maintain and scale community nutrition programs beyond short-term grants and workshops.
• Platform for connecting with peers/neighbors with similar dietary goals to share ideas, recipes, etc.