Development, Implementation and Evaluation of a Culturally Adapted Cooking Curriculum to Address Dietary Acculturation and Food Security in a Refugee Population

Background: Sub-Saharan African refugees in the United States have reported food security rates up to seven times below the national average. Dietary acculturation issues have been noted as a contributing factor. However, there is no existing evidence-based or culturally tailored programs to address the unique dietary acculturation barriers to food security for this population.Methods: A four-phase, community-based curriculum adaptation process (information gathering [literature review, researcher informed, and formative research], preliminary adaptation design [data incorporation and steering committee], pilot testing [n=10 youth/adult dyads], and refinement) was applied to the existing evidence-based iCook 4-H curriculum using a five strategy (peripheral, evidential, linguistic, constituent-involving and sociocultural) cultural adaptation framework. First, the unique dietary acculturation barriers and facilitators to food security among Burundian and Congolese refugees living in the Southeastern region of the United States were explored through semi-structured interviews (n=18). Next, these data were incorporated into the existing curriculum with the aid of a multilingual member of the target population and a community-based steering committee (n=5). Finally, the feasibility (recruitment/retention, implementation, fidelity testing, and dyad assessment procedures) and acceptability (process and program evaluations) of implementation and evaluation of the culturally adapted curriculum were measured.Results: Pika Pamoja [Cook Together], an eight-session cooking curriculum for Burundian and Congolese refugee families, resulted. Adaptations were derived from varying combinations of four data sources (literature review, researcher informed, target population and steering committee), applying all five cultural adaptation strategies. Adaptations addressed the identified dietary acculturation barriers and facilitators to food security including difficulty with language, cooking, shopping, and transportation; social network support; reliance and miscomprehension of nutrition assistance programs; and limited culturally relevant food access. All 10 dyads (control and treatment) were retained throughout the pilot testing. All fidelity measurements were 91% or above. Participant feedback was uniformly positive.Conclusions: This study demonstrated a community-based cultural adaptation process that could be adopted to address dietary acculturation and food security issues among various refugee populations. Based on these results, Pika Pamoja was feasible to implement and was accepted by the target population. Larger scale studies to measure the effectiveness of Pika Pamoja to increase food security among refugee families are needed.