JMIR Publications

ABSTRACT

Background:

Food is Medicine (FIM) interventions are increasingly being integrated into healthcare and community settings. Although FIM interventions show promise for improving diet and clinical outcomes, results have been mixed, and positive effects may attenuate over time. Nutrition education and the integration of evidence-based dietary patterns, such as the Dietary Approaches to Stop Hypertension (DASH), are considered critical components of FIM interventions, but are not consistently applied in FIM programming. Also, nutrition education is often supported by prescriptive, recipe-based instructions that may not prepare individuals to adapt meals based on available ingredients, preferences, and real-world constraints. Digital applications have emerged in FIM interventions, offering an opportunity to extend and sustain this support. Thus, the GRACE Kitchen app was developed based on the GRACE (Ground with a base like grains, add Real vegetables and protein, add Aromatics, use a gentle Cooking method, Enhance with herbs and spices) Framework to support flexible, participant-driven meal construction.

Objective:

We describe the development of the GRACE Framework and its translation into the GRACE Kitchen web application prototype, and we examine preliminary user feedback on the app.

Methods:

A mixed-methods design was used to develop the app supported by the GRACE Framework and informed by the DASH diet, across three phases. First, qualitative interviews (n=17) from participants who had hypertension in a 12-week pilot FIM hypertension (FIM-HT) intervention were analyzed to identify facilitators and barriers to sustaining DASH-aligned eating with produce delivery and nutrition education. Second, these themes informed the development of the GRACE Framework, which led to the GRACE Kitchen app. Third, the prototype was pilot tested among FIM breast cancer survivor (FIM-BCS) participants (n=12) over 8 weeks using the Mobile App Usability Questionnaire (MAUQ) and focus group data to understand further GRACE Kitchen app refinement.

Results:

A total of 29 participants contributed to the development of the GRACE Framework and the GRACE Kitchen app. Of those, the FIM-BCS participants (n=12) reported usability (3.2/5), satisfaction (4.0/5), and usefulness (3.67/5). The FIM-BCS participants also provided qualitative findings that indicated strong acceptability of the meal-building approach, with participants valuing ingredient-based guidance and meal structure over traditional recipes. Reported challenges included navigation and accessibility.

Conclusions:

Participants reported moderate-to-high satisfaction and perceived usefulness with slightly lower ease-of-use ratings for the app. Findings suggest that a flexible, skill-based cooking framework may support sustained dietary practices. The GRACE framework, delivered through the GRACE Kitchen app, integrates practical meal construction and flexible cooking support into FIM interventions and identifies opportunities for continued app development to improve usability. Clinical Trial: 1. ClinicalTrials.gov; # NCT05796648; https://clinicaltrials.gov/study/NCT05796648; "Preparing a Food Is Medicine Intervention to Promote Healthy Eating and Blood Pressure Control" 2. ClinicalTrials.gov; NCT05796648; https://clinicaltrials.gov/study/NCT05796648; "Preparing FIM-BCS - A Lifestyle Modification for African-American Breast Cancer Survivors (FIM-BCS)"