2025 Theses Doctoral

Development, Implementation and Evaluation of a Nutrition Education Intervention for Addressing Food Insecurity and Dietary Acculturation of the Chinese Communities in New York

Wang, Wen-Yuan

Chinese immigrants in the U.S. have historically faced many challenges. At the core of these issues is racial discrimination, ranging from historical injustices like the Chinese Exclusion Act in 1882 to contemporary Asian hate crimes exacerbated by the COVID-19 pandemic. This is coupled with economic and cultural tensions and a pervasive fear of xenophobia. Additionally, the model minority myth masks the real struggles of this community, leading to underreported food insecurity and resistance to utilizing federal assistance programs like SNAP due to associated stigmas and cultural pride. Dietary acculturation presents another layer of complexity. Both high and low acculturation levels are associated with unhealthy dietary habits and related health risks. In addition, the research literature highlighted the health risks of Chinese immigrants in the U.S., including hypertension, diabetes, and cardiovascular disease, along with dietary challenges like low calcium and high sodium intake.

Despite the urgent need, few culturally and linguistically appropriate nutrition interventions have been designed to address the personal, social, cultural, and structural barriers experienced by this population.This dissertation describes the development, implementation, and evaluation of NutriPath—a community-based, theory-informed nutrition education intervention—developed using the Nutrition Education DESIGN Procedure to promote food security and healthy dietary acculturation among food-insecure Chinese American adults.

The intervention was developed through a multi-phase, community-based participatory research (CBPR) approach, grounded in social cognitive theory. The nutrition education design process began with formative qualitative research, including in-depth interviews and focus groups with Chinese community members. The findings of the in-depth interviews revealed four interconnected barriers: (1) limited ability to process and cope with trauma (individual level); (2) negative effects of bonding and bridging social capital (social level); (3) unbalanced dynamics between acculturation and enculturation in dietary behavior (cultural level); and (4) a vulnerable and inequitable food system (environmental level). Next, through a series of community stakeholder focus groups, the program identified objectives of each session and a central behavior change goal: increasing food utilization and food accessibility of free food resources. These findings informed the curriculum design.

The curriculum began with an orientation session, including a tutorial on accessing online food resources and a SNAP benefits workshop in partnership with the Chinese-American Planning Council. Subsequent sessions were designed to address key dietary and behavioral goals: Lesson 1 focused on preventing chronic diseases through culturally relevant MyPlate adaptations; Lesson 2 covered ways to increasing calcium and reducing sodium intake in Chinese diet; Lesson 3 promoted using pantry ingredients to cook familiar Chinese dishes; Lesson 4 encouraged trying healthy American foods in an accessible way. A weekend family workshop (optional) aimed to enhance social connectedness and peer support of the exit session. The program concluded with an action-planning session, post-survey, and focus groups. Each session incorporated interactive activities, food demonstrations, visual handouts, and WeChat-based group chats to reinforce content and build community.

The six-week program, taught in Mandarin, was implemented in two cohorts (n total=53) at UA3, a Chinatown-based food pantry in Manhattan, New York. The evaluation used mix-methods. The quantitative data was collected through pre- and post- surveys that measured behavior change outcomes (food accessibility, food utilization, and food insecurity) and motivating and facilitating determinants (nutrition and health literacy, social support, self-efficacy). For behavior change outcomes, food accessibility showed an upward trend, but was not significant. Although the overall behavior scores of food utilization also did not change, this reflected two underlying variables with significant changes in the opposite directions (utilization of food aid packages decreased p = 0.024 and usage of unfamiliar ingredients increased p = 0.037). Lastly, food security was an exploratory measure and did not significantly change. However, several motivating and facilitating determinants demonstrated significant improvements. Nutrition and health literacy improved, with participants reporting a greater awareness of the negative outcomes of current behavior (p = 0.003) and enhanced knowledge and cognitive skills (p < 0.001). In the category of social support, while there were no significant changes in perceived benefits or affective skills, injunctive social norms showed a meaningful increase (p = 0.033). Additionally, for self-efficacy-related determinants, technology-use self-efficacy significantly increased (p = 0.018), and dietary behavior self-efficacy approached significance (p = 0.062).

Process evaluation, which utilized quantitative and qualitative data, demonstrated strong feasibility and acceptability, with high participant engagement, success of hands-on learning, and minimal financial burden. Challenges such as venue limitations, attendance variability, and literacy/technology barriers were addressed through programmatic adjustments.

This dissertation offers a replicable model for addressing the dual challenges of food insecurity and dietary acculturation in Chinese immigrant communities in New York City. It underscores the importance of culturally tailored curriculum design and collaborative implementation for nutrition interventions that promote health equity and resilience in underserved populations. Building on this model, the study also offers broader insights for improving intervention design and delivery in other immigrant communities:

1. It is essential to reframe food insecurity through a cultural lens when working with linguistically isolated immigrant populations, as standardized tools often overlook cultural nuances, making mixed-methods approaches crucial for capturing lived experiences and uncovering hidden barriers.
2. To improve food accessibility and utilization in immigrant communities, interventions should incorporate culturally relevant content and dietary acculturation strategies. Older adults often require intensive exposure for sustainable adaptation.
3. While a higher engagement level of community-based participatory research (CBPR) in developing curriculum may strengthen cultural relevance, it also requires greater resources and may reduce scalability.
4. Culturally tailored, transcultural approaches that honor traditional practices while introducing elements of the host food culture are key to supporting healthy dietary acculturation for immigrant participants.
5. Depending on financial feasibility, low or uneven English literacy level can be addressed at varied level through bilingual and visual materials, small group format, hands-on learning, and individualized support that ensure program inclusivity and accessibility.

Together, these findings demonstrate the potential of culturally tailored, community-based strategies to advance nutrition equity in immigrant populations and lay the groundwork for scalable, inclusive interventions in diverse underserved communities. These lessons highlight the importance of designing nutrition programs that are not only evidence-based but also deeply responsive to the cultural, linguistic, and structural realities of the populations they are intended to serve.