Research Article|Articles in Press

Complex, Varied and Evolving Manifestations of Food Agency in Daily Life Among Diabetes Prevention Program Participants in Baltimore, Maryland

  • Julia A. Wolfson
    Address for correspondence: Julia A. Wolfson, PhD, Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 N Wolfe St, E2612, Baltimore, MD 21205
    Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

    Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

    Department of Health Management and Policy, School of Public Health, University of Michigan, Ann Arbor, MI
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  • Jillian Tse
    Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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  • Adeline Ho
    Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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  • Janice Bowie
    Department of Health Behavior and Society, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD
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  • Nisa Maruthur
    Department of General Internal Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD

    Department of Epidemiology, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD

    Welch Center for Prevention, Epidemiology and Clinical Research, Johns Hopkins University, Baltimore, MD
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  • Caroline R. Richardson
    Department of Family Medicine, School of Medicine, University of Michigan, Ann Arbor, MI
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  • Amy Trubek
    Department of Nutrition and Food Sciences, College of Agriculture and Life Sciences, University of Vermont, Burlington, VT
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Published:April 25, 2023DOI:



      To characterize food agency (one's capacity to procure and prepare food in particular contexts) among Diabetes Prevention Program (DPP) participants and gather perspectives about experiences with DPP.


      Photograph-elicitation in-depth interviews and survey measures.


      Baltimore, Maryland (June–August 2021).


      Black women (n = 13) who participated in DPP.

      Phenomenon of Interest

      Food agency and strategies used to procure and prepare food and the influence of DPP on daily food behaviors. Surveys measured food agency using the Cooking and Food Provisioning Action Scale and cooking behaviors.


      Thematic analysis of qualitative in-depth interviews and descriptive statistics for quantitative measures.


      As quantitative and qualitative data revealed, participants were frequent and confident cooks with high food agency. Participants viewed cooking as a key strategy for healthy eating and desired more hands-on cooking instruction within DPP to develop new healthy cooking skills. The primary barriers identified were related to lack of time or energy. Food procurement and preparation practices shifted over time, and DPP was a key influence on current behaviors.

      Conclusions and Implications

      Food agency is complex and manifests heterogeneously in daily life. A life course, contextual, and food agency-based approach could be considered for future diabetes prevention interventions.

      Key Words

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