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Feasibility and Acceptability of a Culinary Nutrition Programme for Adults with Mild-to-Moderate Intellectual Disability: FLIP Food and Lifestyle Information Programme

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Title: Feasibility and Acceptability of a Culinary Nutrition Programme for Adults with Mild-to-Moderate Intellectual Disability: FLIP Food and Lifestyle Information Programme
Language: English
Authors: R. C. Asher, V. A. Shrewsbury, B. Innes, A. Fitzpatrick, S. Simmonds, V. Cross, A. Rose, E. Hinton, C. E. Collins
Source: Journal of Applied Research in Intellectual Disabilities. 2024 37(5).
Availability: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
Peer Reviewed: Y
Page Count: 15
Publication Date: 2024
Document Type: Journal Articles
Reports - Research
Descriptors: Foreign Countries, Mild Intellectual Disability, Nutrition, Moderate Intellectual Disability, Program Effectiveness, Nutrition Instruction, Adults, Food, Foods Instruction, Cooking Instruction, Daily Living Skills, Health Promotion, Learner Engagement, Accessibility (for Disabled), Student Volunteers, Service Learning
Geographic Terms: Australia
DOI: 10.1111/jar.13281
ISSN: 1360-2322
1468-3148
Abstract: Background: Culinary nutrition education can support improved diet-related health and wellbeing. This pre-post pilot study aimed to assess feasibility and acceptability of an eight-session culinary nutrition programme, the Food and Lifestyle Information Programme (FLIP), for adults with mild-to-moderate intellectual disability. A secondary aim was to evaluate preliminary programme effectiveness. Method: Participants were recruited through a disability service provider. Feasibility measures were: recruitment and retention; implementation; engagement and participation; adverse outcomes; and feasibility of outcome measures. Acceptability was assessed using an interactive process evaluation. Effectiveness measures included cooking frequency, cooking and food skill confidence and diet quality. Results: Six of eight participants completed the intervention with high attendance and programme engagement. FLIP was well received by participants and support workers. No adverse outcomes occurred. Diet quality was feasible to assess. Conclusions: Findings can inform content, delivery and evaluation of future culinary nutrition programmes for adults with mild-to-moderate intellectual disability.
Abstractor: As Provided
Entry Date: 2024
Accession Number: EJ1435676
Database: ERIC
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  Value: <anid>AN0179071278;e0301sep.24;2024Aug20.06:00;v2.2.500</anid> <title id="AN0179071278-1">Feasibility and acceptability of a culinary nutrition programme for adults with mild‐to‐moderate intellectual disability: FLIP Food and Lifestyle Information Programme </title> <p>Background: Culinary nutrition education can support improved diet‐related health and wellbeing. This pre‐post pilot study aimed to assess feasibility and acceptability of an eight‐session culinary nutrition programme, the Food and Lifestyle Information Programme (FLIP), for adults with mild‐to‐moderate intellectual disability. A secondary aim was to evaluate preliminary programme effectiveness. Method: Participants were recruited through a disability service provider. Feasibility measures were: recruitment and retention; implementation; engagement and participation; adverse outcomes; and feasibility of outcome measures. Acceptability was assessed using an interactive process evaluation. Effectiveness measures included cooking frequency, cooking and food skill confidence and diet quality. Results: Six of eight participants completed the intervention with high attendance and programme engagement. FLIP was well received by participants and support workers. No adverse outcomes occurred. Diet quality was feasible to assess. Conclusions: Findings can inform content, delivery and evaluation of future culinary nutrition programmes for adults with mild‐to‐moderate intellectual disability.</p> <p>Keywords: adults; culinary; inclusive research; intellectual disability; nutrition</p> <hd id="AN0179071278-2">INTRODUCTION</hd> <p>People with intellectual disability experience high prevalence of chronic diseases more frequently (Cooper et al., [<reflink idref="bib16" id="ref1">16</reflink>]; Emerson & Baines, [<reflink idref="bib19" id="ref2">19</reflink>]; Flygare Wallén et al., [<reflink idref="bib21" id="ref3">21</reflink>]; Reppermund et al., [<reflink idref="bib46" id="ref4">46</reflink>]), are more likely to rate their health as poor (Emerson et al., [<reflink idref="bib20" id="ref5">20</reflink>]; Young‐Southward et al., [<reflink idref="bib53" id="ref6">53</reflink>]), and have on average 20 years reduced life expectancy than people without intellectual disability (O'Leary et al., [<reflink idref="bib43" id="ref7">43</reflink>]). Higher rates of overweight and obesity (Melville et al., [<reflink idref="bib39" id="ref8">39</reflink>]; Ranjan et al., [<reflink idref="bib44" id="ref9">44</reflink>]), diabetes mellitus (Cooper et al., [<reflink idref="bib16" id="ref10">16</reflink>]; Flygare Wallén et al., [<reflink idref="bib21" id="ref11">21</reflink>]) and mental health conditions (Cooper et al., [<reflink idref="bib16" id="ref12">16</reflink>]; Emerson & Baines, [<reflink idref="bib19" id="ref13">19</reflink>]) are consistently reported, compared with the population without intellectual disability. Dietary intake studies in people with intellectual disability indicate poor diet quality with inadequate intakes of vegetables, fruit and fibre, and high intakes of energy‐dense, nutrient‐poor 'discretionary' foods, increasing risk of micronutrient inadequacy and diet‐related chronic disease (Gast et al., [<reflink idref="bib23" id="ref14">23</reflink>]; Hamzaid et al., [<reflink idref="bib28" id="ref15">28</reflink>]; Hoey et al., [<reflink idref="bib30" id="ref16">30</reflink>]). Conditions associated with intellectual disability can place people at higher risk of poor diet‐related health outcomes, for example higher risk of diabetes mellitus in people with down syndrome (Nordstrøm et al., [<reflink idref="bib42" id="ref17">42</reflink>]), hyperphagia associated with Prader Willi syndrome (Tan et al., [<reflink idref="bib51" id="ref18">51</reflink>]), and dysphagia that can occur with cerebral palsy (Colver et al., [<reflink idref="bib14" id="ref19">14</reflink>]). While higher rates of poor health can be attributed in part to nonmodifiable factors associated with intellectual disability, risks may be attenuated by changes in diet and lifestyle (Emerson & Baines, [<reflink idref="bib19" id="ref20">19</reflink>]; Ranjan et al., [<reflink idref="bib44" id="ref21">44</reflink>]).</p> <p>In people without disability, frequently preparing meals at home, and having higher cooking and meal planning confidence is associated with dietary patterns that align more closely to recommendations outlined in food‐based dietary guidelines (Lavelle et al., [<reflink idref="bib36" id="ref22">36</reflink>]; McGowan et al., [<reflink idref="bib38" id="ref23">38</reflink>]). Culinary nutrition education uses culinary practice to provide evidence‐based education, which includes practical application of nutrition recommendations (Condrasky & Hegler, [<reflink idref="bib15" id="ref24">15</reflink>]). In people without intellectual disability, research on teaching practical skills in healthy meal planning and preparation has generally shown positive effects on adults' vegetable and fruit intakes and cooking confidence (Asher, Shrewsbury, et al., [<reflink idref="bib4" id="ref25">4</reflink>]; Reicks et al., [<reflink idref="bib45" id="ref26">45</reflink>]). Culinary nutrition education programmes for people with intellectual disability may be a potential strategy to address diet‐related disease risk, while simultaneously increasing capacity for independent living.</p> <p>Group culinary nutrition education programmes have been evaluated in people with intellectual disability (Bennett & Cunningham, [<reflink idref="bib9" id="ref27">9</reflink>]; Goldschmidt & Song, [<reflink idref="bib25" id="ref28">25</reflink>]), and people with intellectual and/or developmental disabilities (Barnhart et al., [<reflink idref="bib8" id="ref29">8</reflink>]; Subach & Sullivan, [<reflink idref="bib50" id="ref30">50</reflink>]; Wilneff, [<reflink idref="bib52" id="ref31">52</reflink>]). Findings indicate the potential for group culinary nutrition education to support independence, confidence and enjoyment in meal preparation and cooking, increase nutrition knowledge, improve dietary intake and opportunities to socialise with peers (Barnhart et al., [<reflink idref="bib8" id="ref32">8</reflink>]; Bennett & Cunningham, [<reflink idref="bib9" id="ref33">9</reflink>]; Goldschmidt & Song, [<reflink idref="bib25" id="ref34">25</reflink>]; Subach & Sullivan, [<reflink idref="bib50" id="ref35">50</reflink>]; Wilneff, [<reflink idref="bib52" id="ref36">52</reflink>]). A mixed methods evaluation of a culinary nutrition programme in people with developmental disabilities reported reduced barriers to cooking (Barnhart et al., [<reflink idref="bib8" id="ref37">8</reflink>]). The same study also found positive changes in food preparation and consuming a balanced diet from pre‐to‐post culinary nutrition programme implementation and at six‐month follow up (Barnhart et al., [<reflink idref="bib8" id="ref38">8</reflink>]).</p> <p>Group culinary nutrition education for adults with intellectual disability requires a different approach to programmes for people without disability (Goldschmidt & Song, [<reflink idref="bib25" id="ref39">25</reflink>]). This may include adaptations to practical hands‐on tasks, use of repetition and additional assistance from people, such as disability support workers and caregivers, who may also reinforce and support translation of culinary nutrition education to the home environment (Barnhart et al., [<reflink idref="bib8" id="ref40">8</reflink>]; Goldschmidt & Song, [<reflink idref="bib25" id="ref41">25</reflink>]). While people with intellectual disability have the capacity to plan, shop, prepare and cook their own meals to different degrees, the level of participation in such activities may fluctuate depending on the day and the situation (Adolfsson et al., [<reflink idref="bib1" id="ref42">1</reflink>]) and needs to be considered in programme planning. Use of inclusive methods and accessible materials, such as those developed for people with low literacy (Australian Government, [<reflink idref="bib7" id="ref43">7</reflink>]) may also be required (Barnhart et al., [<reflink idref="bib8" id="ref44">8</reflink>]; Goldschmidt & Song, [<reflink idref="bib25" id="ref45">25</reflink>]; Naaldenberg et al., [<reflink idref="bib40" id="ref46">40</reflink>]; Subach & Sullivan, [<reflink idref="bib50" id="ref47">50</reflink>]). Furthermore, there are recommendations to include people with intellectual disability in the research process and to support intervention development that addresses the specific needs of people with intellectual disability (Naaldenberg et al., [<reflink idref="bib40" id="ref48">40</reflink>]).</p> <p>To date there are no culinary nutrition education programmes for people with intellectual disability that have been developed and evaluated in the Australian context. Nor have programmes been identified internationally that aim to improve diet‐related health and wellbeing of people with intellectual disability through delivery of culinary nutrition interventions developed specifically for and together with people who have an intellectual disability, utilising expertise of their lived experience through inclusive or co‐design research methods.</p> <p>The aims of the current pilot study were to: (<reflink idref="bib1" id="ref49">1</reflink>) pilot and assess feasibility and acceptability, and identify any potential adverse outcomes, of the 'Food and Lifestyle Information Programme' (FLIP), which is a culinary nutrition education programme for adults with mild‐to‐moderate intellectual disability, and (<reflink idref="bib2" id="ref50">2</reflink>) evaluate feasibility of tools and instruments used for outcome evaluation of FLIP. Secondary aims were to explore preliminary effectiveness of FLIP in increasing FLIP participants': (<reflink idref="bib1" id="ref51">1</reflink>) cooking frequency, cooking and food skill confidence, and (<reflink idref="bib2" id="ref52">2</reflink>) diet quality scores.</p> <hd id="AN0179071278-3">METHOD</hd> <p></p> <hd id="AN0179071278-4">Study design</hd> <p>A pre‐post pilot feasibility study was conducted at the University of Newcastle, in the Hunter region of New South Wales (NSW), Australia. The Cook‐Ed™ model (Asher et al., [<reflink idref="bib3" id="ref53">3</reflink>]) guided development of FLIP, including aims and objectives, implementation and evaluation. The Cook‐Ed™ model consists of eight stages from programme conception, planning, development and evaluation (Asher et al., [<reflink idref="bib3" id="ref54">3</reflink>]). Based on the PRECEDE‐PROCEED model (Gielen et al., [<reflink idref="bib24" id="ref55">24</reflink>]) the Cook‐Ed™ framework guides culinary nutrition programme developers and providers through key stages to create evidence‐based culinary nutrition programmes aimed at improving diet and health and also tailored to the specific needs of the group (Asher et al., [<reflink idref="bib3" id="ref56">3</reflink>]). Utilising co‐design and inclusive research principles (Frankena et al., [<reflink idref="bib22" id="ref57">22</reflink>]; Strnadová et al., [<reflink idref="bib49" id="ref58">49</reflink>]) the FLIP programme and pilot study was developed in partnership with a disability service provider and people with intellectual disability. Details of FLIP development are described elsewhere (Asher et al., [<reflink idref="bib5" id="ref59">5</reflink>]).</p> <hd id="AN0179071278-5">Participants, recruitment and consent</hd> <p>Adults aged 18 years and over with mild‐to‐moderate intellectual disability registered with a disability service provider were eligible to participate. Level of intellectual disability was based on information collected by the disability service provider when clients were registered with their services. Participants were required to have capacity building funding within their National Disability Insurance Scheme (NDIS) plan as a pre‐requisite to attend FLIP with a disability support worker. The NDIS is an Australian Government funding service that supports people with disability to access reasonable and necessary services for participation in society (Laragy & Fisher, [<reflink idref="bib35" id="ref60">35</reflink>]). There was an exception for participants without a support worker if they could manage: (a) independent attendance at FLIP and participation in society, paid or voluntary employment and/or other day programmes, and (b) their transport independently.</p> <p>Disability service provider staff were notified of the study via internal communication and verbally informed eligible participants about the research through their usual activities and interactions. Those expressing interest to participate in the study were provided with both comprehensive and accessible participant information statements and consent forms, developed in accordance with Easy Read guidelines (Australian Government, [<reflink idref="bib7" id="ref61">7</reflink>]), allowing participants to provide their own informed consent. Prospective participants were encouraged to carefully consider and discuss participation with a family member, carer or guardian before providing consent. Participants were supported by their support worker to complete accessible and comprehensive registration forms, which included demographic data and a 35‐item pictorial home kitchen survey adapted from the Home CookERI™ domestic kitchen assessment tool (Schönberg et al., [<reflink idref="bib48" id="ref62">48</reflink>]). This enabled the facilitator to modify cooking equipment used in teaching specific techniques to individual participants as required.</p> <p>The number of participants was selected based on capacity of the teaching kitchen, COVID‐19 considerations, intervention resources available and capacity to individualise programme components to the unique support needs of participants while still maintaining a safe and social learning environment. Being a feasibility study, it was not powered to detect significant changes in outcome evaluation measures.</p> <hd id="AN0179071278-6">Ethics and safety review</hd> <p>The study received ethics approval from the University of Newcastle Human Research Ethics Committee (H‐2019‐0377). Risk assessment and safety review was conducted prior to intervention commencement and included manual handling, use of sharp instruments, small electrical appliances and hot cooking equipment, food handling, kitchen cleaning and hygiene, allergy management, shared meals, and educational considerations for safe conduct of food preparation and cooking outside the programme. Safety review approval was obtained from the University of Newcastle Health and Safety Team (L1 56‐2020). In July 2021, safety procedures were revised prior to commencement of group one in response to changing COVID‐19 public health orders. For example, changes to safety protocols to support social distancing included designated workbenches, fridges, separate dry storage areas and capacity limits in the teaching kitchen. While a teaching kitchen capacity limit was set, it did not influence recruitment targets for either group as the teaching kitchen had adequate capacity. In line with public health orders, changes also included use of face masks for facilitators and support workers. It was not a requirement for participants with intellectual disability to wear face masks, however their choice to do so was supported. Safety procedures were reviewed again prior to commencement of group two in response to revised COVID‐19 public health orders and relocation of the teaching kitchen. For example, as the new teaching kitchen did not allow for designated fridges and dry store areas for participants, safety procedures were revised to enable use of communal food storage areas.</p> <hd id="AN0179071278-7">Intervention</hd> <p>FLIP is an original 8‐week culinary nutrition education programme developed specifically for, and designed with adults with intellectual disability, a disability service provider, and the first author (Asher et al., [<reflink idref="bib5" id="ref63">5</reflink>]). Consisting of three to four‐hour sessions once per week, each session included nutrition, food and kitchen safety education, a cooking activity and a shared meal. An example FLIP session outline is shown in Box 1. Sessions were facilitated by the first author (R.A.) and co‐facilitated by a paid researcher with mild‐intellectual disability and volunteer Bachelor Nutrition and Dietetics and Bachelor Occupational Therapy students. Each session contained a new theme that aligned with Australian Guide to Healthy Eating (AGHE) food groups (National Health and Medical Research Council, [<reflink idref="bib41" id="ref64">41</reflink>]). For example, the week three session theme was 'eat the rainbow', which aligned with the AGHE vegetables/beans food group. Nutrition education focused on the benefits of consuming a wide variety of vegetables, and the cooking activity consisting of preparation of colourful dips with crudités and crackers. The week four theme linked to the AGHE grain (cereal) foods, mostly wholegrain and/or high cereal fibre varieties (National Health and Medical Research Council, [<reflink idref="bib41" id="ref65">41</reflink>]). Nutrition education consisted of benefits of consuming wholegrains and how to identify wholegrain foods. The cooking activity in this session used wholegrain breads and/or cereals (e.g., brown rice). Further details and descriptions of FLIP session content are included in Data S1.</p> <p>The Cook‐Ed™ matrix was used to select and prioritise curriculum content for alignment with Australian Dietary Guidelines (Asher, Jakstas, et al., [<reflink idref="bib2" id="ref66">2</reflink>]; National Health and Medical Research Council, [<reflink idref="bib41" id="ref67">41</reflink>]). All written resources were developed in accordance with the Easy Read style (Australian Government, [<reflink idref="bib7" id="ref68">7</reflink>]). Recipes were designed to promote independent meal preparation by using, pre‐prepared ingredients (e.g. pre‐cut vegetables) where practical and affordable, colour coded measuring utensils, instructions were broken down into individual steps, and presented in Easy Read format (Australian Government, [<reflink idref="bib7" id="ref69">7</reflink>]). Intervention description aligning with the TIDieR checklist (Hoffmann et al., [<reflink idref="bib31" id="ref70">31</reflink>]) is presented in Data S2.</p> <hd id="AN0179071278-8">Families, carers and guardians, and support worker components</hd> <p>To identify strengths and support requirements, evaluate participant proficiency in safe use of knives and hot items, and enable modifications or adaptations, Bachelor of Occupational Therapy students conducted objective evaluation of cooking performance with participants using a cooking task analysis protocol developed specifically for the study. To enable participants the opportunity to become familiar with the teaching kitchen a baseline cooking task analysis was conducted during Sessions 2 and 3. As there is potential for cooking task analysis data to be used as an outcome measure in future FLIP interventions it was repeated in Sessions 7 and 8 and is included in outcome measure data collection feasibility assessment.</p> <p>To support participant learning and further guide session planning as the intervention progressed, preformed journal sheets were completed by participants at the end of Sessions 3–6. Personal journals captured information on dishes made, activities completed, what participants learned, liked and would change. The journals also provided an opportunity for participants to set a weekly goal to prepare a main meal (breakfast, lunch or dinner) at their place of residence if this was suitable.</p> <p>Participants' families, carers or guardians and disability service provider support workers were invited to participate in family and support worker components of the study. Family, carer or guardian components included attendance at the first and last FLIP sessions. Data collection included pre‐post diet quality evaluation, proxy diet quality evaluation for their respective FLIP participant, and a family, carer or guardian process evaluation survey. Support workers attended in their paid role to support participants. Support worker study components included pre‐post proxy diet quality evaluation for their respective FLIP participant and a support workers process evaluation survey.</p> <hd id="AN0179071278-9">1 Box Outline of structure for FLIP session activities</hd> <p></p> <ulist> <item> Welcome, introductions (new co‐facilitators and/or support workers) and discussion of cooking activities and new experiences encountered in eating, cooking and/or meal planning/food provision between sessions</item> <p></p> <item> Review of previous sessions nutrition education</item> <p></p> <item> Sensory and visual food display and nutrition education for the session</item> <p></p> <item> 'Get ready to cook'—perform personal hygiene and setting up the cooking station prior to cooking. The same process was followed each week with an emphasis on organising the cooking station, including collecting ingredients and equipment before food preparation commenced</item> <p></p> <item> Demonstration of cooking activity key skills, food safety and kitchen safety education</item> <p></p> <item> Practical cooking activity with facilitators circulating to supervise and provide further education, support assistance or prompting</item> <p></p> <item> Shared meal that included discussion of the cooking activity and sensory properties of the meal</item> <p></p> <item> Food safety education (e.g., transport and storage of food leftover from cooking activity)</item> <p></p> <item> Journal entries which included goal setting/problem solving challenges to home cooking between sessions (Sessions 3–6)</item> </ulist> <hd id="AN0179071278-10">Data collection</hd> <p>Data collection was integrated into weekly sessions, collected at baseline (Sessions 1–3) and post‐intervention (Sessions 7–8). For the purposes of intervention delivery and task analysis data collection, for Sessions 2, 3, 7 and 8 participants were divided into two groups to facilitate both data collection and programme engagement.</p> <p>Valid and reliable instruments for evaluating health and nutrition promotion programmes for people with intellectual disability are lacking (Naaldenberg et al., [<reflink idref="bib40" id="ref71">40</reflink>]). In consultation with the disability service provider, evaluation instruments were adapted or developed using visual aids, accessible language and Easy Read formatting (Australian Government, [<reflink idref="bib7" id="ref72">7</reflink>]). These were reviewed for readability, flow and relevance by two co‐researchers with intellectual disability in a pre‐pilot phase (Asher et al., [<reflink idref="bib5" id="ref73">5</reflink>]). To allow participants to provide their own responses, support workers were present to assist where required and were advised to provide input only if necessary.</p> <hd id="AN0179071278-11">Feasibility and acceptability (primary aim)</hd> <p>Feasibility study design and reporting follows the CONSORT 2010 statement extension to randomised pilot and feasibility trials (Eldridge et al., [<reflink idref="bib18" id="ref74">18</reflink>]) and guidelines for reporting non‐randomised pilot and feasibility studies (Lancaster & Thabane, [<reflink idref="bib34" id="ref75">34</reflink>]). Feasibility and acceptability measures, assessment criteria and outcomes are outlined in Table 1.</p> <p>1 TABLE Feasibility and acceptability measures, criteria and outcomes of the FLIP intervention in adults with mild‐to‐moderate intellectual disability.</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Measure (Feasibility/acceptability criteria)</th><th align="left">Outcome</th></tr></thead><tbody valign="top"><tr><td align="left">Recruitment and retention</td></tr><tr><td align="left">Recruitment (Group 1 n = 4 and Group 2 n = 6)</td><td align="left">Group 1 n = 3 and Group 2 n = 6</td></tr><tr><td align="left">Eligibility<xref ref-type="fn" rid="tfn1" /></td><td align="left">100%</td></tr><tr><td align="left">Commenced<xref ref-type="fn" rid="tfn1" /></td><td align="left">n = 8/9</td></tr><tr><td align="left">Programme retention target (>70%)</td><td align="left">n = 6/9</td></tr><tr><td align="left">Programme implementation</td></tr><tr><td align="left">Fidelity to programme protocol<xref ref-type="fn" rid="tfn1" /></td><td align="left">100% implemented when participants in attendance</td></tr><tr><td align="left">Programme engagement/session participation</td></tr><tr><td align="left">Session attendance (>60%)</td><td align="left">77% (range 0%–100%)</td></tr><tr><td align="left">Cooking activity participation (>70% completed with assistance or minimal assistance)</td><td align="left">80%</td></tr><tr><td align="left">Nutrition activity participation (>70% participated well or moderately well)</td><td align="left">82%</td></tr><tr><td align="left">Journal completion (>50% complete)</td><td align="left">70%</td></tr><tr><td align="left">Recipe or learning request made by participant</td><td align="left">17%</td></tr><tr><td align="left">Adverse outcomes</td></tr><tr><td align="left">Injuries in kitchen requiring medical attention (no events)</td><td align="left">No events</td></tr><tr><td align="left">Slips and falls (no events)</td><td align="left">No events</td></tr><tr><td align="left">Adverse changes in physical health (nil)</td><td align="left">Nil</td></tr><tr><td align="left">Adverse changes in mental health outcomes (nil)</td><td align="left">Nil</td></tr><tr><td align="left">COVID‐19 outbreaks (nil)</td><td align="left">Nil</td></tr><tr><td align="left">Feasibility of outcome measures (>70% complete data for each outcome measure attempted)</td><td align="left">See Table 4</td></tr><tr><td align="left">Acceptability—process evaluation</td></tr><tr><td align="left">Participants audio‐recorded interactive discussion quantitative and quantitative data (>50% participants enjoyed the programme (i.e., majority process evaluation items liked)</td><td align="left">100%</td></tr><tr><td align="left">Support workers and family/carer/guardian questionnaire (>50% report positive feedback (i.e., positive feedback on majority process evaluation items)</td><td align="left">100%</td></tr></tbody></table> </ephtml> </p> <p>1 a Not set a priori by research team.</p> <hd id="AN0179071278-12">Recruitment and retention</hd> <p>Feasibility of recruitment processes was determined by the number of participants recruited to each group, and percentage of participants approached as per the planned recruitment process who were eligible and recruited once provided with participant information statements and consent forms. Programme retention was defined as participants who completed the FLIP programme irrespective of whether they participated in final data collection.</p> <hd id="AN0179071278-13">Programme implementation</hd> <p>Programme implementation, including reasons why activities were not implemented according to the study protocol or were modified was recorded by the facilitator (R.A.) after each session.</p> <hd id="AN0179071278-14">Programme engagement/session participation</hd> <p>Session attendance, programme engagement and participation were recorded using observations and field notes taken by the facilitator (R.A.) throughout the programme. Partial attendance was defined as participants leaving prior to the completion of the session. Partial attendance was included in attendance scoring if the cooking activity was completed prior to the participant leaving. Partial attendance was not included in attendance scoring if the participant left without participating in the cooking activity. Field notes included information on level of participation in the cooking activity (Categorised: cooked/prepared start to finish with minimal assistance, with assistance or contributed only), participation in nutrition activity and group discussion (Categorised: participated well, moderately well, did not participate), completed journal (yes/no), and if a recipe or learning request was made by participants (yes/no).</p> <hd id="AN0179071278-15">Adverse outcomes</hd> <p>Adverse outcomes were recorded if reported to the research team by participants, families, carers or guardians, support workers, the disability service provider or any other person. A process for reporting and recording incidents (e.g., slips or falls) occurring during sessions was in place. Adverse outcomes in physical health were monitored by baseline and post‐intervention weight and body composition analysis using the InBody270 bioelectrical impedance machine (InBody Body Composition Analysers Pty., Ltd., Miami, Australia), and height using a portable stadiometer.</p> <hd id="AN0179071278-16">Feasibility of outcome measures</hd> <p>Feasibility of collecting outcome measures was based on missing or incomplete data for the different outcome measures, at baseline and post‐intervention. Reasons for missing data were recorded. A feasibility target of 70% for each outcome measure data collection was set a priori by the research team.</p> <hd id="AN0179071278-17">Process evaluation</hd> <p>To obtain participants' views on the intervention with minimal need for written language and literacy skills participants were invited to participate in an audio‐recorded interactive process evaluation during the final FLIP session. In collaboration with the service provider a protocol was developed specifically for the study. The evaluation process was discussed with the group in Session 7 and participants were provided with the questions and an Easy Read summary of what would be involved. Participants were encouraged to discuss the evaluation activity with their family, carer or guardian and were provided with the option to submit written feedback if they did not wish to provide verbal feedback or participate in the audio‐recorded evaluation. The evaluation was moderated by the first author (R.A.). As outlined in Krueger and Casey ([<reflink idref="bib32" id="ref76">32</reflink>]) an assistant moderator took notes (V.C., H.D. (see acknowledgements)) throughout the evaluation. These were used to present a summary to the group at the end of the evaluation, enabling confirmation of key points and providing the opportunity for participants to provide further feedback. During the evaluation participants were asked to rate their enjoyment on 25 items specific to the study. Items were grouped as: food safety activities (5 items), cooking activities (11 items), nutrition education (3 items), social aspects (3 items) and research activities (3 items). Visual aids were provided for 19 items. Participants were each provided with a different coloured sticky note to place on items to indicate if they enjoyed (smiley face) or did not enjoy (frown face) them. Participants could select a neutral response. Once all participants had rated their enjoyment on items in each group the FLIP moderator invited participants to provide verbal feedback on items that they least enjoyed, or anything they wanted to suggest to improve FLIP. An example of a participant question with visual aid and participant responses is presented in Data S3.</p> <p>Paper‐based post‐intervention process evaluation surveys were completed by support workers. Based on a previously used community culinary nutrition education programme evaluation (Burrows et al., [<reflink idref="bib11" id="ref77">11</reflink>]), surveys consisted of 20 items ranking responses on a five‐point Likert scale to capture involvement in pre‐programme consultation (Asher et al., [<reflink idref="bib5" id="ref78">5</reflink>]) (3 items), participant (i.e., support worker's client) enjoyment (3 items), session and programme timing (2 items) and the facilitator's knowledge, communication and approachability (3 items). Perceived or observed changes in participants' (i.e., support worker's client) food and beverage intake (5 items) as a result of participation in the programme was obtained using five closed questions. Three open ended questions gathered qualitative information on aspects most enjoyed by participants, suggestions for improving FLIP, and other useful feedback.</p> <hd id="AN0179071278-18">Cooking frequency, cooking and food skill confidence, and diet quality (secondary aim)</hd> <p>Cooking frequency, cooking and food skill confidence and diet quality of participants with intellectual disability were obtained at baseline (Session 1) and on completion (Session 8) of the 8‐week intervention.</p> <hd id="AN0179071278-19">Cooking frequency, cooking and food skill confidence</hd> <p>An interviewer led 16‐item survey evaluated cooking frequency and cooking and food skill confidence. To evaluate cooking frequency participants were asked individually about preparing breakfast, lunch, dinner and snacks for themselves or other people. They were first asked if they prepared food for that meal or occasion. If they replied yes, they were asked about frequency of cooking for each occasion and to provide an example. A modified version of a 33‐item cooking and food skill confidence tool (Lavelle et al., [<reflink idref="bib37" id="ref79">37</reflink>]) was used to evaluate cooking and food skill confidence. Modifications were informed by cooking abilities and challenges experienced by people with intellectual disability (Brunosson et al., [<reflink idref="bib10" id="ref80">10</reflink>]; Granberg, Brante, et al., [<reflink idref="bib26" id="ref81">26</reflink>]; Granberg, Olsson, & Mattsson Sydner, [<reflink idref="bib27" id="ref82">27</reflink>]), in collaboration with the disability service provider, co‐researchers, and to suit the objectives of the programme (Asher et al., [<reflink idref="bib5" id="ref83">5</reflink>]). The modified tool consisted of six cooking skill and five food skill interviewer‐led questions, with visual aids for each question. Responses were recorded on a three‐point Likert scale. Scores for each item were 0 (never do it or not confident), 1 (in between confident and not confident) and 2 (confident) and were summed yielding an overall cooking and food skill confidence score (range 0–22).</p> <hd id="AN0179071278-20">Diet quality</hd> <p>Diet quality was measured using a modified version of the Australian Recommended Food Score (ARFS) (Ashton et al., [<reflink idref="bib6" id="ref84">6</reflink>]; Collins et al., [<reflink idref="bib13" id="ref85">13</reflink>]). The ARFS is a 70‐question food frequency questionnaire, validated in adults, and has significant correlations with a more comprehensive food frequency questionnaire (Burrows et al., [<reflink idref="bib12" id="ref86">12</reflink>]), and plasma carotenoid concentrations (Ashton et al., [<reflink idref="bib6" id="ref87">6</reflink>]; Collins et al., [<reflink idref="bib13" id="ref88">13</reflink>]). The ARFS assesses usual intake in the categories: vegetables, fruit, meat‐based protein foods, vegetable protein foods, breads and cereals, dairy, water and spreads/sauces. Additional points are scored for consuming vegetables ≥5 nights/week, choosing multigrain or whole meal breads, and choosing reduced fat/skim or soy milk. The ARFS was selected as a dietary assessment tool for people with intellectual disability as majority of response options are 'eat less than once a week' or 'eat more than once a week' (Ashton et al., [<reflink idref="bib6" id="ref89">6</reflink>]; Collins et al., [<reflink idref="bib13" id="ref90">13</reflink>]). Visual aids sourced from Shutterstock (Shutterstock, Inc., New York, NY, USA), corresponding with each question, and as closely as possible representing one serve as outlined in the Australian Dietary Guidelines (National Health and Medical Research Council, [<reflink idref="bib41" id="ref91">41</reflink>]), were presented to participants on a computer screen. Questions were read to participants by a member of the research team who recorded responses on an iPad using a preformed Research Electronic Data Capture (REDCap) survey (Vanderbilt University Medical Centre, Nashville, TN, USA) (Harris et al., [<reflink idref="bib29" id="ref92">29</reflink>]).</p> <hd id="AN0179071278-21">Data analysis</hd> <p>STATA Statistical/Data Analysis software, version 15.1 (StataCorp. 2017. Stata Statistical Software: College Station, TX: StataCorp LLC) was used to conduct analysis on quantitative data. Mean (M) and standard deviation (SD) were used to report continuous variables (diet quality scores). Quantitative process evaluation responses for each group were summed. Verbal responses provided by participants during the process evaluation were transcribed verbatim by the first author (R.A.) and summarised as follows. Assistant moderator notes were collated according to their pre‐determined group. Verbatim quotes and moderator notes were used by the first author (R.A.) to create themes within each pre‐determined group. Alignment of themes with verbatim quotes were checked for consistency by a second author (V.S.). As the aim of the process evaluation was to seek participants' views on the FLIP intervention and give participants the opportunity to provide feedback, a narrative summary of themes is presented.</p> <hd id="AN0179071278-22">Co‐authorship</hd> <p>To facilitate co‐authorship findings and outcomes of the pilot study were presented to co‐researchers through regular meetings, using plain language Microsoft PowerPoint slides (Microsoft PowerPoint for Microsoft 365 MSO) and discussion with the first author (R.A.).</p> <hd id="AN0179071278-23">RESULTS</hd> <p></p> <hd id="AN0179071278-24">Feasibility and acceptability (primary aim)</hd> <p>Overall, FLIP was feasible to implement with majority of recruitment, implementation and engagement targets met, high programme engagement and no adverse outcomes. FLIP was acceptable to all participants and support workers, indicated by their positive feedback about FLIP.</p> <hd id="AN0179071278-25">Recruitment and retention</hd> <p>In total, nine participants were recruited to this pilot study. Figure 1 shows the flow of participants in the intervention, from recruitment through to programme and evaluation completion. Three were recruited to pilot Group 1 (July 2021) and six to pilot Group 2 (October 2022). All participants approached by the disability service provider, as per planned recruitment process, met eligibility criteria. Of participants provided with study information, consent was provided, and the intervention was commenced for eight out of nine participants.</p> <p> <img src="https://imageserver.ebscohost.com/img/embimages/rdk/E03/01sep24/jar13281-fig-0001.jpg?ephost1=dGJyMNHX8kSepq84v%2bvlOLCmsE6epq5Srqa4SK6WxWXS" alt="jar13281-fig-0001.jpg" title="1 CONSORT diagram showing flow of participants through the FLIP pre‐post pilot study." /> </p> <p></p> <p>No family, carers or guardians expressed interest in participating, hence none were recruited to either group. Of the three support workers recruited into Group 1, one completed baseline and post‐programme data collection. The decision was made by the research team not to obtain baseline data from support workers in Group 2 as support worker to participant ratio was one per three participants (as opposed to one support worker per one participant in Group 1G) and support workers were not involved in meal provision within participant homes. In Group 2, support workers completed post‐programme process evaluation data collection.</p> <hd id="AN0179071278-27">Participant characteristics</hd> <p>Demographic data were obtained from all nine participants recruited with eight participants completing accessible registration forms and home kitchen surveys. Comprehensive registration forms were completed for all participants. Participant characteristics are described in Table 2.</p> <p>2 TABLE Characteristics of FLIP participants at baseline (n  = 8).</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Characteristics</th><th align="left">Baseline Groups 1 and 2</th></tr></thead><tbody valign="top"><tr><td align="left">Demographic characteristics</td></tr><tr><td align="left">Age</td><td align="left">Median (range)</td></tr><tr><td align="left">22 (20, 38)</td></tr><tr><td align="left" /><td align="left">n</td></tr><tr><td align="left">Female</td><td align="left">4</td></tr><tr><td align="left">Intellectual disability—mild<xref ref-type="fn" rid="tfn2" /></td><td align="left">4</td></tr><tr><td align="left">Intellectual disability—moderate<xref ref-type="fn" rid="tfn2" /></td><td align="left">4</td></tr><tr><td align="left">Aboriginal or Torres strait islander (n = 7)</td><td align="left">1</td></tr><tr><td align="left">Level of education (n = 7)</td><td align="left" /></tr><tr><td align="left">Did not finish high school</td><td align="left">5</td></tr><tr><td align="left">Finished high school</td><td align="left">2</td></tr><tr><td align="left">Certificates from course after high school</td><td align="left">2<xref ref-type="fn" rid="tfn3" /></td></tr><tr><td align="left">Employment status (n = 7)</td><td align="left" /></tr><tr><td align="left">Not currently employed</td><td align="left">7</td></tr><tr><td align="left">Physical impairment relevant to participation in FLIP (n = 8)</td></tr><tr><td align="left">Cerebral palsy</td><td align="left">1</td></tr><tr><td align="left">Food allergy/intolerance (n = 8)</td><td align="left" /></tr><tr><td align="left">Lactose intolerance</td><td align="left">1</td></tr><tr><td align="left">Special diet/dietary restrictions (n = 8)</td><td align="left" /></tr><tr><td align="left">Type 2 diabetes mellitus</td><td align="left">1</td></tr><tr><td align="left">Low iron diet</td><td align="left">1</td></tr><tr><td align="left">Vegan, lactose free</td><td align="left">1</td></tr><tr><td align="left">Diet related health conditions (n = 8)</td><td align="left" /></tr><tr><td align="left">Type 2 diabetes mellitus</td><td align="left">1</td></tr><tr><td align="left">Hypertension</td><td align="left">1</td></tr><tr><td align="left">Gastrointestinal disorders (e.g., IBS)</td><td align="left">2</td></tr><tr><td align="left">None reported</td><td align="left">6</td></tr><tr><td align="left">Aids/supports used in cooking (n = 7)</td><td align="left" /></tr><tr><td align="left">Air fryer</td><td align="left">1</td></tr><tr><td align="left">Nil indicated</td><td align="left">6</td></tr></tbody></table> </ephtml> </p> <ulist> <item>2 a Level of intellectual disability was based on information collected by the disability service provider when clients were registered with their services.</item> <item>3 b One participant did not indicate this on registration form, however it was disclosed by the participant during the intervention.</item> </ulist> <hd id="AN0179071278-28">Programme implementation</hd> <p>Due to the emerging COVID‐19 outbreak during commencement of Group 1, the shared meal activity was removed. Instead food prepared was packaged as a takeaway meal. Across Groups 1 and 2, one session was not delivered as no participants were in attendance. When FLIP sessions were delivered all nutrition education activities, cooking activities and shared meal/COVID‐19 modified takeaway meal activities, and kitchen safety education activities were implemented as planned.</p> <p>Baseline and post‐programme cooking task analysis was completed with five participants. One participant declined cooking task analysis when offered at both baseline and post‐programme sessions. Findings from the task analysis were used to make minor modifications to programme cooking activities and written resources to enhance participant engagement, and support independence in the cooking activity. For example, a participant was provided with a perching stool to reduce fatigue and support energy conservation, while some participants received targeted supervision at key stages during the cooking process, particularly when using knives or hot kitchen equipment. Where required, targeted supervision led to repeated demonstration and/or verbal prompting to support skill development and promote kitchen safety. A summary of modifications is found in Table 3. Journals were completed 70% of the time.</p> <p>3 TABLE Summary of modifications made to enhance participant engagement in FLIP after participants completed the baseline cooking task analysis (n  = 7).</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">FLIP cooking activity component</th><th align="left">Modification</th><th align="left">Modified to support</th></tr></thead><tbody valign="top"><tr><td align="left">Written recipes</td><td align="left">More detailed descriptionAdded more visual aidsReviewed recipe layout</td><td align="left">Task sequencingComprehension</td></tr><tr><td align="left">Workstation</td><td align="left">Allocation of workstation/s close to food storage areasUse of a perching stool</td><td align="left">Reduce fatigueEnergy conservation</td></tr><tr><td align="left">Kitchen equipment</td><td align="left">Utilisation of standard kitchen equipment (e.g., kitchen tray) to aid collecting ingredients and work station organisation</td><td align="left">EfficiencyKitchen safety</td></tr><tr><td align="left">Opportunity to learn about and in some cases trial easily accessible assistive technology, for example various styles of jar and can openers, and devices to provide stability and protect the fingers when cutting, for example guards and scissors</td><td align="left">EfficiencyKitchen safety</td></tr><tr><td align="left">Verbal instruction</td><td align="left">Staggered delivery of tasks and instructions</td><td align="left">Task sequencingConcentrationReduce anxiety</td></tr><tr><td align="left">Increased verbal prompting</td><td align="left">ConcentrationOn task performance</td></tr><tr><td align="left">Demonstration</td><td align="left">Repeated demonstration to model safe technique, for example knife skills</td><td align="left">Acquisition of skillsKitchen safety</td></tr><tr><td align="left">Supervision</td><td align="left">Targeted supervision at key points in the cooking process</td><td align="left">Kitchen safety</td></tr></tbody></table> </ephtml> </p> <hd id="AN0179071278-29">Programme engagement/session participation</hd> <p>Across both groups mean session attendance of 77% was recorded. In total, four partial session attendances occurred. Two partial attendances occurred as the participants became overwhelmed with the setting. These were both in the first week of the intervention. One due to newly introduced COVID‐19 restrictions requiring wearing of masks. The other was attributed to the participant being inadequately prepared for the new environment beforehand. Strategies to prepare participants for future weeks were implemented. For example, additional communication with the participant through family, support workers and/or staff where the participant lives in the days leading up to attendance at FLIP. Both participants completed the intervention. One partial attendance occurred due to illness, and one where no reason was provided. Session participation is summarised in Table 1.</p> <hd id="AN0179071278-30">Adverse outcomes</hd> <p>No adverse outcomes arising from the intervention were reported or observed.</p> <hd id="AN0179071278-31">Feasibility of outcome measures</hd> <p>Of the six participants who completed the 8‐week intervention, complete baseline and post‐intervention data was obtained from five participants for the diet quality, and two participants for the cooking frequency, cooking and food skill confidence survey. One participant completed the programme but did not participate in outcome data collection. Five participants completed the visual process evaluation with audio‐recorded discussion. Of these, one participant's support worker provided responses on behalf of the participant. One participant was unable to attend the audio‐recorded discussion however provided quantitative responses. As these were considered reasonable adjustments, these data were included in feasibility of outcome measure assessment. Outcome measure data collection feasibility targets were met for diet quality, cooking task analysis and process evaluation data, but not for cooking frequency, cooking and food skill confidence. As the majority of data collection methods met the feasibility target of 70%, overall outcome measure data collection was feasible. Feasibility targets are outlined in Table 1. Details of outcome measure data collection and reasons for incomplete data are included in Table 4.</p> <p>4 TABLE Participant baseline and post‐intervention data collection obtained in FLIP pilot Group 1 (May–December 2021 (COVID‐19 interrupted)) and Group 2 (August–December 2022).</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Week (s) (baseline, post)</th><th align="left">Measure</th><th align="left">Group 1 baseline (<italic>n</italic> = 3)</th><th align="left">Group 1 post (<italic>n</italic> = 1)</th><th align="left">Group 2 baseline (<italic>n</italic> = 6)</th><th align="left">Group 2 post (<italic>n</italic> = 5)</th><th align="left">Total (Group 1 and 2)</th><th align="left">Reason for missing data</th></tr></thead><tbody valign="top"><tr><td align="left">Registration—participants with intellectual disability</td></tr><tr><td align="left">0</td><td align="left">Home kitchen assessment</td><td align="left">2</td><td align="left">NA</td><td align="left">6</td><td align="left">NA</td><td align="left">8</td><td align="left">Group 1 baseline: Communication issues (n = 1)</td></tr><tr><td align="left">0</td><td align="left">Accessible registration</td><td align="left">2</td><td align="left">NA</td><td align="left">6</td><td align="left">NA</td><td align="left">8</td><td align="left">Group 1 baseline: Communication issues (n = 1)</td></tr><tr><td align="left">0</td><td align="left">Comprehensive registration</td><td align="left">3</td><td align="left">NA</td><td align="left">6</td><td align="left">NA</td><td align="left">9</td><td align="left">NA</td></tr><tr><td align="left">Outcome measures—participants with intellectual disability</td><td align="left">Total completers (n = 6)</td><td align="left" /></tr><tr><td align="left">1–2, 7–8</td><td align="left">Cooking frequency, cooking and food skills confidence</td><td align="left">3</td><td align="left">1</td><td align="left">2</td><td align="left">1</td><td align="left">2</td><td align="left">Group 2 baseline: Not offered due to time constraints (n = 4)Group 2 post: Not offered due to time constraints (n = 4)</td></tr><tr><td align="left">1–2, 7–8</td><td align="left">Diet quality</td><td align="left">3</td><td align="left">1</td><td align="left">5</td><td align="left">4</td><td align="left">5</td><td align="left">Group 2 baseline: Declined (n = 1)Group 2 post: Collected but removed due to researcher concerns for accuracy of data collected (n = 1)</td></tr><tr><td align="left">2–3, 7–8</td><td align="left">Cooking task analysis (completed in duplicate)</td><td align="left">2</td><td align="left">1</td><td align="left">5</td><td align="left">4</td><td align="left">5</td><td align="left">Group 1 baseline: Scheduled for Week 3, not completed due to COVID‐19 pause (n = 1)Group 2 baseline: Declined (n = 1)Group 2 post: Declined (n = 1)</td></tr><tr><td align="left">8</td><td align="left">Process evaluation</td><td align="left">NA</td><td align="left">1</td><td align="left">NA</td><td align="left">5<xref ref-type="fn" rid="tfn4" /></td><td align="left">6<xref ref-type="fn" rid="tfn4" /></td><td align="left">Group 2 post: Not present for all data collection (n = 1)<xref ref-type="fn" rid="tfn4" /></td></tr></tbody></table> </ephtml> </p> <p>4 a Partially complete.</p> <hd id="AN0179071278-32">Process evaluation</hd> <p>In total, six participants (one in Group 1, five in Group 2) completed the process evaluation. FLIP participants' quantitative process evaluation responses can be found in Table 5.</p> <p>5 TABLE FLIP participants process evaluation quantitative responses (n  = 6).</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Question</th><th align="left">Not liked</th><th align="left">Neutral</th><th align="left">Liked</th></tr></thead><tbody valign="top"><tr><td align="left">Food safety</td></tr><tr><td align="left">Washing hands</td><td align="char" char=".">0</td><td align="char" char=".">0</td><td align="char" char=".">6</td></tr><tr><td align="left">Wearing an apron</td><td align="char" char=".">2</td><td align="char" char=".">0</td><td align="char" char=".">4</td></tr><tr><td align="left">Wearing a hat or hair net (n = 5)</td><td align="char" char=".">2</td><td align="char" char=".">0</td><td align="char" char=".">3</td></tr><tr><td align="left">Washing fruit and vegetables</td><td align="char" char=".">0</td><td align="char" char=".">0</td><td align="char" char=".">6</td></tr><tr><td align="left">Cleaning up after cooking</td><td align="char" char=".">3</td><td align="char" char=".">0</td><td align="char" char=".">3</td></tr><tr><td align="left">Cooking</td></tr><tr><td align="left">Setting up my cooking station</td><td align="char" char=".">0</td><td align="char" char=".">0</td><td align="char" char=".">6</td></tr><tr><td align="left">Collecting ingredients</td><td align="char" char=".">1</td><td align="char" char=".">0</td><td align="char" char=".">5</td></tr><tr><td align="left">Collecting equipment I needed to cook</td><td align="char" char=".">0</td><td align="char" char=".">0</td><td align="char" char=".">6</td></tr><tr><td align="left">Reading/following the recipes</td><td align="char" char=".">0</td><td align="char" char=".">2</td><td align="char" char=".">4</td></tr><tr><td align="left">Being able to choose what I cook</td><td align="char" char=".">1</td><td align="char" char=".">0</td><td align="char" char=".">5</td></tr><tr><td align="left">Cutting ingredients with a knife</td><td align="char" char=".">1</td><td align="char" char=".">0</td><td align="char" char=".">5</td></tr><tr><td align="left">Mixing ingredients</td><td align="char" char=".">0</td><td align="char" char=".">0</td><td align="char" char=".">6</td></tr><tr><td align="left">Cooking food on the stove</td><td align="char" char=".">0</td><td align="char" char=".">0</td><td align="char" char=".">6</td></tr><tr><td align="left">Cooking food in the oven</td><td align="char" char=".">1</td><td align="char" char=".">0</td><td align="char" char=".">5</td></tr><tr><td align="left">Eating the food (i.e., was the food tasty?)</td><td align="char" char=".">0</td><td align="char" char=".">1</td><td align="char" char=".">5</td></tr><tr><td align="left">Trying food I have not tasted before</td><td align="char" char=".">0</td><td align="char" char=".">3</td><td align="char" char=".">3</td></tr><tr><td align="left">Nutrition education</td></tr><tr><td align="left">The talks about different foods (i.e., core food groups)</td><td align="char" char=".">1</td><td align="char" char=".">2</td><td align="char" char=".">3</td></tr><tr><td align="left">The talks about the healthy eating plate</td><td align="char" char=".">1</td><td align="char" char=".">2</td><td align="char" char=".">3</td></tr><tr><td align="left">The talks about how different foods affect my health</td><td align="char" char=".">1</td><td align="char" char=".">1</td><td align="char" char=".">4</td></tr><tr><td align="left">Social aspect</td></tr><tr><td align="left">Cooking with other people</td><td align="char" char=".">1</td><td align="char" char=".">0</td><td align="char" char=".">5</td></tr><tr><td align="left">Sharing the food we made with other people</td><td align="char" char=".">0</td><td align="char" char=".">1</td><td align="char" char=".">5</td></tr><tr><td align="left">Meeting new people (i.e., the researchers and co‐facilitators)</td><td align="char" char=".">0</td><td align="char" char=".">2</td><td align="char" char=".">4</td></tr><tr><td align="left">Research activities (n = 5)</td></tr><tr><td align="left">Being watched when I cooked the scrambled eggs (cooking task analysis)</td><td align="char" char=".">2</td><td align="char" char=".">0</td><td align="char" char=".">3</td></tr><tr><td align="left">Completing the surveys (Being asked about what I eat, cooking and meal planning confidence)</td><td align="char" char=".">1</td><td align="char" char=".">2</td><td align="char" char=".">2</td></tr><tr><td align="left">Having measurements on my body taken (Having my height, body composition and skin colour measured)</td><td align="char" char=".">1</td><td align="char" char=".">2</td><td align="char" char=".">2</td></tr></tbody></table> </ephtml> </p> <p>Majority of food safety activities were liked by participants. Regarding wearing the apron and hat one participant stated 'I quite like the apron and the cap...it looks professional'. Even if participants did not like the food safety activities there were indications they understood the need to do it at FLIP. On wearing an apron participant three stated 'even if I don't wear one at home but that's my choice at home', similarly participant three accepted cleaning up was important stating 'I don't like cleaning at all....but that's health and safety, so technically we have to learn that'.</p> <p>Majority of cooking activities were liked by participants. Regarding visual recipes participant three stated 'I found it pretty easy to do', while a support worker stated 'participant two needed someone to tell participant two, participant two couldn't read it independently, but participant two definitely went off the photos, that helped participant two a lot'.</p> <p>Majority of nutrition education activities were liked. Discussion centred around participants dislike of the non‐practical nutrition education with participant three stating 'Yeah. I really like prac. Prac, just get straight into it, no theory'. Participant six wanted more engaging nutrition education stating 'I get bored just sitting and listening to people.... Something more engaging... educational ones that relate to the topics, but in a way that engages you more so, rather than just sitting around'. Participant five responded that 'Well, I still think of food the same, but now, I like, know how to make more'.</p> <p>Majority of the social aspects of FLIP were liked. One participant did not like cooking with other people stating, 'I don't like cooking with other people cos (<emph>sic</emph>) everyone always tries to take over the kitchen and I want to take over the kitchen'. Participant one was mixed about whether they preferred to cook dishes as a team effort, or to cook on their own 'I don't know I prefer to do it myself somedays. Somedays I would do it with someone, somedays I don't'.</p> <p>Research activities were the least liked by participants. Participant one stated 'that was creepy' when referring to research measures, participant six stated 'It's the feeling like you're being watched'. One participant did not like completing the interviewer led cooking and diet quality surveys 'Being asked what I eat, that was even creepier'.</p> <p>Overall participants reported that they would recommend FLIP to other people or come back themselves. Participant three stated 'I really liked FLIP. I would come back', while when asked about recommending FLIP to others participant one stated 'Yeah, yeah. If they would be interested'.</p> <p>Of four support workers who attended with completing participants three support workers completed the support worker process evaluation. Support worker process evaluation results are presented in Data S4.</p> <hd id="AN0179071278-33">Cooking frequency, cooking and food skill confidence, and diet quality (secondary aim)</hd> <p>Given that baseline to post‐intervention cooking frequency, cooking and food skill confidence data were obtained from only two participants this pre‐post measure was not considered feasible in this study. Preliminary effectiveness data for cooking frequency, cooking and food skill confidence is therefore not presented. Five participants completed baseline and post‐intervention diet quality scores, which are presented in Table 6. From baseline to post‐intervention there was a decrease in scores for vegetable, fruit, meat‐based protein foods, vegetable‐based protein foods, breads and cereals, spreads/sauces, and total scores indicating reduced intake of foods in these categories, and overall diet quality from baseline to post‐intervention. Scores in the dairy and water categories were unchanged.</p> <p>6 TABLE Diet quality scores for FLIP participants completing baseline and post‐programme data collection (n  = 5).</p> <p> <ephtml> <table><thead valign="bottom"><tr><th align="left">Outcome measure</th><th align="left">Baseline<xref ref-type="fn" rid="tfn5" /></th><th align="left">Post‐intervention</th></tr><tr><th align="left">Diet quality—ARFS (maximum points)</th><th align="left"><italic>M</italic> (±SD)</th><th align="left"><italic>M</italic> (±SD)</th></tr></thead><tbody valign="top"><tr><td align="left">Vegetables (21)</td><td align="char" char="(">12.8 (4.7)</td><td align="char" char="(">11.2 (1.5)</td></tr><tr><td align="left">Fruit (12)</td><td align="char" char="(">4.8 (4.1)</td><td align="char" char="(">3.2 (3.6)</td></tr><tr><td align="left">Meat, chicken, fish and seafood (7)</td><td align="char" char="(">2.2 (2.9)</td><td align="char" char="(">1.4 (0.9)</td></tr><tr><td align="left">Nuts, eggs and vegetarian meat alternatives (6)</td><td align="char" char="(">2.8 (2.7)</td><td align="char" char="(">2.4 (2.3)</td></tr><tr><td align="left">Breads and cereals (13)</td><td align="char" char="(">5.8 (2.8)</td><td align="char" char="(">4.6 (1.7)</td></tr><tr><td align="left">Milk, cheese and yogurt (11)</td><td align="char" char="(">3.8 (1.5)</td><td align="char" char="(">3.8 (2.3)</td></tr><tr><td align="left">Water (1)</td><td align="char" char="(">0.8 (0.4)</td><td align="char" char="(">0.8 (0.4)</td></tr><tr><td align="left">Spreads and sauces (2)</td><td align="char" char="(">1 (0.7)</td><td align="char" char="(">0.6 (0.5)</td></tr><tr><td align="left">Total score (73)</td><td align="char" char="(">34 (15)</td><td align="char" char="(">28 (7.5)</td></tr></tbody></table> </ephtml> </p> <p>5 a Baseline and post‐intervention FLIP completers only.</p> <hd id="AN0179071278-34">DISCUSSION</hd> <p>The current study assessed feasibility and acceptability of a culinary nutrition programme for adults with mild‐to‐moderate intellectual disability. Overall, FLIP was feasible to implement and received positive feedback from participants and support workers who participated. However, not all outcome measures were feasible to implement in their current form, and the programme retention target was narrowly missed.</p> <p>Successful recruitment was likely due to recruitment methods being devised in consultation with the disability service provider, highlighting the benefit of collaboration between researchers and committed disability service providers. Challenges to recruitment were encountered. Incomplete enrolment forms led to some demographic data being missed, with paper‐based forms possibly contributing to incomplete data fields. Missing information was not essential for safe provision of FLIP and was obtained subsequently through the course of the intervention. Information that was essential prior (e.g., diet‐related health conditions) was obtained through the disability support provider using comprehensive enrolment forms, with participants having the option to be present when being completed. Health information was able to be provided by the disability support provider as participants had previously signed agreements to provide the information as needed. Future studies' recruitment strategies will need to consider alternative methods to obtaining essential health information where these agreements are not in place.</p> <p>Retention target of 70% was narrowly missed, with six of the nine participants enrolled across both groups completing the pilot study. Retention was lowest in Group 1 due to COVID‐19 disruption meaning the intervention was temporarily suspended, with one of the three participants enrolled completing, compared with Group 2 where five of six participants completed the intervention. Group 1 paused two weeks after commencement and was not able to resume until more than three months later due to COVID‐19 lock downs. Virtual sessions were considered, however potential safety issues and the availability of resources precluded a pivot to online at that time. While no Group 1 participants were restricted from returning to FLIP by public health orders, only two of three participants returned. Restrictions imposed by vaccination status, either self‐imposed or imposed by public health orders, impacts on recruitment and retention in face‐to‐face health promotion programmes for people with intellectual disability.</p> <p>FLIP was implemented as planned, however between Group 1 and Group 2 refinements to session structure were made. Session plans were initially constructed to conduct the cooking activity before nutrition education. As pilot Group 1 progressed it became evident that conducting nutrition education before the cooking activity was preferrable, as some participants tired by the end of the session. Additionally, the static display presented on the table generated curiosity from participants upon entering the room and while formalities of checking in were being conducted. This naturally led to further discussion of the nutrition display and dissemination of nutrition education and key messages before the cooking activity. The shared meal then provided further opportunity to reinforce key messages allowing for repetition. This highlights the need to remain flexible with the format of intervention delivery.</p> <p>Participant feedback on FLIP nutrition education was for less theory and more interaction. Qualitative evaluation of a nutrition education intervention in adolescents and young adults with intellectual and developmental disabilities confirm a desire for cooking lessons as an adjunct to nutrition education (Subach & Sullivan, [<reflink idref="bib50" id="ref93">50</reflink>]), while practical instruction of healthy meal preparation was also requested following a lifestyle intervention in adults with intellectual disability (Salomon et al., [<reflink idref="bib47" id="ref94">47</reflink>]). This highlights the value of culinary nutrition education as a method for nutrition education in adults with intellectual disability, and the need to further refine FLIP curriculum.</p> <p>Poor feasibility of outcome measures can be attributed to challenges in planned data collection, which will be used to inform future FLIP and can guide other culinary nutrition interventions in people with intellectual disability. The cooking frequency, cooking and food skill confidence survey was not feasible to implement in the opening and closing sessions in Group 2. This was due to the larger group, with a quiet, private space and additional facilitator resources needed, which were not available. Obtaining this information is an important step in understanding participants' home cooking practices, which can be used by facilitators to adapt programme components to the individual abilities of participants. Future interventions can seek to collect this information during an exit interview. While task analysis and the home kitchen assessment were feasible, and used to adapt programme components, future interventions could consider completing interviewer‐led cooking surveys prior to participants commencing the intervention and exit interviews after completion to assess pre‐post changes.</p> <p>Research components were the least enjoyed by participants, possibly as it was an unfamiliar experience, with feelings of being watched and judged reported by some participants. The process and rationale for data collection was explained to participants as an important step and was reiterated by the co‐researchers during intervention development (Asher et al., [<reflink idref="bib5" id="ref95">5</reflink>]). Future studies could consider using less imposing methods to obtain outcome data. For example, use of discreet cameras with consent, or observation integrated into facilitator and/or co‐facilitator roles, rather than overt observers as was the case in the cooking task analysis assessment. Furthermore, within Group 2 occupational therapy observers were only involved during cooking task analysis assessment. It could be possible that interaction with participants throughout the intervention, and establishment of rapport with them, may help the participants feel more at ease with the research components. In particular, the cooking task analysis, which involves direct observation, at the end of the programme. Participants expressed a desire to receive their individual results of outcome measure results, which potentially may help participants feel more at ease with the research, in addition to playing an important role in advocating for their future nutrition support.</p> <p>While there was a trend from higher to lower overall diet quality scores from baseline to post‐intervention, results must be interpreted with caution as numbers were small and the method has not been specifically validated in people with intellectual disability and results may be affected by a practice effect. There is a lack of valid, low researcher and participant burden instruments for collecting diet quality data from people with intellectual disability (Hoey et al., [<reflink idref="bib30" id="ref96">30</reflink>]). As this method of evaluation of diet quality was feasible, future studies could consider validating the ARFS against weighed food records and/or biomarkers, such as skin and/or plasma carotenoids to develop a valid measure that could be used in diet quality assessment in people with intellectual disability.</p> <p>A strength of the current study is the use of inclusive research and co‐design principles, which has the potential to improve intervention relevance and success, has benefits for academic researchers and co‐researchers (Strnadová et al., [<reflink idref="bib49" id="ref97">49</reflink>]), and can support ongoing intervention modifications. Future interventions may also seek to explore and report the experiences of co‐researchers.</p> <p>Limitations need to be acknowledged. A small sample size was due to the impact of the COVID‐19 pandemic. While many restrictions on public gatherings imposed by the COVID‐19 pandemic were lifted before Group 2 commenced some restrictions, particularly concerning people with disability, and those who provide services to people with disability, remained in place when Group 2 was delivered. Building contingency time into health promotion programmes is recommended to support full programme implementation.</p> <p>Given this is a pilot study only baseline and post‐intervention data were collected. Future effectiveness studies may have follow‐up outcome measures taken at timepoints post‐intervention completion. Future studies may also seek to use structured qualitative methods to obtain insights into which programme components support individual participation and programme effectiveness. With consideration to participant burden, and use of least obtrusive methods, these data could be obtained from focus groups, observational field notes and potentially exit interviews. Qualitative evaluation could be conducted by a researcher independently of the intervention development and facilitation team to reduce risk of bias (Creswell, [<reflink idref="bib17" id="ref98">17</reflink>]). Coding qualitative data in duplicate, analysis of intercoder agreement, and additional data triangulation promote rich, robust and comprehensive qualitative data (Creswell, [<reflink idref="bib17" id="ref99">17</reflink>]), and could also be used in future studies. It is also possible that with appropriate support and training for both academic and co‐researchers, qualitative data collection and analysis could be conducted in collaboration with co‐researchers with intellectual disability (Frankena et al., [<reflink idref="bib22" id="ref100">22</reflink>]). Future studies may also consider training for support workers to support intervention delivery, which has the potential to benefit staff behaviour and nutrition status in addition to their clients with disability (Naaldenberg et al., [<reflink idref="bib40" id="ref101">40</reflink>]). As barriers include time to complete training and difficulty obtaining support worker involvement (Lally et al., [<reflink idref="bib33" id="ref102">33</reflink>]) a co‐design approach involving all relevant stakeholders, including people with intellectual disability is recommended.</p> <hd id="AN0179071278-35">CONCLUSIONS</hd> <p>Many positive outcomes arose from the feasibility study. Recruitment strategies were effective, and participants were engaged with FLIP. Feedback through process evaluation indicated acceptability of FLIP. Participant feedback on research activities, and feasibility of outcome measures were mixed. Future studies to evaluate FLIP effectiveness should seek to address the necessary modifications to intervention evaluation using inclusive research and co‐design principles, and findings reported here.</p> <hd id="AN0179071278-36">AUTHOR CONTRIBUTIONS</hd> <p>Conceptualization: R.C.A., V.A.S., B.I. and C.E.C. Methodology: R.C.A., V.A.S., B.I., A.F., S.S., A.R., E.H. and C.C. Software: R.C.A. Formal analysis: R.C.A. Investigation: R.C.A., V.C., A.F., S.S. and A.R. Resources: R.C.A., B.I., A.F., S.S. and A.R. Data curation: R.C.A. Writing—original draft preparation: R.C.A. Writing—review and editing: R.C.A., V.A.S., B.I., A.F., S.S., V.C., A.R., E.H. and C.E.C. Visualisation: R.C.A. and V.C. Supervision: R.C.A., V.A.S., A.R. and C.E.C. Project administration: R.C.A., V.A.S., B.I., A.R., E.H. and C.E.C. Funding acquisition: R.C.A., V.A.S., B.I. and C.E.C. All authors have read and agreed to the published version of the manuscript. See CRediT taxonomy for the term explanation.</p> <hd id="AN0179071278-37">ACKNOWLEDGEMENTS</hd> <p>Travis Hall, Kate Clarke, Christopher Burns, Hailey Donnelly, Breanne Plint, Mary Searl, Lauren White, Romy Milligan, Chelsie McKnight, Lorna Wilson, Vicki Good and Arif Kamal Ahmed for assisting with data collection and co‐facilitation. Dr. Katherine Brain for assisting with data collection. Grace Manning for contributing to resource design. Robyn Mainey for support with volunteer student induction. Open access publishing facilitated by The University of Newcastle, as part of the Wiley ‐ The University of Newcastle agreement via the Council of Australian University Librarians.</p> <hd id="AN0179071278-38">FUNDING INFORMATION</hd> <p>Roberta Asher is supported by an Australian Government Research Training Program Scholarship and a King and Amy O'Malley Trust Postgraduate Scholarship. Challenge Community Services provided seed funding to support the development, implementation and evaluation of FLIP (G1900308). CEC is supported by an NHMRC Leadership Research Fellowship (APP2009340). Vanessa Shrewsbury is supported by funding from the Hunter Medical Research Institute.</p> <hd id="AN0179071278-39">CONFLICT OF INTEREST STATEMENT</hd> <p>Beth Innes and Emily Hinton were employees of Challenge Community Services. Neither Beth Innes nor Emily Hinton had a role in data analysis or interpretation. All other authors have no conflict of interest to declare.</p> <hd id="AN0179071278-40">DATA AVAILABILITY STATEMENT</hd> <p>The data that support the findings of this study are available on request from the corresponding author. The data are not publicly available due to privacy or ethical restrictions.</p> <p>GRAPH: Data S1. Supporting Information.</p> <p>GRAPH: Data S2. Supporting Information.</p> <p>GRAPH: Data S3. Supporting Information.</p> <p>GRAPH: Data S4. 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  Label: Title
  Group: Ti
  Data: Feasibility and Acceptability of a Culinary Nutrition Programme for Adults with Mild-to-Moderate Intellectual Disability: FLIP Food and Lifestyle Information Programme
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  Label: Language
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  Data: English
– Name: Author
  Label: Authors
  Group: Au
  Data: <searchLink fieldCode="AR" term="%22R%2E+C%2E+Asher%22">R. C. Asher</searchLink><br /><searchLink fieldCode="AR" term="%22V%2E+A%2E+Shrewsbury%22">V. A. Shrewsbury</searchLink><br /><searchLink fieldCode="AR" term="%22B%2E+Innes%22">B. Innes</searchLink><br /><searchLink fieldCode="AR" term="%22A%2E+Fitzpatrick%22">A. Fitzpatrick</searchLink><br /><searchLink fieldCode="AR" term="%22S%2E+Simmonds%22">S. Simmonds</searchLink><br /><searchLink fieldCode="AR" term="%22V%2E+Cross%22">V. Cross</searchLink><br /><searchLink fieldCode="AR" term="%22A%2E+Rose%22">A. Rose</searchLink><br /><searchLink fieldCode="AR" term="%22E%2E+Hinton%22">E. Hinton</searchLink><br /><searchLink fieldCode="AR" term="%22C%2E+E%2E+Collins%22">C. E. Collins</searchLink>
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  Label: Source
  Group: Src
  Data: <searchLink fieldCode="SO" term="%22Journal+of+Applied+Research+in+Intellectual+Disabilities%22"><i>Journal of Applied Research in Intellectual Disabilities</i></searchLink>. 2024 37(5).
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  Data: Wiley. Available from: John Wiley & Sons, Inc. 111 River Street, Hoboken, NJ 07030. Tel: 800-835-6770; e-mail: cs-journals@wiley.com; Web site: https://www.wiley.com/en-us
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  Data: 15
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  Data: 2024
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  Label: Document Type
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  Data: Journal Articles<br />Reports - Research
– Name: Subject
  Label: Descriptors
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  Data: <searchLink fieldCode="DE" term="%22Foreign+Countries%22">Foreign Countries</searchLink><br /><searchLink fieldCode="DE" term="%22Mild+Intellectual+Disability%22">Mild Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Nutrition%22">Nutrition</searchLink><br /><searchLink fieldCode="DE" term="%22Moderate+Intellectual+Disability%22">Moderate Intellectual Disability</searchLink><br /><searchLink fieldCode="DE" term="%22Program+Effectiveness%22">Program Effectiveness</searchLink><br /><searchLink fieldCode="DE" term="%22Nutrition+Instruction%22">Nutrition Instruction</searchLink><br /><searchLink fieldCode="DE" term="%22Adults%22">Adults</searchLink><br /><searchLink fieldCode="DE" term="%22Food%22">Food</searchLink><br /><searchLink fieldCode="DE" term="%22Foods+Instruction%22">Foods Instruction</searchLink><br /><searchLink fieldCode="DE" term="%22Cooking+Instruction%22">Cooking Instruction</searchLink><br /><searchLink fieldCode="DE" term="%22Daily+Living+Skills%22">Daily Living Skills</searchLink><br /><searchLink fieldCode="DE" term="%22Health+Promotion%22">Health Promotion</searchLink><br /><searchLink fieldCode="DE" term="%22Learner+Engagement%22">Learner Engagement</searchLink><br /><searchLink fieldCode="DE" term="%22Accessibility+%28for+Disabled%29%22">Accessibility (for Disabled)</searchLink><br /><searchLink fieldCode="DE" term="%22Student+Volunteers%22">Student Volunteers</searchLink><br /><searchLink fieldCode="DE" term="%22Service+Learning%22">Service Learning</searchLink>
– Name: Subject
  Label: Geographic Terms
  Group: Su
  Data: <searchLink fieldCode="DE" term="%22Australia%22">Australia</searchLink>
– Name: DOI
  Label: DOI
  Group: ID
  Data: 10.1111/jar.13281
– Name: ISSN
  Label: ISSN
  Group: ISSN
  Data: 1360-2322<br />1468-3148
– Name: Abstract
  Label: Abstract
  Group: Ab
  Data: Background: Culinary nutrition education can support improved diet-related health and wellbeing. This pre-post pilot study aimed to assess feasibility and acceptability of an eight-session culinary nutrition programme, the Food and Lifestyle Information Programme (FLIP), for adults with mild-to-moderate intellectual disability. A secondary aim was to evaluate preliminary programme effectiveness. Method: Participants were recruited through a disability service provider. Feasibility measures were: recruitment and retention; implementation; engagement and participation; adverse outcomes; and feasibility of outcome measures. Acceptability was assessed using an interactive process evaluation. Effectiveness measures included cooking frequency, cooking and food skill confidence and diet quality. Results: Six of eight participants completed the intervention with high attendance and programme engagement. FLIP was well received by participants and support workers. No adverse outcomes occurred. Diet quality was feasible to assess. Conclusions: Findings can inform content, delivery and evaluation of future culinary nutrition programmes for adults with mild-to-moderate intellectual disability.
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– Name: DateEntry
  Label: Entry Date
  Group: Date
  Data: 2024
– Name: AN
  Label: Accession Number
  Group: ID
  Data: EJ1435676
PLink https://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=eric&AN=EJ1435676
RecordInfo BibRecord:
  BibEntity:
    Identifiers:
      – Type: doi
        Value: 10.1111/jar.13281
    Languages:
      – Text: English
    PhysicalDescription:
      Pagination:
        PageCount: 15
    Subjects:
      – SubjectFull: Foreign Countries
        Type: general
      – SubjectFull: Mild Intellectual Disability
        Type: general
      – SubjectFull: Nutrition
        Type: general
      – SubjectFull: Moderate Intellectual Disability
        Type: general
      – SubjectFull: Program Effectiveness
        Type: general
      – SubjectFull: Nutrition Instruction
        Type: general
      – SubjectFull: Adults
        Type: general
      – SubjectFull: Food
        Type: general
      – SubjectFull: Foods Instruction
        Type: general
      – SubjectFull: Cooking Instruction
        Type: general
      – SubjectFull: Daily Living Skills
        Type: general
      – SubjectFull: Health Promotion
        Type: general
      – SubjectFull: Learner Engagement
        Type: general
      – SubjectFull: Accessibility (for Disabled)
        Type: general
      – SubjectFull: Student Volunteers
        Type: general
      – SubjectFull: Service Learning
        Type: general
      – SubjectFull: Australia
        Type: general
    Titles:
      – TitleFull: Feasibility and Acceptability of a Culinary Nutrition Programme for Adults with Mild-to-Moderate Intellectual Disability: FLIP Food and Lifestyle Information Programme
        Type: main
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      – PersonEntity:
          Name:
            NameFull: R. C. Asher
      – PersonEntity:
          Name:
            NameFull: V. A. Shrewsbury
      – PersonEntity:
          Name:
            NameFull: B. Innes
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            NameFull: A. Fitzpatrick
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            NameFull: S. Simmonds
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            NameFull: V. Cross
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            NameFull: A. Rose
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            NameFull: E. Hinton
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            NameFull: C. E. Collins
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          Dates:
            – D: 01
              M: 09
              Type: published
              Y: 2024
          Identifiers:
            – Type: issn-print
              Value: 1360-2322
            – Type: issn-electronic
              Value: 1468-3148
          Numbering:
            – Type: volume
              Value: 37
            – Type: issue
              Value: 5
          Titles:
            – TitleFull: Journal of Applied Research in Intellectual Disabilities
              Type: main
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