Teaching Kitchens: An innovative program for enhancing self‐management skills in adolescents living with type 1 diabetes (T1D) – A feasibility study

Abstract

Aims

Adolescents living with type 1 diabetes (T1D) are faced with unique challenges to nutrition management. The current Perth Children's Hospital (PCH) T1D management model includes individualised education at diagnosis and annual reviews. Currently, no group education is provided to develop self‐management skills for healthy meal preparation. Teaching Kitchens offers a skills‐based program in food literacy and nutrition. This feasibility study explored if a Teaching Kitchens program at PCH engaged adolescents aged between 13 and 17 years, living with T1D.

Methods

Each workshop involved a demonstration followed by hands‐on cooking and a discussion (e.g. core food‐groups, carbohydrate counting, food safety, mindfulness and exercise). Pre‐ and post‐questionnaires were captured electronically from participants and their parents. Quantitative and qualitative data were extracted for content analysis. Feasibility was assessed through ease of recruitment, attendance and retention.

Results

Twenty‐one participants (12F;9M) attended sessions held in October 2022 and March 2023. Content analysis identified participants response patterns of learning new culinary skills, especially vegetable and fruit preparation and how to incorporate everyday healthy eating habits. 47.4% reported enjoying making new friends and interacting positively with peers and 94.7% responded, ‘yes’ to recommending the program. Parent responses included their child's increased confidence and interest in cooking at home. The workshops had an 92.4% attendance and an 88.9% retention rate.

Conclusions

The first Teaching Kitchen in Australia for adolescents with T1D showed positive engagement and feedback. This is a feasible program that could be incorporated into routine clinical care at PCH.

What's new?

• Adolescents living with T1D face unique challenges around food every day as they need to estimate the macronutrient composition of meals.

• Teaching Kitchens have been found to be effective in increasing food and nutrition literacy in people with chronic disease, but have never been tested in young people living with diabetes in Australia.

• This study found adolescents with T1D who participated in Teaching Kitchens improved their culinary skills, learned healthy eating habits, and made new friends.

• Teaching Kitchens could be used in clinical paediatric diabetes settings to strengthen food literacy skills and autonomy related to healthy eating.

1. INTRODUCTION

Type 1 diabetes management is complex and a balance between food intake, physical activity, insulin administration and blood glucose monitoring. ¹ Adolescence is often marked by physical, emotional and social changes and can present unique challenges to T1D management, including peer pressure, assertion of independence and competing demands. ² This phase can be a steep learning curve for parents and young people, where a decline in T1D management is common as young people take on more responsibility. ³ Adolescents with T1D are at greater risk of poor mental health and can experience social isolation and consequently this can lead to a reduction in self‐management and worsened glucose levels – a phenomenon known as ‘diabetes burnout’. Adolescent food choices can change with peer pressure, social events and changes in schedules. ² Pairing this with an increase in autonomy and targeted marketing of highly processed, energy dense and nutrient‐poor foods, it is a common concern that Australian adolescents either with or without T1D do not meet the recommended dietary guidelines with 41% of their energy intake from discretionary food. ⁴ , ⁵ It is vital that adolescents have good nutrition as this is essential for growth, bone health, academic performance, sufficient strength and energy for an active lifestyle. ²

Teaching Kitchens are practical skills‐based programs aiming to improve health or disease outcomes through culinary interventions and education. ⁶ Teaching Kitchens have been shown to improve diet quality, food choices and behaviours and promote healthy food choices and eating behaviours through a reduction in energy dense‐nutrient poor takeaway meals ⁷ and increased vegetable and fruit intake. ⁸ , ⁹ Globally, Teaching Kitchens have been used in adults with type 2 diabetes, cancer and groups of parents in low socio‐economic locations. ⁸ , ⁹ , ¹⁰ , ¹¹ Adults with type 2 diabetes have reported increased nutrition knowledge (label reading), confidence in meal preparation ¹⁰ , ¹² and improved cardiometabolic risk factors ¹¹ after participating in Teaching Kitchens. Whilst not all studies presented direct improvements in cardiometabolic risk factors, the change in health behaviours and self‐efficacy are foundational elements for sustainable lifestyle modifications.

Building confidence in food literacy skills during adolescence is important given the increase in autonomy and independent food choices. Research has found adolescents involved in food preparation have higher diet quality than their non‐involved peers. ¹³ , ¹⁴ Despite significant recent work among adults, there is limited evidence of the Teaching Kitchens model being used for young people living with chronic disease in Australia and globally. ¹⁵ , ¹⁶ This model has the potential to empower adolescents with T1D to have more control of their food choices and behaviours and strengthen their food literacy skills.

The current diabetes management model at Perth Children's Hospital offers a Diabetes Service structured with quarterly, age‐based clinics and regional and suburban visits. The current nutrition education model includes a total of 4 h of spaced‐out education for a family at diagnosis, along with a 20‐page information booklet. Following this, patients have an annual one‐on‐one dietitian review incorporating verbal information targeted at eating habits and food choices. However, it does not include practical assessments of cooking skills and knowledge. Moreover, there are no interventions or culinary group education, such as Teaching Kitchens, ⁶ in Australia for adolescents with T1D.

This feasibility study aimed to explore if piloting a Teaching Kitchen can engage adolescents living with T1D in developing skills for preparing healthy meals by incorporating individualised core nutrition principles, coupled with practical cooking skills tailored to adolescent food preferences. The objectives of this study were to:

1. Measure demand for a Teaching Kitchen program in T1D adolescents.

2. Assess the practicality and acceptability of Teaching Kitchens for adolescents and parents.

3. Examine the feasibility of a Teaching Kitchens program for adolescents with T1D.

2. METHODS

This feasibility study was conducted at a tertiary paediatric hospital in Perth, Western Australia and was a pilot single‐arm pre‐post study design. The National Cancer Institute framework for feasibility studies was used to guide the data, addressing four of the areas: demand, acceptability, practicality and adaptation ¹⁷ (see Table 1).

TABLE 1.

Feasibility data measures.

Demand and recruitment	Sign up rate (eligible people attending, vs. those expressed original interest vs. pool of adolescents) Demographic characteristics Pre‐questionnaire reasons for attending
Practicality	Weekly attendance rates Adherence to completing pre‐ and post‐questionnaires Pilot retention rate Post questionnaire content analysis of open‐ended questions
Acceptability	Implementation of skills Post‐questionnaire content analysis of responses to the intervention
Adaptation of program	Modifications made after the first workshop (structure, content, from facilitator reflections) Pivoting program structure and content (stakeholder co‐design from clinical experience). Feasibility of Teaching Kitchens for further adaptions

2.1. Participants

Participants in this study were aged between 13 and 17 years old with T1D who access the PCH Diabetes Service. This is the age range of patients seen in the Adolescent Diabetes Services at Perth Children Hospital. Participants were excluded if they had food allergies, coeliac disease, did not easily understand English, or if they were unable to attend the PCH for the workshops. Demographic and anthropometric data biomedical (glycated haemoglobin, HbA1c) were collected from the Diabetes Patient Management System database at their last visit. A factsheet was provided before the first workshop and parents and guardians were given the opportunity to ask any questions, where consent was obtained. Photo and video consent was obtained from all parents and guardians prior to the first workshop, as the funding body required media content and footage.

2.2. Co‐design

Eligible participants and their parents were sent a Research Electronic Data Capture (REDCap) questionnaire to gather information to inform the planning and delivery of our Teaching Kitchen. Participants were asked questions about their preferred time to run the program, preferred session frequency, age group split and what topics they would like to learn about.

Several stakeholder meetings of various team members' expertise were held to design and refine the program and evaluation tools. The professionals were experts in adolescent diabetes management and nutrition research. This group had specific and valuable experience in the clinical setting as diabetes nurse educators, dietitians, researchers, endocrinologists and psychologists. Additionally, they had built specific rapport with the targeted cohort of adolescents and had valuable insight into their behaviour, informing recommendations like ice‐breaker activities, music and peer partnerships. These meetings focused on the design of workshop lesson plans, incorporating multiple behaviour change techniques (BCTs) described below in more detail.

2.3. Recruitment

To recruit participants, email invitations were sent to all families who responded ‘yes’ to an initial survey sent in 2020 to families who attend the PCH diabetes service. Once the list of interested participants was exhausted, emails were sent out to eligible patients who were identified from the Western Australian Children's Diabetes Database at PCH. Community recruitment was also undertaken via online notices on the Children's Diabetes Centre Twitter account, Diabetes WA's Facebook account, and the Children's Diabetes Centre website.

2.4. Questionnaires

Short pre‐and‐post questionnaires were sent to the adolescent participants and were administered electronically using REDCap to capture changes in nutrition knowledge and cooking confidence. The questionnaires were developed using a mixture of open‐ended and close‐ended validated questions previously used in other studies. ⁸ , ¹⁸ , ¹⁹ , ²⁰ Each questionnaire took 5–10 min to complete. The pre‐questionnaire was administered before the start of the first session and the post‐questionnaire at the end of session four (Appendices S1 and S2). The pre‐questionnaires were emailed to participants 1 week before the first workshop. If participants did not complete the pre‐questionnaire prior to the first workshop, printed copies were available for participants to complete at the first workshop prior to commencing. Post‐questionnaire workshops were sent to participants the day after the last workshop to complete within a timeframe of a week. Follow‐up text messages and emails were sent appropriately. Post‐questionnaire results from workshop 1 were analysed before commencing workshop 2, and adjustments were made accordingly, which have been included in the manuscript, such as recipe adaptations. In both questionnaires, three questions measured nutrition knowledge and three questions measured cooking confidence (see Table 2). An electronic questionnaire was sent to the parents of participants in the second workshop only (Appendix S3).

TABLE 2.

Pre‐ and post‐questionnaires.

	Behaviour change questions
Nutrition knowledge	How often did you prepare and cook a meal from basic ingredients?
	How confident do you feel about your knowledge of healthy eating?
	How confident do you feel identifying foods that are healthy?
Cooking confidence	How confident do you feel about your ability to prepare healthy foods for yourself/friends/family?
	How confident do you feel about your food preparation skills?
	How confident do you feel about following a simple recipe?

2.5. Workshops

The Teaching Kitchen intervention was designed as a practical workshop with experiential learning. Workshops were based on other successful group cooking programs ⁸ , ⁹ , ¹⁰ , ²⁰ and were facilitated by an Accredited Practising Dietitian with fundamental culinary and presentation experience and assisted by a multidisciplinary team of health professionals. Each workshop consisted of four sessions held weekly for 2 h between 5 PM and 7 PM. Workshops were conducted in October 2022 and March 2023 in the collegiate lounge at PCH. Temporary tables, with electricity accessed via extension cables and portable electric frypans, were used as cooking stations. Equipment was stored in a storeroom facility between sessions. Volunteers from PCH helped with the workshop set‐up and pack down.

Workshops were facilitated with individual behaviour change techniques (BCT). ²¹ The intended changes for this program were to increase cooking skills and the ability to practically apply nutrition principles in diabetes management. Each week was structured around a main recipe using BCTs of persuasion, incentivisation, training and modelling. The setting provided opportunities to re‐frame participants' interpretation of feasibility to use culinary skills and the social support aided the participants to discuss nutritious choices in language appropriate and relevant to them. Discussing these ideas in the group permits social comparison and social support. At the end of each session, the participants were provided with leftovers of their cooking, a printed recipe and summary of the information covered. Receiving these promotes individual reflection on one's capability and creates the unique opportunity to feel accomplished from commitment to the cooking classes, compared to 1:1 education dietetic consultations. ²²

2.6. Educational content

Each week included education from a credible source (doctor, dietitian, psychologist) whilst demonstrating the intended behaviour change, for example, foundational cooking and food preparation, in addition to mindful eating and exercise. Nutrition education incorporated the five core food groups, serving sizes for age and sex, macronutrient awareness, building a nutrition balance plate, purchasing of seasonal produce, applicable food safety including contamination, risk of chopping boards and the food‐safety principles for food refrigeration and re‐heating. Participants were shown how to prepare vegetables with various cooking skills including knife skills and use of graters, fry pans and sieves. Participants were guided through use of dissolving, boiling, simmering, frying, mixing, dicing, crushing, melting, cutting, chopping, slicing, measuring, grating and emulsifying liquids. ²³ Carbohydrate counting for the meal was completed by the Dietitian and disseminated by the Diabetes Nurse Educator, 15 minutes prior to the estimated completion of the cooking process, as each participant has different insulin requirements and portion sizes. This gave the participants adequate time to administer the appropriate insulin for their meal.

2.7. Recipes

Each session incorporated a different recipe designed by the research team; one‐pot pasta bolognaise, rainbow beef stir fry, vegetable fritters with salad and guacamole, salsa and nachos. Desserts prepared included chocolate dipped fruit and almond crumble with caramelised fruit. The adolescent target group was considered by incorporating a mixture of familiar and new recipes, with simplified steps and age‐appropriate (targeted 9+) knife skills and a flexibility of ingredients for participants to adapt when at home. ²³ The step‐by‐step recipes were provided, and cooking demonstrations were delivered by a Dietitian to the group, before ongoing guidance and assistance across the two‐hour session. Vegetarian options were made available.

2.8. Data analysis

Quantitative responses were summarised as frequencies. The questionnaire responses were analysed by RL and VS using content analysis. ²⁴ Systematic coding and categorising were applied to text responses enabling quantification where required and then categories were aligned with the feasibility areas. Two experienced researchers (RL and VS) independently reviewed questionnaire responses for consistent ideas and topics. Quotes were used to illustrate categories with abbreviations to indicate different participants such as duration of diabetes (DOD). Demographic data was summarised using descriptive statistics. Data from participants who withdrew from the program were not included in the final analysis.

3. RESULTS

3.1. Demand and recruitment

Emails were sent out to 318 families in December 2020 to obtain interest about future Teaching Kitchen workshops. In total, 86 individuals responded (response rate: 27.0%), 62.8% responded ‘yes’ and 37.2% responded ‘no’ to being interested in attending a Teaching Kitchen workshop. Reasons for ‘no’ were personal choice of distance restrictions, not interested and busy with after school activities, such as sport. The intention for the pilot was to run two workshops of 4 weeks with 12 participants per workshop. A total of 275 recruitment emails were sent out to families until the quota (12 participants per workshop) was met. This included all families who responded yes to the initial email.

3.1.1. Participant characteristics

Data from 21 participants were collected (12 females and 9 males). The mean ± SD for the age of participants was 14.96 ± 1.15 years, duration of diabetes of 6.03 ± 3.37 years and HbA1c of 61 ± 8 mmol/mol (7.74 ± 1.42%). Nine parents completed the post‐questionnaire.

3.1.2. Reasons for attending

In response to the pre‐questionnaire questions, 52.6% of participants expressed their interest in learning how to cook healthier meals and 21% were interested in increasing their knowledge on different foods. Other reasons included improving cooking skills, learning new recipes, about diet and diabetes and meeting T1D peers (Table 3).

TABLE 3.

Pre‐ questionnaire responses related to attending.

Question	Content	Quote
What are you hoping to get out of the Teaching Kitchens program?	Nutrition knowledge	I want to learn about managing my diet and diabetes as well as improve my skills in a kitchen environment. (Female, DOD 2 years) More knowledge on how to prepare different meals. (Female, DOD 4 years) Learn how to cook healthy and balanced food. And make better choices. (Male, DOD 7 years) To learn new recipes and strategies for my cooking. I also like to meet other people with T1D because I only know 2 other people at school with it. (Female, DOD 8 years)
What are some barriers that stop you from cooking more?	Cooking confidence	I'd prefer it if I had some sort of supervision or help with what I'm doing, this takes more time to set up since I need to find a time that works with my parents as well. (Female, DOD 2 years) I have a lot of kitchen accidents and am not really experienced in cooking, so I'm often hesitant to try it again after an unsuccessful outcome from the previous time. (Female, DOD 2 years) Supply of food and opportunity. (Female, DOD 3 years) Don't know how to cook. (Female, DOD 10 years)

Abbreviation: DOD, duration of diabetes.

3.2. Practicality

3.2.1. Attendance

Pre‐ and post‐ questionnaire completion was 100% for participants. Post‐ questionnaire completion was 100% for parents. The two workshops had an average attendance rate of 85.1%, with a retention rate of 90.5% (n = 19). The weekly attendance rate varied between 83.3% and 100%. Twelve participants attended the first workshop, and nine participants attended the second workshop. Reasons for a lack of attendance included sickness and school camp. Two participants withdrew from the second workshop after attending the first session because one reported a lack of interest and one reported mental health issues. Parent responses post‐questionnaire regarding practical considerations to aid attendance included, ‘it would be good to have parking relief’, ‘the program could be incorporated with hospital visits’ and ‘allowing parents to sit at a distance to help reassure anxious children’.

3.3. Acceptability

3.3.1. Participant acceptability and enjoyment

Half of the participants (47.4%) responses included the positive social interactions participants had with their peers and most responses (78.9%) included a reference to cooking skills and trying new recipes (Tables 4 and 5). When asked if participants would return to more workshops, 16 of the 19 participants responded yes and 3 of the 19 participants did not provide a response.

TABLE 4.

Post‐questionnaire responses related to acceptability.

Question	Content	Quote
What did you enjoy the most about the Teaching Kitchens program?	Cooking meeting others with T1D having help/being in a group	Getting to try new recipes and learn more about mindful eating. (Female, DOD 4 years) The eating of food with others and working in a group together. (Male, DOD 3 years) Being able to cook by yourself and getting help when needed. (Female, DOD 5 years) Cooking and eating the food as well as meeting some new people my age with diabetes. (Female, DOD 6 years) Learning new skills, recipes, connecting with other people with Type 1 (Male, DOD 7 years)

Abbreviation: DOD, duration of diabetes.

TABLE 5.

Participant responses post‐workshops.

Question	Content	Quote
Did you learn any new food preparation skills?	Culinary skills	Grating veg's to include in the meal. Following a recipe. Time for cooking. (Male, DOD 6 years) Yes. How to mince garlic without crusher and how to use electric frypan. (Male, DOD 10 years) Yes, I feel more confident with preparing meal. (Female, DOD 2 years) I learned how to cut vegetables more effectively than what I had known before. (Male, DOD 10 years)
	Nutrition knowledge	Cooking from fresh ingredients instead of tins. Mindful eating. Choosing proteins and carbs and veggies for each meal. (Male, DOD 6 years) Yes, I learnt more about how to include healthier food options into everyday dishes. (Female, DOD 4 years)

Abbreviation: DOD, duration of diabetes.

When asked if participants would recommend these workshops to other kids and teenagers either with or without type 1 diabetes, 94.7% participants responded, ‘yes’. Comments about recommending these workshops included ‘Yes! It is such a fun program, and you actually learn things’ and ‘I believe it would benefit others with type 1 diabetes’.

Most participants (84.2%) stated they learned new food preparation skills, 15.8% responded that they did not learn any new skills because they have ‘learned most of my skills from my mum at home’ and ‘because of the cooking lessons at school’.

Figure 1 shows a trend to more frequent preparation and cooking of a meal with basic ingredients, confidence increases in knowledge about healthy eating, ability to prepare healthy foods for yourself/friends/family, food preparation skills and following a simple recipe. Confidence was high pre‐program for following a recipe (73.7%), identifying foods that are healthy (57.9%) and food preparation skills (47.4%). Questions around diabetes management were not directly asked or measured around specific changes to diabetes management.

FIGURE 1.

Pre and post questionnaire responses (n = 19). (a) How confident do you feel about your knowledge of healthy eating?, (b) How often did you prepare and cook a meal from basic ingredients?, (c) How confident do you feel about your ability to prepare healthy foods for yourself/friends/family?, (d) How confident do you feel about your food preparation skills?, (e) How confident do you feel about following a simple recipe?, (f) How confident do you feel identifying foods that are?

The major feedback resulting from this program, as reported by participants and parents, was food literacy skills and confidence in food preparation (Tables 5 and 6).

TABLE 6.

Parental responses to children's participation in Teaching Kitchens program.

Question	Content	Quote
Since completing the Teaching Kitchens workshops, have you noticed a change in your child's interest in cooking?	Culinary skills Culinary interest Culinary enjoyment Culinary knowledge	Definitely more cooking She asks me if I could buy some stuff so she can cook They are more aware of what types of foods to put together (Child's name) baked occasionally but now makes savory meals. The cooking class has broadened (Child's name) food choices for cooking They are enjoying being in the kitchen and have more confidence in their own abilities and food choices, she's more interested in preparing and cooking meals now
What part/s did your child enjoy the most about the Teaching Kitchens program?	Peer connections Diabetes related culinary skills Culinary nutrition	Making the food and meeting the other children Learning new kitchen skills with diabetes in mind. She does cooking at school preparing food she finds hard to control her levels after eating; that is, inappropriate food for diabetics She has enjoyed making salads and noodles with loads of veggies
Would you recommend these Teaching Kitchens Program to other parents with for their teenagers with type 1 diabetes	Fun environment Confidence Knowledge Skill development	The friendly and fun atmosphere makes it a pleasure to attend I think it greatly helps the teenage children to try making their food and they also will get to learn quick tasty recipes and carbs in their diet, I think it can help boost their confidence and encourage them trying more home cooked healthy food I think this is a fantastic course and opportunity for the children to learn new skills
Do you have any other comments to make about the Teaching Kitchens program?	Practical elements Engagement with adolescence	It's great to show diabetic adolescence rather than just tell them how to eat As a parent it is hard at times to talk about healthy eating to a teenage kid, but when they learn it via other educators and seeing other children talk and make food, I think they learn out of it! Having it at the hospital was lovely for them to be able to see the service as an a as enjoyable, friendly environment and not just a clinic room

3.3.2. Parental acceptability

Responses from parents (n = 9) indicated a positive response to the program. These comments indicated the value of the practical components to support healthy eating, the social aspects and supported the hospital as the delivery location. Parents were also asked if they had noticed a change in their child's interest in cooking, and responses indicated an increased interest and capability with cooking skills (Table 6). Notably, parents identified Teaching Kitchens role of engaging more with clinical staff, such as, ‘if the teaching program can be incorporated with hospitals visits to enable more people to attend’, and to, ‘have more diabetes educators there for the kids to meet from their clinics’.

3.4. Adaptation of program

3.4.1. As a result of participant feedback

There were mixed responses to the question about suggestions for improvements to the program. 21% stated they wanted more complex recipes or the types of dishes that could be expanded. Other comments included more sessions and improving the connection of the electric frypans as they sometimes lost power (Table 7). Most participants indicated they would participate in more Teaching Kitchens, with 84.2% of participants saying ‘yes’ and 15.8% of participants saying ‘undecided.’

TABLE 7.

Adaptation questions to participants.

Question	Content	Quote
Which part of the Teaching Kitchens Program could be improved?	Complexity Recipe autonomy Equipment Program length	Could be a few weeks longer. (Male, DOD* 6 years) I think the recipes could be more complicated and ingredients could be at a wider range. (Female, DOD 4 years) And maybe option of what we would like to learn to cook. (Male, DOD 7 years) The pans that we used kept turning off so I think we could have used different one. (Female, DOD 8 years) Types of dishes could be expanded. (Female, DOD 2 years)

Abbreviation: DOD, duration of diabetes.

3.4.2. As a result of parent feedback

Most parents would recommend the workshops, only one parent responding ‘maybe’ with the caveat, ‘I would only recommend to those who have no cooking experience at all’. Further comments indicated suggestions to enrich experience such as recipes and a longer duration of workshops (Table 8).

TABLE 8.

Adaptation responses from parents.

Question	Content	Quote
Do you have any suggestions on how the Teaching Kitchens Program could be improved?	Recipes Link with clinic visits/clinicians	Easy, healthy, fast meals with variety for kids Timing was good, I think it was really great that they learnt making their food and more raw and quick recipes can help them give more confidence I think if the teaching program can be incorporated with hospitals visits. This will enable more people to attend I feel Have more diabetes educators there for the kids to meet from their clinics
Do you have any other comments to make about the Teaching Kitchens program?	Practical elements Longer	This is a great program that I hope all teenagers with Diabetes gets to expand for more than 4 weeks do and even Could maybe give out a little recipe book or recipes for other dishes so they have more variety to try at home

3.4.3. As a result of clinician observations

After the first round of workshops, the team discussed the specific recipes and topics addressed, as well as shifting approach from assigned ‘teaching time’ to a briefer section and greater focus on the practical elements of the program. Recipes were adapted based on culinary review (palatability) and participant feedback of recipe simplicity. See Appendix S4 for full summary.

4. DISCUSSION

This study is the first to explore the feasibility of a Teaching Kitchen program in an Australian paediatric setting with adolescents with T1D. The results indicated a sufficient demand for Teaching Kitchens within adolescents and that it is possible to recruit numbers suitable for group education. Furthermore, 12 participants per group (allowing for a 10–15% drop out rate), is considered adequate for a feasibility study. ²⁵ Additional considerations for our feasibility study included financial limitations and the decisions that the ratio of one cooking instructor to ten participants would better facilitate a more ‘hands on’, engaging and interactive workshop. Responses relating to acceptability indicate enjoyment of experiential cooking, and practicability was reflected in attendance rates and skill implementation. Feasibility was facilitated by rapport between patients and staff, and the implementation of co‐design principles through pre‐questionnaires and a flexible workshop model. Teaching kitchens model is adaptable to specific target‐groups regarding recipes, educational content, location, timing, group size and clinician involvement.

The group setting offers the ability to deliver clinically relevant patient nutrition education to multiple patients at one time, expanding upon the traditional 1:1 model. This program intersects between specialties, allowing more holistic observations of patient mental health, social and culinary skills. Assessing and addressing these skills aids more targeted application of diabetes knowledge, beyond in‐clinic education. Utilising food and meal preparation as the foundational skills, this program also incorporated exercise and mental health education, contributing to a more holistic health care approach that considers multiple facets of health.

The potential cost‐savings of this program are highlighted by the ratio of 12 child participants to one endocrinologist, coupled with the expertise of Diabetes Nurse Educators, a Psychologist and a Dietitian. To assist with program delivery, donated food vouchers and volunteers were feasible options for a limited pilot budget. Future programs should consider the number of staff required for smooth facilitation, whereby volunteers are a feasible option to help reduce costs. Although donated food vouchers helped reduce costs, the inconsistent weekly attendance rate had an impact on the feasibility of weekly food planning. It is important that programs have a contingency plan for food waste reduction for budget management and program sustainability; therefore, setting up a Teaching Kitchen within a food service (e.g. hospital, café or established educational facility) may aid economic viability and streamline services. Additionally, an appropriate setting of cooking equipment will promote safety, ergonomics and program sustainability by reducing the staff time required for set up, pack up and coordination of the program in a room not designed for cooking.

The adolescent cohort represented in high‐income countries is a difficult group to engage, as reflected by the complex and rapidly evolving factors in their lives. The nuanced and reflexive interpersonal skills required of health professionals often lead to inconsistent quality, poorly coordinated and consequential inability to engage with adolescents effectively. ²⁶ This can translate to poor health outcomes (higher HbA1c) of teenagers living with T1D, a statistic represented globally and at PCH. ²⁷ , ²⁸ , ²⁹ Comments from participants around positive peer‐to‐peer engagement with other children with T1D were core strengths of this Teaching Kitchen program (Table 4). This highlights group education as conducive to positive patient learning environments, which engage the high‐risk adolescent cohort and improve physical and mental health outcomes. ¹³ , ³⁰

Many participants commented about learning new food skills, preparation techniques and recipes in the program, indicating successful outcomes for teaching hands‐on skills that are not taught in clinic. Parents identified Teaching Kitchens role in engaging more with clinical staff. Combined with tertiary clinical care, these skills could be used to empower adolescents in their dietary diabetes management.

There are a few learnings that can be implemented to improve future programs. The study team observed a wide gap between different participants culinary skills, a challenge when providing a program to teenagers of various socio‐economic backgrounds and ages. One participant informed the study team of not continuing with the program due to the content being too simple. Despite this, it was decided to maintain the same recipes across both workshop one and two, for consistency. Some participants started with high confidence with nutrition knowledge and cooking and future programs could assess level of cooking skills. However, it is likely that those interested in participating in this program, tend towards a greater interest in cooking, introducing a participant bias. The co‐design phase of this study guided location and timing of session but, lacked specific screening on cooking experience and ability. Future programs could include screening questions such as; ‘Do you have experience in cooking?’ or ‘List dishes you can prepare with confidence’. This screening could tailor to food literacy and skills sets to increase participant retention and capitalise on enthusiasm and learning opportunities of extension to more advanced skills.

Given the colloquial nature of the workshops, a response bias should be considered in the interpretation of the results. Future programs may consider including data on participant dietary intake using food diaries or 24‐h recall. In addition, collecting socioeconomic status and parent demographics as indicators of food literacy and data set would be beneficial to utilize for program design and service gap mapping. The small sample size of this study does not accurately represent all adolescents and all experiences of food and diabetes management when living with T1D. Further co‐design could also expand with adolescent preferences for environments appropriate for mental health, in addition to screening. This would enable facilitators to prepare adequate staff training to provide psychosocial safety and risk management protocols.

5. CONCLUSION

This study was the first study in Australia to pilot a Teaching Kitchens program for adolescents with T1D. Our study highlighted key considerations and learning for implementing a Teaching Kitchen within a paediatric hospital setting for patients with chronic disease. Embedding this program within a hospital service can enable ongoing co‐design with participants and potential tailoring to a broader range of patients living with both chronic and acute conditions (e.g. Coeliac disease, Crohn's disease, Cystic fibrosis and Oncology). The model may be the way forward by fostering peer support and improving quality of clinical service provision and ultimately, patient care.

AUTHOR CONTRIBUTIONS

Conceptualisation, V.S.; methodology, V.S., A.J.H, R.L., A.B. and N.E.C.; session facilitation, N.E.C. and R.L.; data collection, R.L.; formal analysis, R.L., N.E.C. and V.S.; writing—original draft preparation, R.L. and N.E.C.; writing—review and editing, N.E.C., R.L., V.S. and A.J.H.; funding acquisition, V.S.

FUNDING INFORMATION

This study was conducted at the Perth Children's Hospital in collaboration with Children's Diabetes Centre (CDC), an integrated clinical and research centre situated within the Perth Children's Hospital and the Telethon Kids Institute. The study was funded through the Perth Children's Hospital Foundation. The food was donated by Farmer Jacks in Subiaco.

CONFLICT OF INTEREST STATEMENT

The authors declare no conflict of interest.

ETHICS STATEMENT

GEKO at Perth Children's Hospital. [2023‐000440] approved by the Medicine Division: Endocrinology GEKO Committee.

INFORMED CONSENT STATEMENT

Informed consent was obtained from all subjects involved in the study.

Supporting information

Data S1.

Lim RJ, Crosby NE, Harray AJ, et al. Teaching Kitchens: An innovative program for enhancing self‐management skills in adolescents living with type 1 diabetes (T1D) – A feasibility study. Diabet Med. 2025;42:e70053. doi: 10.1111/dme.70053

DATA AVAILABILITY STATEMENT

Data will be provided upon request.