From TBI to Table: an Application of the Food Choice Process Model Among Adults with Traumatic Brain Injury and Caregivers

Traumatic brain injury (TBI) is a leading cause of disability. TBI affects 1.1 million people in the United States every year. More people are surviving their initial injury and living with chronic symptoms. As a result, there is also an increasing number of caregivers for people living with TBI. Both populations experience permanent changes to their food choices and food-related behaviors after injury; however, these experiences are not reported in the literature. This qualitative research explored food acquisition and preparation behaviors among people living with TBI and caregivers of this population. The Food Choice Process Model (FCPM) was used as the theoretical framework to guide the development of research questions. The FCPM has three main levels: 1) Life Course Events and Experiences; 2) Influences; and 3) Personal Food System. Participants with TBI (n=10) and caregivers (n=10) completed demographic surveys and semi-structured Zoom interviews based on the constructs from each level of the FCPM. Themes were developed through deductive coding and thematic analysis. For people living with TBI, the biggest changes experienced after injury were increased planning and decreased cooking. The biggest influences of food choice were challenges with memory and fatigue. Thus, people with TBI developed strategies such as shopping with a partner or simplifying recipes and using convenient cooking equipment after injury. For caregivers, the biggest changes experienced after injury were less time shopping in person and an increase in cooking load. The biggest influences of food choice were time, money, and social factors. Thus, caregivers developed strategies such as shopping online, modifying foods or cooking routines, and choosing convenient foods or recipes to satisfy time demands after injury.Participants in this study described strategies for food acquisition and preparation that helped them adapt to stress, memory issues, and fatigue (person with TBI) and increased food-related tasks and time-demands (caregivers) following TBI. The findings from this study can be used by Registered Dietitian Nutritionists to help people impacted by TBI identify changes and overcome challenges in food acquisition and preparation, and guide clients toward simple personalized food choice strategies that are affordable and time efficient. Keywords: Traumatic brain injury, caregiver, Food Choice Process Model, food acquisition, food preparation, Registered Dietitian Nutritionist