From Counseling to Capacity: Patient-Care-Team Perspectives on Healthy Eating Support in Underserved Community Clinics.

Introduction: Healthy eating supports diabetes management and may reduce colorectal cancer risk, yet patients in underserved clinic settings often face structural barriers that limit dietary behavior change. This study examined patient-care-team and health-system factors influencing diet counseling, nutrition referral, and food-resource linkage in two community clinics. Methods: Before launching a patient-facing colorectal cancer and colon-healthy nutrition education intervention, we conducted an exploratory study to inform the intervention design with 23 patient-care-team members from two community-based clinics serving medically underserved populations. Participants completed semi-structured interviews supplemented by a brief descriptive survey. Interviews examined diabetes-related diet counseling, colorectal cancer risk-reduction nutrition, nutrition referral, food access, cultural food practices, and clinic workflow barriers. Survey items assessed knowledge of diets to prevent colorectal cancer, familiarity with diet-related risks and benefits, counseling practices, resources, and perceived patient barriers. Transcripts were analyzed using deductive codes based on interview domains and inductive refinement based on recurring patterns. Survey data were summarized descriptively. Results: Participants described diet counseling as important, particularly for patients with diabetes, but often constrained by limited time, competing visit priorities, referral availability, and patient social needs. Themes included routine but variably structured counseling; diabetes-focused counseling that created opportunities to reinforce colorectal cancer risk-reduction nutrition; barriers related to affordability, food access, housing, cooking resources, and competing priorities; the need for culturally responsive counseling; inconsistent availability or use of nutrition referrals and food-resource linkages; and variable patient-care-team knowledge, training, and confidence. Among all participants, 61% rated their knowledge of diets to prevent colorectal cancer as low, very low, or "don't know." Among role-applicable participants, 23% reported counseling patients about dietary changes to prevent colorectal cancer at every visit. Conclusion: In underserved clinics, healthy eating support should move beyond brief advice toward resource-linked, culturally responsive care pathways that connect counseling, referral, food access support, and follow-up.