Barriers and facilitators to the consumption of fresh produce among food pantry clients

Adherence to the Mediterranean Diet Among Families from Four Countries in the Mediterranean Basin

Background/Objectives: The cultural and socioeconomic changes to which societies are exposed can alter individuals' lifestyles and dietary habits. The nutritional patterns of Mediterranean countries may also be affected by these factors at varying levels, depending on the changing social characteristics of the countries. This study aimed to determine Mediterranean diet (MedDiet) adherence among family members from four Mediterranean countries (Türkiye, Spain, Italy, and Lebanon). Methods: The survey was structured around sociodemographic data, family relationships, the Mediterranean diet adherence screener (MEDAS), the Mediterranean lifestyle index (MEDLIFE), the Mediterranean diet quality index (KIDMED), and the obstacles and drivers of MedDiet adherence. Results: The data were obtained from adults (n = 812), with the contribution of their children (n = 500) if they had any. According to the MEDAS, 22% of the adults strongly adhered to the MedDiet. Similar results were obtained when Mediterranean lifestyle adherence was analyzed using the MEDLIFE score, with 20% of the adults presenting a strong adherence, while significantly stronger adherence was found in Lebanon than in the other countries. Regarding the children and adolescents, around 30% presented strong adherence to the MedDiet. Price, availability, and accessibility were significant obstacles, whereas the perceptions of health and diet quality were identified as the drivers of the MedDiet. Conclusions: Overall, our results highlight the need for national policies to reduce the economic burden of healthy food options while encouraging equitable access to re-popularize the MedDiet pattern. Future research should focus on intervention strategies tailored to different age groups and socioeconomic backgrounds, the long-term impact of family-based strategies, and the cultural influences on MedDiet adherence.

A Pilot Study on Ad Libitum Mediterranean Diet Intervention for Women with PCOS: A Mixed-Methods Exploration of Acceptability, Adherence, and Participant Lived Experience

Background/Objectives: A healthy diet is essential for managing Polycystic Ovary Syndrome (PCOS), yet optimal recommendations remain unclear, highlighting the need to explore alternative lifestyle interventions. The Mediterranean diet (MedDiet) supports cardiometabolic health; however, challenges with adherence within this population are unknown. This study examines the acceptability and experiences of an ad libitum MedDiet in women with PCOS, offering recommendations for implementation. Methods: A 12-week MedDiet intervention was conducted with women aged 18-45 years, diagnosed with PCOS and a BMI ≥ 25 kg/m2 (n = 12). Adherence was assessed using the Mediterranean Diet Adherence Screener. Surveys and semi-structured interviews, guided by the Capability, Opportunity, Motivation-Behaviour (COM-B) model, explored participants' experiences. Thematic analysis identified barriers and facilitators, which were mapped to the COM-B and Theoretical Domains Framework (TDF), with all findings subsequently aligned with the Behaviour Change Wheel to inform implementation strategies. Results: MedDiet adherence significantly improved from baseline to week 12 (Baseline: 4.1 ± 1.8; week 12: 8.3 ± 2.3; p = 0.001), alongside increases in knowledge (p = 0.004), cooking confidence (p = 0.01), and time management (p = 0.01). Adherence factors were mapped to 12 of the 14 TDF domains. Key facilitators included health benefits, reduced weight pressure, educational resources, and simple guidelines. Barriers involved organisation, food availability, and external influences. Effective implementation should integrate MedDiet education, behaviour change support, practical resources, and professional training for nutrition professionals and healthcare providers to support referrals and weight-neutral dietary management. Conclusions: A short-term ad libitum MedDiet is acceptable for women with PCOS. Strategies for patients and healthcare providers, aligned with the intervention functions of education, training, and enablement, are key to supporting adherence.

Food sources and acquisition by consumers of low income in urban neighborhoods: A conceptual framework and food decision tree

Food decision-making among urban consumers of low income is comprised of a complex interplay of strategies, influenced by sociodemographic and environmental factors. This study was conducted in the Bronx, New York City, a borough marked by disparities and limited healthy food access. The study aimed to co-develop with urban consumers of low income a conceptual framework representing food procurement decision-making, with special attention paid to the multifaceted dynamics of food acquisition in the context of food insecurity. In-depth interviews and focus group discussions were conducted with bodega customers and food pantry clients to inform a food procurement decision tree. The framework illustrated the hierarchical order of food sources and coping strategies influenced by factors like household income, food assistance program participation, perceived access to food sources, living conditions, and immigration status. While grocery stores and supermarkets were the primary food sources, secondary sources like bodegas and food pantries were relied upon when physical or financial access was constrained, and superstores when resources were available. Farmers' markets and online grocery shopping were tertiary sources and oftentimes unrealistic options for participants. This study highlights the challenges faced by consumers of low income in accessing healthy food and underscores the need for food pantries to meet nutritional and cultural food needs. The findings emphasize the importance of considering contextual factors in interventions and policies to address food insecurity and their implications on community health.

The impact of food aid interventions on food insecurity, diet quality and mental health in households with children in high-income countries: a systematic review

OBJECTIVE

Households with children accessing food aid in high-income countries are often food insecure. We aimed to review the evidence on food aid interventions in households with children and impact on food insecurity, diet quality and mental health.

DESIGN

A systematic search was conducted using Web of Science, MEDLINE, CINAHL and PsycINFO. Articles published from January 2008 to July 2022 including cross-sectional, cohort and interventional studies in high-income countries were eligible.

SETTING

Food aid is defined as the use of interventions providing free food items by community and/or charitable organisations.

PARTICIPANTS

Two-parent, lone parent or households with a primary caregiver with at least one child ≤ 18 years.

RESULTS

From a total of 10 394 articles, nine were included. Food banks, mobile pantry combined with a free meal for children, backpack provision during school term and food parcel home delivery interventions were evaluated. Food bank models offering additional support such as community programmes, health and social services, cooking classes and free meals for children, client-choice-based models and programmes providing convenient access were associated with improved food security and diet quality (increased intake of wholegrains, fruit and vegetables). One study reported an improvement in mental health and food bank access at the end of 18 months but not at earlier timepoints and one study reported no change in parents' mental health.

CONCLUSIONS

Accessing food aid was linked to improved diet quality and reduced food insecurity in some studies. Allowing clients to choose food items and providing support services were most effective.

Use of Interactive Food Labels to Increase Confidence in Preparing Produce among College Students

College students may have limited access to produce and may lack confidence in preparing it, but cooking videos can show how to make healthy dishes. The Cognitive Theory of Multimedia Learning suggests that learning is enhanced when visual and auditory information is presented considering cognitive load (e.g., highlighting important concepts, eliminating extraneous information, and keeping the video brief and conversational). The purpose of this project was to pilot test a food label for produce grown at an urban university and assess whether student confidence in preparing produce improved after using the label and QR code to view a recipe video developed using principles from the Cognitive Theory of Multimedia Learning. The video showed a student preparing a salad with ingredients available on campus. Students indicated the label was helpful and reported greater perceived confidence in preparing lettuce after viewing the label and video (mean confidence of 5.60 ± 1.40 before vs. 6.14 ± 0.89 after, p = 0.016, n = 28). Keeping the video short and providing ingredients and amounts onscreen as text were cited as helpful. Thus, a brief cooking video and interactive label may improve confidence in preparing produce available on campus. Future work should determine whether the label impacts produce consumption and if it varies depending on the type of produce used.

The role of the community café in addressing food security: Perceptions of managers and directors

In the United States, the pay-what-you-can restaurant model (community cafes) is an increasingly popular approach to addressing food insecurity in local communities. We conducted semi-structured interviews (n = 13) with community café executive managers and directors to assess their perceptions of the role that their cafes play in addressing food security (FS). Analysis of interviews revealed two major areas of emphasis by participants. Filling an unoccupied space in the food security landscape. Interviewees regularly cited the goal of making meals available through a dependable schedule, convenient location, and welcoming atmosphere for guests to promote regular visits to the café, and they did so with an awareness of how their practices were shaped by perceived shortcomings in comparable services. In addition, guest agency and social aspects of the café as components of utilization, was another major area. Interviewees often regarded the opportunity of the food insecure guest to choose healthy options (i.e., nutritionally dense) over less healthful ones (i.e., calorically dense) from the menu as a critical component of their service. The social component of the café (e.g., community atmosphere, 'dining-out' experience) was another aspect of the café's function that promoted dignity for the guest which can lead to greater likelihood of return visits. Perceptions shared by participants of the café's role in addressing food security suggest that rather than simply adding to the available options of hunger relief services, the café model attempts to address many areas of concern, such as structural and cultural barriers, found in the traditional forms of charitable food provision.

Experiences of New Visitors With Low Food Security Seeking Food Assistance During the COVID-19 Pandemic

OBJECTIVE

To describe the experiences of first-time visitors with low food security seeking food assistance during the coronavirus disease 2019 pandemic.

DESIGN

A qualitative study.

SETTING

Emergency food distribution sites in West Central Florida.

PARTICIPANTS

Adults (aged 18-64 years) seeking food assistance between November, 2020 and July, 2021.

PHENOMENON OF INTEREST

Using food security as a multidimensional concept, in-depth interviews explored the impact of emergency food assistance on food availability, access, utilization, and stability.

ANALYSIS

Applied thematic analysis was conducted to identify emergent themes.

RESULTS

Participants (n = 18) were White (55.6%), female (72.2%), and aged 40-59 years (55.6%). Seven salient themes described participants' experience seeking food assistance (eg, the crisis resulting in seeking food assistance, mixed quality of pantry foods, and gaining firsthand insight on hunger). Although food assistance increased food availability and access, there were barriers to using the pantry foods (eg, foods not preferred, health/allergies).

CONCLUSIONS AND IMPLICATIONS

Study findings suggest that first-time visitors seeking emergency food assistance during the coronavirus disease 2019 pandemic may be experiencing temporary cycles of financial instability, which could impact dietary quality. Because pantry foods are often the primary source of household food supply, client-focused emergency food distribution tailored to client needs can increase food availability, access, and utilization.

Barriers and Facilitators Associated with the Adoption of and Adherence to a Mediterranean Style Diet in Adults: A Systematic Review of Published Observational and Qualitative Studies

The Mediterranean diet (MedDiet) has been linked with physical and mental health benefits. Previous research, however, suggests that adoption and adherence to a Mediterranean diet might be difficult for people who live outside of the Mediterranean region. The aim of this systematic review was to investigate the factors that influence adoption and adherence to a Mediterranean style diet in adults aged 18 years old and over, as identified in published observational and qualitative studies. Following registration of our protocol on PROSPERO (ID: CRD42018116515), observational and qualitative studies of adults' perceptions and experiences relevant to following a Mediterranean style diet were identified using systematic searches of databases: MEDLINE, the Cochane Library, CINAHL, Web of Science and Scopus, over all years of records until February 2022. A narrative synthesis was then undertaken. Of 4559 retrieved articles, 18 studies fulfilled our inclusion criteria and were included. Factors influencing adoption and adherence to a MedDiet were identified and categorized as: financial, cognitive, socio-cultural, motivational, lifestyle, accessibility & availability, sensory & hedonic and demographic. Similar barriers and facilitators are often reported in relation to healthy eating or the consumption of specific healthy foods, with a few exceptions. These exceptions detailed concerns with specific components of the MedDiet; considerations due to culture and traditions, and concerns over a cooler climate. Suggestions for overcoming these barriers and facilitators specific to adoption and adherence to the Mediterranean diet are offered. These data will inform the development of future studies of robust methodology in eating behaviour change which offer pragmatic approaches for people to consume and maintain healthy diets.

Food Pantry Clients' Needs, Preferences, and Recommendations for Food Pantries: A Qualitative Study

A qualitative formative approach was used to explore food pantry clients' needs, preferences, and recommendations regarding food received from food pantries. Fifty adult clients of six Arkansas food pantries were interviewed in English, Spanish, or Marshallese. Data analysis used the constant comparative qualitative methodology. In choice and minimal choice pantries, three themes emerged: clients need increased quantities of food, particularly more proteins and dairy; clients desire higher quality food, including healthy food and food not close to expiration; and clients desire familiar foods and food appropriate for their health needs. System level policy changes are needed to address clients' recommendations.

Religion and Food Insecurity in the Time of COVID-19: Food Sovereignty for a Healthier Future

The COVID-19 pandemic has exposed and amplified food insecurity in marginalized communities of color, revealing systemic health and socioeconomic inequalities. Given the role that religious organizations play in building social capital, disseminating information to local communities, and facilitating the distribution of basic necessities such as food, they are integrally involved in short- and long-term solutions to food insecurity. Yet, literature on the role of religious institutions for mitigating food insecurity is limited. The literature related to methods and means by which religious organizations engage community efforts to mitigate food security as well as studies in food sovereignty will be reviewed.

Experiences and Situations of Shame among Food-insecure Adolescents in South Carolina and Oregon

Shame experienced with food insecurity and participating in food assistance may affect adolescents. We investigated adolescents' experiences of shame related to food insecurity and situations for these experiences in an ethnically diverse sample of 40 adolescents aged 9-15 years from South Carolina and Oregon. In-depth interviews were recorded, transcribed, coded, and analyzed. Participants described feelings of sadness, anger, and internalized shame with food insecurity. Salient situations were participating in food assistance, seeking food assistance from others or community services, and social encounters at school among peers. Adolescents felt shame knowing that peers were aware of their food insecurity and about them participating in food assistance through school.

A Mixed-methods Study to Understand Food Environments and Grocery Shopping Patterns of Community Residents in Underserved Neighborhoods in Tampa, Florida

A mixed methods study was conducted to better understand food access, food retail store environment, and perspectives of community residents on their grocery store shopping patterns and access to healthy foods in underserved, predominantly African American neighborhoods. GIS mapping, grocery store observations (n = 4), a food access and grocery store environment survey (n = 126), and focus groups (n = 48) were used. The results indicate that these neighborhoods have a low density of grocery stores, and only two out of four grocery stores meet the standard for a healthy retail store. Barriers to getting healthy foods and solutions to improve food access are discussed.

The lived experience of food pantry users in Minnesota: Qualitative findings from a statewide survey

Objectives

In 2017 a community-University of Minnesota collaborative conducted a statewide survey of food pantry clients.

Methods

Of the 188 food pantries surveyed, 4321 individual client surveys were returned, from which 2,251 open-ended responses were analyzed.

Results

Respondents shared gratitude for the food pantry in meeting their needs for food and support. Many described accessing healthy food that was needed to address health needs. Respondents described life circumstances and hardships that led to food pantry use.

Conclusion

The supportive environment provided by food pantries position them to address the needs of clients, including those with complex health needs.

Hunger and Health: Taking a Formative Approach to Build a Health Intervention Focused on Nutrition and Physical Activity Needs as Perceived by Stakeholders

The intersections between hunger and health are beginning to gain traction. New interventions emphasize collaboration between the health and social service sectors. This study aimed to understand the nutrition and physical activity (PA) needs as perceived by food pantry stakeholders to inform a health intervention approach. The study used formative research incorporating mixed methods through surveying and semi-structured interviews with three food pantry stakeholder groups: Clients (n = 30), staff (n = 7), and volunteers (n = 10). Pantry client participants reported; high rates of both individual (60%, n = 18) and household (43%, n = 13) disease diagnosis; low consumption (0-1 servings) of fruits (67%, n = 20) and vegetables (47%, n = 14) per day; and low levels (0-120 min) of PA (67%, n = 20) per week. Interviews identified five final convergent major themes across all three stakeholder groups including food and PA barriers, nutrition and PA literacy, health status and lifestyle, current pantry operations and adjustments, and suggestions for health intervention programming. High rates of chronic disease combined with low health literacy among pantry clients demonstrate the need to address health behaviors. Further research piloting the design and implementation of a comprehensive health behavior intervention program in the food pantry setting is needed.

Family meal characteristics in racially/ethnically diverse and immigrant/refugee households by household food security status: A mixed methods study

While there is some research examining frequency of family meals by food insecurity (FI) status, there is little research examining other family meal characteristics (e.g., type of food served at meal, emotional atmosphere) or parent feeding practices by FI status. If food and money is scarce, it may be that the broader family meal environment looks different in families with continuous access to food (food secure, FS) compared to families with FI. Using ecological momentary assessment (EMA) and qualitative data, this study explores meal characteristics and parent feeding practices at nearly 4000 family meals in a low-income, racially/ethnically diverse and immigrant/refugee sample. For 8 days, participants (i.e., parents of 5-7-year-old children) completed a survey every time they shared a meal with their child. Additionally, parents completed a qualitative interview regarding family meals. There were many meal characteristics statistically correlated with a family being FI, including: who prepared the meal and how the meal was prepared, the makeup of people at the meal, the meal location and meal atmosphere, and the food served at the meal. Qualitative data illuminated many of these findings from EMA meal surveys. Quantitatively, families with FI and FS reported similar parent feeding practices during family meals. Qualitatively, families with FI and FS reported differences in (1) parent feeding practices; (2) food served at family meals; (3) challenges to having family meals; and 4) adults' role in the family meal. This study provides suggestions for interventionists working with families, including helping families identify time management strategies, including fruits and vegetables into family meals on a budget, reducing screen time at family meals while improving the meal's emotional atmosphere, and developing positive parent feeding practice strategies.

Food Acquisition Behaviors and Perceptions of Food Pantry Use among Food Pantry Clients in Rural Appalachia

Rates of food insecurity vary highly across and within regions in the U.S., with rural Appalachia having higher rates compared to the rest of the country, leading parts of the population to rely on food pantries as a source of food. This article explores how food pantries fit into a broader scope of food acquisition strategies of rural Appalachian households and aims to contextualize this with an understanding of how food pantry users perceive their food pantry use. Semi-structured interviews (n=20) were conducted with food pantry users in Eastern Tennessee, followed by a survey for collection of demographic data. NVivo 11.4 software was used for thematic analysis and theory formulation. In addition to pantry use, participants reported reliance on grocery stores, and reciprocal, informal, food-sharing social networks to get food. Lack of transportation, insufficient food quantity, and other factors depleted participants' food resources. Food stretching, refusing to waste food, acceptability of food pantry food, and money-saving strategies enhanced participants' food resources. Food pantries are a consistent, but not the only food source for those who use them. Food pantry users are savvy with their resources and employ multiple strategies to maintain their food supply despite high levels of food insecurity.

Primary Care and Food Bank Collaboration to Address Food Insecurity: A Pilot Randomized Trial

Food insecurity is common in the United States and linked to poor control of conditions influenced by diet. We conducted a pilot randomized trial to test whether a novel partnership between a primary care practice and a municipal food bank would improve control of type 2 diabetes among patients with food insecurity. Participants received food bank produce delivered twice monthly to the practice site, brief teaching from a food bank dietitian, and home-based education from a community health worker. After 6 months, glycosylated hemoglobin decreased (absolute change) by 3.1% in the intervention group vs 1.7% in the control group (P = .012). Scores on Starting the Conversation-Diet, a brief dietary measure, improved in the intervention group by 2.47 on a 14-point scale (P < .001). Body mass indexes (BMIs) were unchanged. In this early-stage study, onsite collaboration between primary care and a regional food bank generated clinically meaningful reductions in HbA1c and improvements in diet.