Hunger and Health: Taking a Formative Approach to Build a Health Intervention Focused on Nutrition and Physical Activity Needs as Perceived by Stakeholders
Abstract
:1. Introduction
2. Materials and Methods
2.1. Pantry Context
2.2. Sample
Demographic Characteristics
2.3. Measures
2.3.1. Client Survey Measures
2.3.2. Client Semi-Structured Interviews
2.3.3. Volunteer/Staff Survey Measures
2.3.4. Volunteer/Staff Semi-Structured Interviews
2.4. Data Collection
2.4.1. Participant Surveys
2.4.2. Participant Interviews and Focus Group
2.5. Data Analysis
Interview/Focus group Analysis
3. Results
3.1. Client Results
3.2. Staff Results
3.3. Volunteer Results
3.4. Final Convergent Major Themes
4. Discussion
Study Limitations
5. Conclusions
- High rates of disease combined with low nutrition and PA literacy highlight the importance of holistic health intervention programming targeting health behaviors and chronic disease among food pantry clients. This includes considering intervention designs that go beyond addressing a single disease (e.g., diabetes) and work within a broader framework to address disease prevention and management (e.g., health coaching).
- A lack of expertise among volunteers and staff suggests program implementation will require hired staff members, specialized volunteers, and/or partnerships with local health organizations. This warrants the need to build community partnerships and create opportunities for additional training within pantry staff and volunteers to include an ecological approach to intervention design and implementation.
- Key characteristics of health intervention programming included accountability, incentives and individual attention. Mixed results regarding the program delivery platform lend to hybrid format options (in-person, virtual, group, and individual). Health coaching incorporates elements such as individual attention, social support, motivational interviewing, and accountability that match these intervention characteristics. This approach has been minimally tested in the food pantry setting.
- All three stakeholder groups recognized individual-level client needs and gaps in programming, aimed at prevention, prior to disease onset. Intervention programming that is focused on individual level need, such as health coaching, can lend to an intervention, which meets both disease management and disease prevention needs of food insecure pantry clients.
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Demographic Category | Food Pantry Client Characteristics (n = 30) | n | % |
---|---|---|---|
Gender | Male | 8 | 26.7 |
Female | 22 | 73.3 | |
Age, years | 20–30 | 4 | 13.3 |
31–40 | 2 | 6.7 | |
41–50 | 9 | 30.0 | |
51–60 | 9 | 30.0 | |
61–73 | 6 | 20.0 | |
Race | Caucasian/White | 24 | 80.0 |
African American/Black | 5 | 16.7 | |
Hispanic/Latino | 1 | 3.3 | |
Annual Household Income | <$10,000 | 13 | 43.3 |
$10,000–$24,999 | 15 | 50.0 | |
$25,000–$49,999 | 2 | 6.7 | |
Occupational Status | Working full-time | 5 | 16.7 |
Working part-time | 4 | 13.3 | |
Unemployed, currently seeking | 8 | 26.7 | |
Unemployed, not currently seeking | 7 | 23.3 | |
Retired | 6 | 20.0 | |
Education Level | Some high school | 1 | 3.3 |
High school graduate or GED | 5 | 16.7 | |
Some college | 14 | 46.7 | |
Associate degree | 6 | 20.0 | |
Bachelor’s degree | 3 | 10.0 | |
Master’s degree | 1 | 3.3 | |
Number of health conditions (individual) | Zero chronic disease listed | 1 | 3.3 |
One chronic disease listed | 18 | 60.0 | |
More than one chronic disease listed | 11 | 36.7 | |
Specification of health condition (individual) | Diabetes | 4 | 13.3 |
High Blood Pressure | 11 | 36.7 | |
High Cholesterol | 7 | 23.3 | |
Heart Disease | 3 | 10.0 | |
Metabolic Syndrome | 5 | 16.7 | |
Overall Health | Excellent | 1 | 3.3 |
Very Good | 9 | 30.0 | |
Good | 11 | 36.7 | |
Fair | 9 | 30.0 | |
Last Doctor Visit | 1–3 months | 21 | 70.0 |
4–6 months | 5 | 16.7 | |
>1 yr. | 4 | 13.3 | |
Health Insurance Status | Insured | 22 | 73.3 |
Uninsured | 8 | 26.7 | |
Number of health conditions (household) | Zero chronic disease listed | 12 | 40.0 |
One chronic disease listed | 13 | 43.3 | |
More than one chronic disease listed | 5 | 16.7 | |
Specification of health condition (household) | Diabetes | 5 | 16.7 |
High Blood Pressure | 7 | 23.3 | |
High Cholesterol | 5 | 16.7 | |
Heart Disease | 4 | 13.3 | |
Metabolic Syndrome | 4 | 13.3 |
Major Theme | Participant Quotes |
---|---|
Nutrition and physical activity barriers | “Mostly the prices [referring to barriers]. The cheaper it is, the less healthy it is. I have walked through a few organic isles, but it is just off the charts, even for food stamps.” (C.1) “I am a single person and I can’t buy a whole chicken, I just want one or two pieces, if I buy a roast, I want to buy a small one. I don’t want to have a whole bunch of spoiled stuff.” (C.9) “The short life of the produce, some of the stuff from the farmers market here will last a week, but some of the stuff from the supermarkets is old.” (C.21) “The hip, back pain or issues [barrier to PA]. I found out I have first stage emphysema so breathing issues.” (C.14) “Honestly, when my depression gets bad I have issues with that [motivation for physical activity] (C.15) “I don’t think people quite understand the importance of nutrition and physical activity because they are just trying to survive.” (V.8) “Sometimes I see the specific recipes and I think there is no way they are going to have those ingredients.” (V.5) “There is a high proportion of individuals who also have physical limitations or physical barriers to physical activity” (S.5) “I have experience direct interactions with clients that view physical activity as perhaps a luxury that they can’t afford yet.” (S.3) “I would say in my experience I get very little interaction with clients who are on a preventative track [related to disease, diet, exercise].” (S.3) |
Nutrition and Physical Activity Literacy | Sometimes the knowledge of what to do with certain food. Not knowing how to cook it or what to do with it. Knowing how to use different ingredients or spices.” (C. 26) “A lot of health issues, when you have diabetes or that other stuff, how to incorporate that into your daily life or eating. Foods that you’re able to make to help you with your health challenges like diabetes and other things.” (C.10) “I think I would be interested in learning what type of activities I could do, due to the fact of arthritis in the knees.” (C.20) “It would always be nice to know types of exercises you could do. I was in wrestling in high school, and all we did was like weights and stretch. So that is all I know.” (C.1) “Even stuff like the plate [referencing MyPlate]. It is basic, but it is useful for people to know” (V.5) “Maybe explaining you can walk and it’s still exercise. The little things that are PA and the benefits so like losing weight and the actual health benefits to your heart” (V.3) “I get a lot of recipe questions, or what does this go with, or does this go together, what can I do with these three things.” (S.2) “I think partially, it is a lack of knowledge about preparation, but also there is an assumption that I can’t prepare something a certain way because I don’t have the specialized machinery for it.” (S.3) |
Health Status and Lifestyle | “I have PTSD and Depression, high blood pressure, the knee injury, the hand injury, my boyfriend he has high cholesterol. He also has PTSD from Afghanistan and Iraq.” (C.6) “Hip problems and osteoporosis in the hip, stage one emphysema, I have problems that I feel are manageable as far as, yeah, I have been diagnosed with depression and I have been for years.” (C.14) “I have a 13-year-old now that has prediabetes and I am scared to death. We all have ADHD, we control it with medication. I also have schizoaffective disorder. I am living in recovery from drugs and alcohol. My sons are high anxiety. I just began taking antianxiety meds. Because of the stress I was being put under, I am a survivor of child sex abuse, so I am still very affected. It’s more like coming back to the surface. It took just 10 pounds more to make me just start getting really sensitive again.” (C.19) I have had gastric sleeve surgery, so pretty much 80% of everything I eat needs to be protein. Since the surgery, my stomach is real finicky so even stuff I am supposed to eat I can’t. I am limited by what surgery did to me.” (C.2) “I have a thyroid condition that I am supposed to be working on. And I supposed to be on a diet for it. But it’s hard to get the meal planning to get it situated.” (C.4) “People asking about health related things. I am finding more and more hyper specificity for [clients requesting] this is my diet, I have talked to my doctor and they say I need to be eating these specific items, can you help me find those, or do you have any of those?” (S.3) “I keep going back to mental and emotional health. So we know that majority of our clients live in really high stress situations for a number of reasons, so I think food can be, I have seen clients in the past that had food addiction, and this place can be incredibly triggering.” (S.1) |
Current Pantry operations and adjustments | “Identification of vegetables that are a bit different. We have had them here before, but they are incredibly passive, so that is people to sign up for SNAP.” (V.9) “Maybe you could be [pantry name] certified to help with that kind of thing [specialty diet recommendations]. Then if somebody has that issue then put it on their profile and you know what volunteers are certified to help with that. So specific volunteers can be certified in certain things and not everything.” (V.3) “If you train more in blood pressure and things like that, it would be nice, but I don’t know if I have time for something like that.” (V.9) “From a programmatic standpoint, I am asked about every type of chronic disease and nutrition for those specific diseases.” (S.5) “It would be kind of cool to have point guides [referencing how to get the most out of your allowable pantry points].” (S.6) “Nutrition facts placed around the place. Like what is the average suggested caloric intake for a day, and sodium intake.” (S.1) “I would love to know more nutritional information [reference to additional training]. Honestly, I don’t know much of any. Maybe, I know my ways of stretching meals, but that doesn’t mean it will work for everybody, like how can I help support.” (S.1) |
Health Intervention Program logistics | “I don’t do technology, so I would want face-to-face. I think maybe a lot of people don’t have the money, if they are coming here, they maybe can’t afford internet” (C.3) “You might get more people there if you reward them somehow. Like food or gift certificates to some place. Preferably some place healthy.” (C.3) “Individual [intervention delivery] because everyone has individual difference. Because you have your physical limits, but you also have your health. Some are disabilities. everybody is different.” (C.8) “If you can make it available online face-to-face like through zoom, wouldn’t that be great. Just the touching base.” (C.19) “If you go at them, I guess too forcefully or judgmental, you push them away. Approaching something with a positive outline.” (C.12) “Accountability, you need to be able to hold people accountable. If you don’t do that you aren’t going to get a good result.” (C. 27) “Ideally how to eat healthier. Healthy eating. Do that, but not do it in a patronizing way. It is too often it’s blamed on the individual.” (V.9) “I think that is one of the biggest one. Educating on how to effectively use their points. Some people only have 10 points and they get 4 sandwiches and that is going to last you max of 2 days.” (V.2) “Like the meal kits stuff they come up with [referencing premade meal kits available to clients]. Like super simple stuff that doesn’t require a lot of time or something I can maybe order a lot that [food items] we could use every week.” (S.4) “Budget stuff, I think talking to them about process of food acquisition, do you come here first or do you go to the grocery store first, you should come here first see what you can get with your points, and then build recipes off what you can make with what you get kind of thing.” (S.6) “We have had a lot of people recently asking specifically for items. So they want to do it, but sometimes they can’t. So maybe it would help to get together with the coach and say hey this week we are going to have this, or I can order this, then we can really encourage people to go down this route.” (S.4) |
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Fortin, K.; Harvey, S. Hunger and Health: Taking a Formative Approach to Build a Health Intervention Focused on Nutrition and Physical Activity Needs as Perceived by Stakeholders. Nutrients 2021, 13, 1584. https://doi.org/10.3390/nu13051584
Fortin K, Harvey S. Hunger and Health: Taking a Formative Approach to Build a Health Intervention Focused on Nutrition and Physical Activity Needs as Perceived by Stakeholders. Nutrients. 2021; 13(5):1584. https://doi.org/10.3390/nu13051584
Chicago/Turabian StyleFortin, Kelsey, and Susan Harvey. 2021. "Hunger and Health: Taking a Formative Approach to Build a Health Intervention Focused on Nutrition and Physical Activity Needs as Perceived by Stakeholders" Nutrients 13, no. 5: 1584. https://doi.org/10.3390/nu13051584