What qualitative research can tell us about food and nutrition security in the UK and why we should pay attention to what it’s telling us.

Poor dietary patterns leading to poorer health and increased health care use, have affected people living in disadvantaged economic circumstances in the UK for decades, which many fear will be exacerbated due to the UK's current so-called 'cost of living crisis'. The voices of experts by experience of those health and social inequalities are not routinely included in health improvement intervention development in relation to obesity prevention policy and programmes. Obesity is highly correlated with food insecurity experience in high income country contexts (where food insecurity data is routinely collected) and is similarly socially patterned. Using a health equity lens, this review paper highlights qualitative research findings that have revealed the perspectives and direct experiences of people living with food insecurity, or those others supporting food insecure households, that shed light on the role and influence of the socio-economic contextual factors food insecure people live with day-to-day. Insights from qualitative research that have focused on the granular detail of day-to-day household resource management, can help us understand not only how food insecurity differentially impacts individual household members, but also how behavioural responses/food coping strategies are playing into pathways that lead to avoidable ill-health such as obesity, diabetes and other chronic health conditions, including mental health problems. This review paper concludes by discussing research and policy implications in relation to food insecure households containing people with chronic health conditions, and for pregnant women and families with infants and very young children living in the UK today

Families, finances and food insecurity: Implications for health visitors and public health practitioners.

This study investigated the early implementation of the Financial Inclusion Pathway within the NHS Grampian area, and how it relates to clinical practice and the experience of care. The perspectives and experiences of low-income parents and their engagement with early years health professionals about financial challenges and income maximisation were explored. As were the observations and experiences of community-based health care professionals’ in addressing income poverty during their routine practice in relation to pregnant women and parents/carers of children under 5 years. Parent interview topics included views and experiences of conversations of financial issues during routine health care and any perspectives of benefits and possible consequences of the FIP concept. Health care professionals were also asked on their experiences on raising financial issues during routine care and their roles in relation to discussing financial challenges with clients

Maternal and infant food insecurity. [Blog post]

In 2021, I was both privileged and humbled to lead a qualitative research study that involved interviewing parents, health visitors, community midwives, and family nurse practitioners about their experiences of both enacting, and benefiting from, the so-called Financial Inclusion Pathway (FIP). The FIP is designed as one of several strategies that operate within Local Child Poverty Action Plans which all Scottish territorial health boards are required to produce and act on in collaboration with their respective local authorities. The FIP aims, through routine health professional enquiry, to identify families with children under five who are experiencing financial hardship and offer onward referral for financial advice and support to help increase their household incomes. Our study aimed to find out how NHS Grampian's FIP was working in practice, and in this blog, I offer my reflections on its key learning points

Resourcefulness, Desperation, Shame, Gratitude and Powerlessness : Common Themes Emerging from A Study of Food Bank Use in Northeast Scotland

Acknowledgements This study received funding support from the Scottish Government’s Rural and Environment Science and Analytical Services (RESAS), Theme 7 ‘Healthy Safe Diets’ Research Programmed. The authors would also like to thank and acknowledge the invaluable support and time given by Fiona Rae and Dave Simmers, the Community Food Initiative North East food bank volunteers and study participants. The authors would also like to thank Professor Elizabeth Dowler and Dr Lucia d’Ambruoso, and the anonymous peer reviewers for their helpful comments during the preparation of the manuscript.Peer reviewedPublisher PD

It's making us look disgusting…and it makes me feel like a mink…it makes me feel depressed!: using photovoice to help ‘see’ and understand the perspectives of disadvantaged young people about the neighbourhood determinants of their mental well-being.

There is growing recognition that poor adolescent mental well-being is a serious global health issue. Research exploring adult mental well-being issues has shown positive and negative associations with environmental factors such as quality of the neighbourhoods and social support. However, little is known about young people's notions of mental well-being, or factors they associate with generating, sustaining or eroding it. A qualitative community-based participatory research study was conducted using photovoice (PV), with young people attending a youth project based in a deprived inner-city neighbourhood in Scotland. The research enabled participants to identify and explore aspects of their neighbourhood they experienced as having a direct impact on their mental well-being. The following themes emerged as those most important to participants' mental well-being: (1) perceived levels of local neighbourhood investment and care; (2) access to various forms of capital (including social, economic and natural capital) and (3) fears about personal safety. Concerns about being perceived as poor by others and feeling neglected by city officials and councillors also pervaded participants' accounts. Young people actively engaged in this research and helped generate rich, contextualised data about their lives and neighbourhoods. Moreover, they identified feasible, locally based remedies to perceived problems. PV is a powerful tool for engaging disadvantaged adolescents in research about their health. This study revealed that there are several important and modifiable aspects of the neighbourhood environment that if remedial actions were taken, it could have a beneficial effect on young people's mental well-being

Understanding lived experiences of navigating supermarket foodscapes when living on a low income.

Despite being a public health priority for over 30 years, the prevalence of obesity in the UK remains high. Strategies to tackle obesity have typically focused on behaviour change at the individual level, ignoring wider health and social inequities that can increase an individual's risk of developing obesity and decrease responsiveness to interventions. Many people living on low incomes face food insecurity: the inability to afford or reliably access food that meets recommended nutritional requirements. Ultra processed foods, often high in fat, salt and sugar which tend to be cheaper than healthier alternatives can become a sensible economic choice, however, repeated consumption can present challenges for weight management. Interventions helping support the purchase and consumption of healthy food which move beyond individual responsibility to consider the existing socio-economic factors that contribute to weight gain and prevent weight reduction are required. Additionally, research suggests eating a healthy diet, in line government recommendations (i.e., the Eatwell Guide), would also bring about environmental benefits, through associated reductions in greenhouse gas emissions, helping tackle climate change. Individuals in high income countries purchase the majority of their food in supermarkets, making this the ideal context for research into and the delivery of 'upstream' social and economic level interventions. This study aims to provide a starting point for intervention development by exploring the experiences of people living with obesity and food insecurity when shopping in the supermarket environment, to help identify the instrumental factors and environmental cues that currently influence the purchase of healthy, environmentally sustainable food. Semi-structured interviews and focus groups will be conducted to explore broad experiences of shopping, choice of retailer, the receipt of emergency food provision and its impact on purchasing behaviour and external influences (i.e. others they shop for). The ways in which people living with obesity and food insecurity believe supermarkets can help support them purchase healthy, environmentally sustainable food will also be examined. Interviews will be audio recorded and transcribed verbatim, and data subject to thematic analysis. Findings will be used to inform intervention development as part of the FIO (Food Insecurity in People Living with Obesity) Food project

A qualitative investigation of the perspectives and experiences women and families living on low income in Aberdeen City associated with the introduction of the Financial Inclusion Pathway in 2019/2020.

This research project aimed to investigate several things: 1) the lived experiences of parents/carers and mothers of infants and young children in relation to the challenges of parenting on very low incomes (including food coping strategies) in Aberdeen City; 2) the challenges parents may face talking to health professionals about financial problems; 3) their thoughts about nursing and midwifery clinical practice that would facilitate and support the aim of income maximisation through the "Financial Inclusion Pathway" (FIP) approach; 4) parents' perspectives of the acceptability and usefulness of the FIP policy concept. This interview study took place with parents who used or were supported by the Woodside or Community Foods North East (CFINE) food pantries or food bank between July-August 2020

Good food is good medicine. [Blog post]

The growth of charitable food aid in the UK is a phenomenon that needs deep and persistent questioning. This was the reasoning behind our recent web-based Creative Conversation, and the motivation to co-write this piece as we reflected upon this experience. As the numbers of food banks and emergency food parcels given out have grown alongside the tonnes of surplus food redistributed, food insecurity levels have also increased, telling us, if we are willing to listen, that "food banks are no solution to poverty" and the conflation of the food surplus and food poverty problems must be addressed. This blog post, originally posted on 12 November 2021 and updated on 11 May 2022, reflects the authors conversation with Laura Chalmers as part of the RGU's Creative Conversations: Climate Change 2021 forum, 4-8 October 2021, Aberdeen, UK

Parents’ perspectives and experiences of parenting and caring for young children on a low income in the North East Scotland.

Background: Families with young children, and lone parent families in particular, are at greater risk of poverty and food insecurity, compared to other UK population groups. Tackling child poverty has been a key Scottish Government policy since the introduction of the Child Poverty Act (2017) in which local authorities and health boards are required to report on their Local Child Poverty Action Plans. In north east Scotland little formal research had focused on the lived experiences of parents and parents of infants and young children in relation to the challenges they face parenting on very low incomes, and, on questions about income maximisation strategies to alleviate child poverty. This paper focuses on some key findings of a study undertaken to address this knowledge gap in Grampian in 2020. Methods: Parents with young children supported by an Aberdeen City-based poverty alleviation social enterprise were invited to take part in an interview study. One-to-one semi-structured telephone interviews lasting between 30–40 minutes took place during July and August 2020. Interviews were transcribed and thematically analysed. Results: Ten women took part; two participants lived with partners. Eight participants were unemployed and two worked part-time. Each had between one and five child(ren), and all had one child under school-age. Five key impact themes emerged, i. limited participation in paid employment; ii. insufficient social security income; iii. household food insecurity experiences; iv. practical and emotional challenges and anxiety associated with their children’s overall development; and v. anxieties related to treats and special occasions. Four coping strategy themes were also revealed, i.e. i. budgeting and bill prioritisation; ii. self-sacrifice; iii. relying on others, and iv. keeping up appearances. Food coping strategies were explored in more depth, and two broad themes emerged: acquisition methods and management techniques. Discussion: Parents with young children experience significant barriers accessing paid employment due to caring responsibilities. Consequently, generating sufficient household income from alternate income sources, such as social security, is problematic. Parents reported devoting significant emotional and physical energy to dealing with the challenges of raising children in poverty, and it was notable that participants employed a range of sophisticated coping strategies and skill to make ends meet and maximise food resources, within highly constrained budgets. This research challenges notions that budgeting education initiatives have much to offer low income parents already well-versed on this issue. Strategies to increase their incomes seem a more effective way of alleviating their related anxieties

Combining different worlds: interdisciplinarity in action research.

The Foodways and Futures (2013-2016) project is of interdisciplinary nature, shaped by the fields of education, public health, sociology and nutrition. Foodways and Futures is a qualitative action research project based in the North East of Scotland. The project is to explore the socioeconomic environment surrounding food choices of so called ‘vulnerable’ young people, aged 16 to 25. During the course of the research project, it became apparent that interdisciplinarity brings many strengths to the project work but also bears some difficulties. Investigating the discussions surrounding interdisciplinary work is important because it helps to better understand the processes of knowledge production, and to develop the practices of research funders and policy-makers. Unfolding interdisciplinarity as a buzzword in academia based on the researcher’s experience is also part of the action researcher’s self-reflective practice, contributing to the project’s quality.This article is to make clear that it makes sense to tackle the obstacles of interdisciplinarity to ultimately develop better interdisciplinarity