Across-Agency Partnerships and Within-Agency Capacities Facilitate Holistic, Tailored Approaches to Addressing Food Insecurity: A Qualitative Study.

Abstract

Capacity-oriented approaches have the potential to reduce food insecurity (FI) and promote nutrition and health equity in low-resource settings. The objective of this study was to identify multilevel capacities in San Diego County, CA that key informants from diverse food- and nutrition-related stakeholder agencies perceived to be helping to address FI. Trained qualitative interviewers conducted face-to-face, semi-structured interviews (30-60 minutes) with key informants. The Socioecological Model and a capacity-oriented approach informed interview guides. Participants were key informants (n= 23) from diverse purposively sampled stakeholder agencies (n= 16) providing food or nutrition services and programs across San Diego County. Interviews were conducted between April 2019 and December2021. Interviews were audio-recorded, transcribed verbatim, and checked for accuracy. The research team conducted thematic content analysis to identify themes. Two interrelated themes, within-agency capacities and across-agency partnerships, collectively appeared to influence each individual agency's ability to provide tailored, holistic care to their clients and, thus, expand each agency's reach and impact to address the 4 domains of food security (ie, quantity, quality, psychological, and social). Multilevel (ie, individual, interpersonal, organizational, and macro) within-agency human, social, and cultural capital (eg, volunteers, staff-client relationships, and cultural competency) positively influenced the reach and impact of the individual agencies by enabling them to provide clients with personalized, holistic care. Alongside within-agency capacities, multilevel (ie, interpersonal, organizational, community, and macro levels) across-agency partnerships allowed individual agencies to address FI more effectively and holistically by connecting clients to other services (eg, housing and mental health) related to the circumstances of FI. In San Diego County, multilevel capacities in the form of within-agency capacities and across-agency partnerships collectively influenced the effectiveness of stakeholder agencies in addressing the 4 domains of FI among at-risk households. Future research should consider how to evaluate the impact of these existing capacities on FI.