Coping Strategies Used by Food Insecure Households

Food Insecurity Clinical Trial

Official title:

Understanding the Interdependencies Among Three Types of Coping Strategies Used by Very Low Food Security Households With Children

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02767141
• Other study ID #: 13224
• Status: Completed
• Phase: N/A
• First received: April 11, 2016
• Last updated: May 9, 2016
• Start date: May 2012
• Est. completion date: December 2014

Study information

• Verified date: May 2016
• Source: RTI International
• Contact: n/a
• Is FDA regulated: No
• Health authority: United States: Institutional Review Board
• Study type: Observational

Clinical Trial Summary

Children without consistent access to sufficient and nutritious food show sustained disadvantages. To improve food security, households utilize three types of coping strategies- participating in governmental feeding and financial assistance programs; obtaining food from nongovernment providers; and using individually developed strategies. To understand the interdependencies among strategies and decision-making processes used to select them, the investigators conducted a two-phased, mixed-methods study using a socio-ecological theoretical framework. First, employing a cross sectional, observational design the investigators administered in-person surveys to 320 adults in very low food secure (VLFS) households with children. Over 1 year later, the investigators repeated select questions and conducted in depth interviews with a cohort (n=28) of participants. Descriptive statistics defined magnitude of associations among strategies. Following bivariate analysis, the investigators assessed interdependencies and factors affecting relationships with log-linear models. The investigators analyzed interviews using an hierarchically ordered, analytical coding structure. With Qualitative Comparative Analysis (QCA), the investigators developed typologies of VLFS and created models treating food security as an outcome. The association of soup kitchen use and nutritionally risky behavior was altered by Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). Food safety-related risky behavior level related to intensity of food pantry use by participation in school food programs. Supplemental Nutrition Assistance Program (SNAP) did not affect the association between soup kitchen use and risky food safety behaviors. Key interview constructs included becoming and being short of food; coping strategies; decisions used to inform choice of strategies; and managing a devalued social status. Improved income stability was a necessary condition for improving food security.

Description:

Food insecurity is a serious issue facing households in the United States. In 2012, the time this study was begun, the U.S. Department of Agriculture reported that almost 15% of U.S. households and one in five households with children were considered to be food insecure. Over one third of these experienced very low food security (VLFS), with multiple indicators of disrupted eating patterns due to inadequate resources. These statistics are of particular concern because children without consistent access to sufficient and nutritious food show sustained disadvantages, including effects on cognition, academic performance, long-term nutritional status, and psychosocial development. To improve their food security, households utilize three types of coping strategies- (1) participating in federal feeding and financial assistance programs ("safety net"), (2) obtaining food from nongovernment Emergency Food Providers (EFPs), and (3) using individually developed coping strategies. The objectives of this study related to developing a better understanding of the coping strategies that VLFS households with children use to ensure that their households have sufficient food. Specifically, the study addressed two main research questions: What are the interdependencies among three types of coping strategies: participating in federal feeding and financial assistance programs ("safety net"), obtaining food from EFPs, and using individually developed coping strategies. What decision-making processes do people in VLFS households with children use when selecting coping strategies to ensure that their households have sufficient food? The investigators conducted a two-phased mixed-methods study of coping strategies used by VLFS households with children <18 years in North Carolina (NC), using a socio-ecological theoretical framework to guide their hypotheses, methods, and analyses. For phase I, the investigators employed a cross sectional, observational design. The investigators used a two-stage sample to recruit 320 clients of service providers who offer assistance to people with limited resources within eight NC counties with the highest food insecurity rates. Trained interviewers administered in-person a survey interview asking clients socio-demographic questions and about their use of three categories of coping strategies. Using a longitudinal design, more than a year after Phase I, in Phase II, the investigators completed in depth interviews with a cohort (n=28) of Phase I participants, selected using maximum variation sampling. During the largely unscripted interviews, participants were asked a select number of close ended questions from Phase I, including the 18 item food security module, to assess changes over the past year and permit comparisons between times one and two. To address the first question, two by two and multi-dimensional contingency tables were constructed to analyze the interdependencies among the three types of coping strategy outcomes. Descriptive statistics (odds ratios, counts and percentages) were performed to define the magnitude of the association among coping strategies. Fisher's exact tests and Chi-square statistics were then employed to assess the statistical significance of the interdependency among the outcomes. To further determine the interdependencies among the three coping strategies, and to assess how individual and household-level factors affect those interdependencies, the investigators employed log-linear models. To address the second research question, the investigators formulated a hierarchically ordered, analytical coding structure that reflected key decision-making constructs (e.g., knowledge of coping strategies, perception of risk of accessibility and availability of coping strategies, barriers to participation in "safety net" programs) and examined the results in terms of the key constructs. Lastly, responses to both sets of questions were jointly reviewed using Qualitative Comparative Analysis (QCA), a mixed-methods analysis technique. The investigators implemented a conventional, crisp set for (1) developing typologies of households and individuals experiencing very low food insecurity, and (2) exploring pathways to improving food security status among participants in the follow-up interviews. All procedures involving human participants was reviewed and approved by RTI International's Institutional Review Board (IRB).

Recruitment information / eligibility

• Status: Completed
• Enrollment: 320
• Est. completion date: December 2014
• Est. primary completion date: December 2014
• Accepts healthy volunteers: No
• Gender: Both
• Age group: 18 Years and older

Eligibility

Inclusion Criteria::

• 18 years of age or older

• responsible for getting food for household

• household assessed to have very low food security

• children <18 in household

• consent to participate

Exclusion Criteria:

• less than 18 years of age

• never responsible for getting food for household

• no children <18 in household

• do not consent to participate

Study Design

Observational Model: Case-Only, Time Perspective: Cross-Sectional

Related Conditions & MeSH terms

• Food Insecurity

Intervention

Behavioral:
• Coping Strategies
Coping strategies for households in the US with food insecurity

Locations

Country	Name	City	State
United States	Christians United Outreach Center	Asheboro	North Carolina
United States	Salvation Army	Asheboro	North Carolina
United States	Bladen Family Support	Clarkton	North Carolina
United States	Bladen Crisis Assistance Center	Elizabethtown	North Carolina
United States	Liberty Baptist	Ellenboro	North Carolina
United States	Chase Corner UMC Ministries	Forest City	North Carolina
United States	Grace Country Kitchen at Grace of God Rescue Mission	Forest City	North Carolina
United States	St. John's UMC	Gibson	North Carolina
United States	Higher Dimensions	Laurel Hill	North Carolina
United States	Church Community Service of Scotland County	Laurinburg	North Carolina
United States	Laurinburg Hope In Christ Ministries	Laurinburg	North Carolina
United States	Robeson County Church and Community Center	Lumberton	North Carolina
United States	Living Bread Holiness Church	New Bern	North Carolina
United States	Religious Community Services	New Bern	North Carolina
United States	Sacred Pathways	Pembroke	North Carolina
United States	Little White Country Church	Rutherfordton	North Carolina
United States	New Bethel Church	St. Pauls	North Carolina
United States	Black Swamp Church of Christ	Williamston	North Carolina
United States	Holy Trinity Church	Williamston	North Carolina
United States	Liberty Christian Center Food Pantry	Williamston	North Carolina
United States	Unlimited Care	Williamston	North Carolina
United States	Christ Deliverance Tabernacle Ministries	Wilson	North Carolina
United States	New Christian Food Pantry	Wilson	North Carolina
United States	Salvation Army	Wilson	North Carolina
United States	Willson Praise & Worship Church	Wilson	North Carolina
United States	Wilson County Interfaith Services: Hope Station	Wilson	North Carolina

Sponsors (1)

Lead Sponsor	Collaborator
RTI International

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Identify participants who have used at least one target coping strategy	Participants were administered a survey to document their use of at least one target coping strategy within the last twelve months	Initial contact	No