Balancing nutrition and budgets: Socio-ecological impacts on nutritional environments of families with low incomes.

Background: Research on childhood nutritional environments, which are predictive of a variety of child and family health and wellbeing outcomes, has primarily focused on parenting behaviors and the home food environment. However, broader social and community factors play an important role in shaping nutritional environments during early childhood. Food security is a key example that is closely linked to nutrition-related health disparities, which can arise from constrained financial resources and material deprivations. Understanding parent and caregiver lived experiences related to social and community components of family nutritional environments in the context of economic constraints could help to support multi-level nutritional practices that are optimal for healthy child development.

Method: Semi-structured in-depth interviews were conducted using a narrative approach with parents (n = 21) of pre-school aged children living near or below the poverty line. Participants were recruited from social and community service sites pertinent to maternal and child health in Philadelphia where health disparities are highly concentrated. Analysis was conducted using MAX QDA analytic software following a systematic approach for thematic analysis in narrative research.

Results: Three themes describe the feeding and eating environments in the home and community context: 1) Food Procurement and Meal Planning; 2) Family Togetherness; 3) Creativity, Variety, and Flexibility. Creative decision making and food procurement strategies responsive to child preferences were balanced by shopping to save and visiting multiple stores for the best foods and savings. Logistical (e.g., transportation, childcare) and emotional supports facilitated food shopping habits and routines, while lack of trusted childcare, reliable transportation, and social support barriers challenged feeding and eating decisions.

Conclusion: Strategies for improving cost and time-efficiencies could help support health-promoting nutritional environments of families with food insecurity. Building social and community capacity and facilitating connections to practical supports that include trustworthy childcare and peer support may be particularly important for this population.