A Qualitative Study to Compare Barriers to Improving Food Security among Households with Young Children in the U.S. as Perceived by Different Types of Stakeholders before and during COVID-19

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TL;DR

This qualitative study interviewed 32 community stakeholders across five sectors in Florida to identify perceived barriers to improving food security in households with children under 3 years old, both before and during COVID-19. Before the pandemic, each stakeholder group identified a different primary barrier (e.g., stigma for healthcare providers, lack of transportation for early childhood educators), and COVID-19 introduced new barriers including fear of virus exposure, virtual programming limitations, and volunteer shortages. The findings highlight that coordinated, multi-sector policy and systems changes are needed because barriers vary by stakeholder type and were exacerbated by the pandemic.

Full summary

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**Background:** Food insecurity affects 15.3 percent (2.5 million) of U.S. households with children under age 6 (as of 2020) and is associated with poor diet quality, iron deficiency, cognitive-developmental problems, and increased hospitalizations in young children. The COVID-19 pandemic exacerbated food insecurity, particularly in low-income communities, by increasing unemployment and disrupting access to healthy foods. While community stakeholders offer unique perspectives on barriers and needs, minimal research has examined how perceived barriers to improving food security in households with children under three vary across different types of stakeholders. This study aimed to explore perceptions of barriers to providing services and resources to food-insecure families with children 0–3 years of age, both before and during COVID-19, across five stakeholder categories: healthcare providers, early childhood education specialists, community health planning and policy development professionals, emergency food assistance providers, and nutrition education professionals.

**Methods:** A qualitative study using in-depth, semi-structured interviews was conducted with community stakeholders in Florida. Purposive sampling supplemented by convenience sampling was used to recruit 32 participants across five sectors: healthcare (n = 8), early childhood education (n = 7), community health planning and policy development (n = 6), emergency food assistance (n = 6), and nutrition education (n = 5). The majority of participants were non-Hispanic (91%), white (64%) females with at least a Bachelor's degree (84%) and an average of 8 years of experience. Interviews lasting approximately 90 minutes were conducted via Zoom between November 2019 and August 2021 by one researcher (E.G.V.). The interview guide was based on the PREDISPOSE–PROCEED model, specifically the Predisposing, Reinforcing, and Enabling Constructs. Interviews were audio-recorded, transcribed verbatim, and analyzed using a deductive thematic approach. A cross-tab qualitative analysis compared data across stakeholder categories. The response rate was 85%, and participants received a $30 electronic gift card. 80% of transcripts were independently double-coded by three female researchers, with disagreements resolved through discussion.

**Key Results:** Before COVID-19, each stakeholder group identified a different primary barrier: healthcare providers and nutrition educators cited pride and stigma; community/policy development stakeholders cited lack of time; emergency food assistance personnel cited limited access to food; and early childhood professionals cited lack of transportation. Across all groups, the most frequently mentioned barriers were lack of or limited access to transportation, logistical issues with recruiting and retaining participants (scheduling, cost, visit length), and pride/stigma. During COVID-19, new barriers emerged: COVID-19 restrictions (social distancing, shutdowns, limited hours) affected all sectors; virtual programming limitations (lack of technology, internet access, face-to-face preference) affected early childhood education, healthcare, and nutrition education; fear of COVID-19 exposure was cited primarily by healthcare providers; and lack of or limited number of volunteers was cited by emergency food assistance and healthcare providers. Stakeholders also reported that pre-existing barriers were exacerbated during the pandemic. Regarding needed resources, stakeholders across sectors identified: (1) access to affordable and high-quality childcare services, (2) marketing strategies to increase awareness about available services and resources, and (3) a centralized referral system to efficiently match individuals with appropriate programs.

**Clinical Implications:** This study demonstrates that barriers to improving food security in households with young children are not uniform—they vary substantially by stakeholder type, and COVID-19 introduced distinct new challenges while worsening existing ones. The finding that no two stakeholder groups shared the same primary barrier before COVID-19 underscores the importance of engaging multiple stakeholder perspectives when designing interventions. The emergence of virtual programming limitations and fear of virus exposure as major barriers during COVID-19 highlights the need for flexible, multi-modal service delivery that accounts for both technological inequities and safety concerns. Stakeholders' calls for centralized referral systems and better marketing of existing resources suggest that improving coordination and awareness may be as important as creating new programs. These findings have direct implications for policymakers and program planners seeking to adapt food security interventions for vulnerable families with young children, particularly in the post-pandemic context where many barriers persist.