Nutrition Environment Gaps and Distribution Challenges in Rural Food Pantries During the COVID-19 Pandemic: A Mixed-Methods Study

Background Food insecurity disproportionately affects low-income, racially marginalized, and rural communities. The COVID-19 pandemic led to higher demand for emergency food distribution, potentially impacting food pantry operations and services. Limited research exists assessing consumer nutrition environments of pantries in rural regions. Objectives To assess the consumer nutrition environment of rural food pantries and report challenges and adaptations encountered during the pandemic. Design A mixed-methods, cross-sectional survey. Participants/Setting Nineteen food pantry representatives from California's San Joaquin Valley were surveyed between August 2020 and June 2021. Representatives were eligible if their pantry served the general population and was open at least once a week. Nine were church-based pantries, and 10 were from other settings. Main outcome measures The Nutrition Environment Food Pantry Assessment Tool (NEFPAT) measured the nutrition food environment and scored pantries as bronze (0-15), silver (16-31), or gold (32-47) categories. Eleven items were developed to explore pandemic-related challenges. Statistical analyses performed Independent c2 2 tests assessed the relationship between the organization type and NEFPAT scores and food supply sources. Fisher's exact test explored associations between food pantry type, NEFPAT category, and challenges. Nonparametric tests were run on non-normally distributed data. Inductive content analysis was used to examine open-ended pandemic-related questions. Results The nutrition environment of most pantries was suboptimal, because no pantry scored in the "gold" category based on total NEFPAT scores (median, 18 of 47). No statistically significant differences were found in the NEFPAT scores by organization type. Most pantries did not provide healthy food nudges or culturally diverse foods. Key COVID-19 challenges encountered consisted of supply- and demand-side issues, including reduced personnel, capacity, and resources, and increased client quantity and demand for food. Conclusions Assessing the nutrition environment of rural food pantries revealed gaps and strategies for improvement, including the use of healthy nudges and increasing the availability of culturally diverse foods.