Seeking Food Assistance: Food Insecure Veterans' Experiences Navigating through Systems

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Background: Food insecurity is defined as limited or uncertain access to adequate food due to a lack of money and is a social determinant of health.6 An estimated 1 in 4 Veterans using VHA services are food insecure.1–3 Working-age Veterans (i.e., those aged 18-59 years) have increased risk for food insecurity compared to elder veterans and non-veterans.1,17 The VHA screens Veterans in primary care for food insecurity. Significance/Impact: However, screening does not equate receiving assistance. Despite having a high prevalence of food insecurity, a smaller percentage of Veterans enroll in the Supplemental Nutrition Assistance Program (SNAP), formally known as food stamps.10,11 We do not know why more Veterans do not use this service. Additionally, as the VHA installs on-site food pantries, we know little about Veterans’ experiences with and perceptions of food pantries. Anecdotal evidence suggest that stigma & concern for quality of food may be barriers to use.12 Innovation: This is the first study to formally take a user-centered approach to learn what Veterans experience as they navigate systems in search of food assistance. Our proposal is set within the design thinking framework which consists of 3 phases: problem identification, solution ideation, & implementation.13,14 Each phase demands stakeholder participation. Our proposal focuses on the first phase. Using journey maps (i.e., visual tools developed through in-depth interviews that document lived experiences), we will identify unmet needs and gaps in service. Specific Aims: 1. Through qualitative, in-depth 1:1 interviews with food insecure Veterans (n=40), we will visually map food insecure Veterans’ experiences with seeking food assistance. 1a) These journey maps will be aggregated and analyzed to identify barriers and facilitators to improve access to food assistance for Veterans living with food insecurity. 1b) Because COVID-19 may have impacted the ability of Veterans to obtain food assistance, we will specifically ask Veterans if and how COVID-19 affected their experience with seeking food assistance. 2. We will strengthen our relationships with community partners and other key stakeholders in preparation for the next two phases of the design thinking framework that require collaboration. We will increase routine communication, host discussion groups, and evaluate responses to the Research Partnership Checklist15,16 which will inform us of partner expectations. Methodology: Using in-depth, 1:1 interviews with 40 Veterans aged 18-59, living in and around southeast Texas, we will construct journey maps to document Veterans’ actions and emotions as they sought food assistance. Aggregated maps will be shared with community partners and other stakeholders. To strengthen relationships, community partners will complete an assessment tool that will help us build working relationships in alignment with their expectations. Implementation/Next Steps: The journey maps will identify areas of difficulty or frustration for Veterans needing food assistance. In collaboration with our community partners and other stakeholders, we will brainstorm and prototype solutions to better meet their needs. Eventually our designed solutions will be trialed and implemented as appropriate.