Improving client experience and charitable food reach and access at food pantries: A qualitative study

Abstract

Food pantries are promising community partners in health promotion. This study explored client perspectives in food pantries to inform new approaches to improve client experience, reach, and access. We interviewed 52 adult clients who visited participating food pantries two or more times over 12 months in Cook County, Illinois in English, Spanish, or Cantonese. We analyzed transcripts using the Health Equity Implementation Framework. Participants were 69% female, 48% Black, 29% Asian, and 15% Hispanic/Latino. Participants identified availability of healthy and high-quality foods, client choice models, client-personnel interactions, multilingual services, and wait times as influential to pantry reach and access. Participants felt that client feedback opportunities and client-led community outreach could successfully engage community members who avoided food pantries due to stigma. Creating opportunities for client-centered feedback may improve client experience, reach, and access of food pantries, reduce stigma, and optimize a novel setting for community-based health promotion in diverse populations.

Introduction

Food insecurity is a health-related social need and risk factor for chronic disease, including diabetes, hypertension, and cardiovascular disease.^1–4 Food insecurity contributes to an estimated $77.5 billion of health care spending per year.⁵ However, food-insecure adults with diet-related comorbidities are less likely than those without food insecurity to engage in routine outpatient care,⁶ highlighting a need to develop novel settings for health promotion to address health disparities in food-insecure households.

Food pantries are community-based organizations that provide free groceries directly to food-insecure households. Food pantries obtain many of their groceries from regional food banks, and food pantries and regional food banks make up a large part of the U.S. charitable food system. Historically, offerings at food pantries have lacked the nutritional value necessary to support healthy diets,⁷ but charitable food organizations are increasingly interested in promoting healthy diets in food-insecure households.⁸ Of the one in eight American households experiencing food insecurity annually,⁹ approximately one quarter report using food pantries,¹⁰ with many of these food-pantry clients relying regularly on charitable food.^11,12 These data suggest that the majority of food-insecure Americans are still not accessing the charitable food system. While food pantries play an essential role in many low-income households, they are underutilized, and barriers to access and reach must be identified and addressed to increase food pantries’ potential impact in improving the diet and health of food-insecure people.¹³

Food pantries provide essential food assistance in their communities, and improving client experience at food pantries may increase reach and acceptability of health promotion programs hosted through food pantries. Different factors can act as barriers or discourage food-insecure families from visiting food pantries, but these factors have not been identified using client perspectives. In this qualitative study, we use the Health Equity Implementation Framework (HEIF), an implementation science determinant framework that articulates factors related to health with an explicit eye towards closing health inequities in programs, in this case provision of charitable groceries through community food pantries.¹⁴ The HEIF integrates health equity domains, using the Health Care Disparities Framework, with an implementation science determinant framework, the Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS), to assess implementation and equity barriers together.¹⁵ The HEIF contains 4 main elements: 1.) innovation factors (innovation refers to an intervention or program), 2.) clinical encounter (i.e., the patient-provider interaction; adapted for this study as the “clients-pantry encounter” and capturing the client-personnel interaction), 3.) recipient factors (i.e., those who influence or are affected by program implementation), and 4.) context factors (i.e., different levels within and beyond an implementation setting) (Box 1). We applied the HEIF in the qualitative analysis of this study to organize the determinants that influence client experience at food pantries and to center health equity. We focused primarily on factors that influenced decisions to access food pantries, with the objective of identifying modifiable factors to increase pantry reach and access as a preliminary step to developing future interventions to reduce inequities in food insecurity.

Box 1. Health Equity Implementation Framework elements.

Element	Definition
Innovation factors	Innovation refers to a treatment, program, intervention, or practice adopted by providers or staff and delivered to patients or clients. In this study, the innovation is provision of charitable groceries directly to clients.
Pantry encounter (adapted from “clinical encounter”)	The pantry encounter encompasses the patient-provider interaction, or in this study, the client-personnel interaction related to the innovation.
Recipient factors	Recipients can be individuals who influence innovation implementation (e.g., staff) and individuals who are affected by the innovation’s outcomes (e.g., clients).
Context factors	Context can capture different micro, meso, or macro levels that influence innovation implementation. Factors can include resources, culture, and leadership at various levels (e.g., food pantry, community organization, food bank, national charitable food system, or greater society)

Methods

Participants and setting.

Eligible participants were adults (age 18 years and older) who spoke English, Spanish, or Cantonese, and visited one of three food pantries in Cook County, Illinois at least twice in the past 12 months. The research team approached clients who were waiting for pantry services at the three sites. After obtaining spoken informed consent, we collected up to three phone numbers and one email address for each English- or Spanish-speaking individual and scheduled them for a phone or Zoom interview. For Cantonese-speaking individuals, interviews were same-day and offered in person at the food pantry, based on recommendations from community members. All three recruiting sites were located more than nine miles from the others and in urban areas (defined by Rural Urban Commuting Area Codes).¹⁶ Two sites offered client choice (i.e., clients chose their groceries), while one site offered pre-packaged groceries largely selected by pantry personnel with client choice limited to one protein selection. Each site used one or more of the following service delivery modes: in-person shopping, menu shopping (i.e., choosing groceries from a paper or digital list), and/or drive-through. One site allowed client visits monthly while the other two allowed client visits every two weeks. Each site was operated by a different community-based organization with all organizations offering enrollment in federal food assistance. Availability of additional enabling services varied by organization and included housing resources, charitable clothing, nutritional education, and enrollment support for other benefits.

Qualitative guide development.

To capture the priorities of food pantry staff and clients, we conducted three rounds of iterative development with community members to provide the opportunity to review and provide feedback on interview guides. The first meeting was in person and included pantry leadership, staff, and a client representative from four local food pantries to review and communicate their priorities on client interview topics. The second meeting was held via Zoom and included food pantry clients from metropolitan Chicago recruited through a community design studio funded by a university clinical and translational sciences institute to provide feedback on proposed interview topics and questions. The third meeting included participants from the first meeting to refine and finalize interview questions.

Qualitative procedures.

A research team member conducted up to two semi-structured interviews with each client respondent. We used a serial interview approach due to the number of topics included and to build rapport with the participants, reserving sensitive topics for the second interview. The first interview explored client perceptions of the service experience at food pantries. It included questions on the food selection, cultural relevance, and health considerations at food pantries, followed by a brief, self-reported demographic survey assessing age group, gender, race, ethnicity, educational attainment, household federal assistance, and medical conditions. The second interview explored willingness to provide feedback, stigma, and community outreach. In interviews, participants were asked about client experiences at any food pantry and were not limited to perspectives on the three recruiting sites. All interviews were conducted between October 2022 and January 2023. We audio-recorded interviews with consent and transcribed English interviews using automated transcription and Spanish and Cantonese interviews using professional transcription. A professional translation service translated Spanish and Chinese transcripts into English. This study was approved by the Northwestern University Institutional Review Board.

Data analysis.

We used descriptive statistics to analyze quantitative data from the sociodemographic survey. We conducted content analysis of interview transcripts using a deductive and inductive approach with open and axial coding.^17,18 Preliminary deductive codes included cultural relevance, food pantry stigma, and food inventory. Inductive codes arose from unplanned and important themes that developed organically in interviews. Two research team members independently coded 10% of transcripts to create the codebook for the remaining transcripts. After codebook creation, we added new codes for novel concepts that arose in subsequent transcripts and iteratively re-coded prior transcripts. The same two research team members coded all subsequent transcripts with a third team member checking each transcript for coding accuracy and agreement. We reconciled any coding discrepancies in team research meetings. In the axial coding stage, we grouped codes by larger categories identified through comparing their distribution within and throughout transcripts and in relation to each other. We then reviewed the content and categories from axial coding to generate themes, guided by the HEIF.¹⁵ We used Dedoose (version 9.0, SocioCultural Research Consultants, LLC) to apply and organize codes in the codebook creation and open coding step and Excel (version 16.0, Microsoft Corporation) in the axial coding and thematic analysis steps. While most interview questions were open-ended, the closed-ended questions that were included enabled counting frequences of “yes” and ‘no” responses to generate corresponding percentages.

Results

Sample characteristics.

Of 85 pantry visitors who consented to participate in interviews and provided contact information during in-person recruitment, 22 (26%) did not respond to a phone call or voicemail, seven (8%) had invalid or disconnected phone numbers, three (4%) withdrew, one (1%) was deemed ineligible, and 52 (61%) were included in the study sample. Of the 52 participants, all 52 completed one interview, and 38 completed two interviews. In this convenience sample, participants were predominately 65 years old or older (60%) and female (69%) with a high school diploma or less education (60%) (Table 1). For race or ethnicity, 48% self-identified as Black, 29% as Asian, 12% as White, and 15% as Hispanic or Latino. More than half of households (62%) captured in this study sample participated in the Supplemental Nutrition Assistance Program (SNAP) while 29% did not participate in any federal needs-based food assistance programs. Most participants (73%) reported at least one household member having a preexisting medical condition relevant to diet, including hypertension (60%), overweight or obesity (17%), diabetes (13%), and heart disease (10%); most households (69%) did not follow low-sodium, heart healthy, or diabetic diets. Of the 38 participants (73%) who reported at least one household comorbidity, 23 (61%) did not endorse following any of the listed medical diets.

Table 1.

Individual and household characteristics of a sample of adults who visit food pantries in Cook County, IL

	n (%)
N	52 (100)
Individual characteristics
Age
25–44	6 (12)
55–64	15 (29)
65 and older	31 (60)
Gender
Female	36 (69)
Male	15 (29)
Non-binary	1 (2)
Race
Asian	15 (29)
Black	25 (48)
White	6 (12)
Additional	4 (8)
Prefer not to answer	2 (4)
Ethnicity
Hispanic or Latino	8 (15)
Language of Interview
Cantonese	15 (29)
English	32 (62)
Spanish	5 (10)
Education
Less than a high school diploma	22 (42)
High school diploma or GED	9 (17)
Some college or associate degree	9 (18)
Four year college degree or higher	4 (8)
Prefer not to answer	8 (15)
Transportation to food pantry
Drive personal car	19 (37)
Ride or borrow car	13 (25)
Take public transportation	10 (19)
Take taxi	2 (4)
Walk or cycle	3 (6)
No predominate method	3 (6)
Unknown	2 (4)
Household characteristics
Federal Food Assistance
SNAP	32 (62)
WIC	2 (4)
Free or reduced price school meals
Breakfast	4 (8)
Lunch	8 (15)
Dinner	1 (2)
Summer meals	0 (0)
Head Start	2 (4)
None	15 (29)
Prefer not to answer	2 (4)
Medical conditions
Cancer	1 (2)
Diabetes	7 (13)
Heart disease (including myocardial infarction and congestive heart failure)	5 (10)
Hypertension	31 (60)
Kidney disease	1 (2)
Overweight or obesity	9 (17)
Pregnant	0 (0)
None	14 (27)
Medical diets
Diabetic diet	4 (8)
Heart healthy diet	5 (10)
Low sodium diet	7 (13)
None	36 (69)

Innovation factors.

Many participants stated that food pantries assist them with household food needs, citing the services as helping to offset household costs, particularly in the face of rising food costs and economic disruption from COVID (Box 2.1). Items obtained from food pantries complemented items purchased for the household and increased purchasing power at grocery stores. Items that interviewees mentioned commonly purchasing from grocery stores included meat and seafood, specific vegetables, and spices.

Box 2. Themes of client experience at food pantries by Health Equity Implementation Framework element.

Element	Theme	Excerpt
Innovation Factors
1)	Food pantries help alleviate restricted household budgets among pantry clients, especially in the context of rising living costs and economic disruption.	“It helps because it gives me more options when I go to the store. I’m limited in the options when you only have so much money to buy things, and the cost of living is more expensive now. So they offset, they offset definitely.” (1a, +) “You don’t have to starve to death or borrow money to the point you can’t pay it back… With the pandemic and everything, people losing their jobs, can’t get jobs. You know, it’s just helpful.” (1b, +) “Maybe this weekend I’m going to prepare the family some chicken alfredo. So I go to the pantry, I get chicken and make it easier when I go to the grocery store to get shrimp and sauce and everything else.” (1c, +)
2)	Clients want foods that support general health and chronic diseases.	“There were pantries before the pandemic, but now people are more health conscious. And so, there’s better selections of items and new recipes. And you know, it just uplifts, you know, individually and for the community.” (2a, +) “We got heart problems real bad in my family. So we watch everything we eat. So if we could pick out certain things like get more vegetables and things with no sodium.” (2b, −)
3)	Clients have mixed views on whether pantries should provide culturally appropriate foods.	“I feel that if [the pantry] knows what kind of people are coming there, you know what kind of foods can be passed out.” (3a, +) “Just because a person has a certain nationality or a certain culture doesn’t mean that that’s their food of choice. A lot of people have become very Americanized, and whatever their culture was, they prefer pizza or something rather. ” (3b, −/+) “January, they had the Rosca de Reyes, which is a Mexican or Latino tradition… I felt very identified because, wow, this is important for us. As a Mexican, that’s a big effort they made to give us something like that.” (3c, +) “Not one person is supposed to expect everything they need to be given. No organization can expect to give everything a person needs. It’s impossible because they’re different cultures.” (3d, −)
4)	Receiving spoiled or expired foods can leave negative impressions.	“Some of the other stuff they give you at them other pantries ain’t fitting. It is expired. They don’t eat it, and ain’t nobody was eating, but they still give it to you.” (4a, −) “You can already tell it’s mushy. Don’t give it to us for the sake of just giving it to us.” (4b, −) “They have food and stuff that’s rotting. And you got to pick through. Oh, no, oh, no, it’s just like the dogs out there in food that somebody else don’t want.” (4c, −) “I really was excited that I got a bag of avocados. But each one I cut open was already black… I’m not trying to complain. But since you asked me, I was disappointed with the avocados, excited to get them, but I couldn’t use them.” (4d, −)
5)	Clients strongly support having the ability to choose the items at food pantries.	“Let us pick what we want. Because you don’t know our diet. If you don’t know what we could eat, you might give us something that’s not good for us.” (5a, +) “It was the ideal pantry. I have not seen one since then… it was a big room. It was like born in a grocery store. She said ‘Take your time.’ When you got to the meat, the meat was laid out in a cooler.” (5b, +) “That was fine going in and picking out what you wanted and needed so that you don’t waste stuff that other people probably could use, you know, if you know you don’t want it.” (5c, +)
Pantry Encounter
6)	Client-personnel interactions at food pantries play an important role in client stigma and pantry use.	“They make it dignified. People usually worry about dignity when they at the pantry…Going to the pantry isn’t easy for anyone. You don’t want people to look at you weird… They make me feel like a person. It is dignified.” (6a, +) “I was a little ashamed going in. I see people’s comments there. And I’m a senior citizen, and I’m not working, and I didn’t have no choice but to go there. And they were very respectful… And so that’s why I go back when I can.” (6b, +) “I didn’t want to go back to that food pantry because they were mean, and it was snobbish and they’re rolling their eyes. I don’t know if it still exists.” (6c, −) “I was getting stuff two other pantries. And I wasn’t comfortable going there. So I went because I needed to. But when I started going to [study food pantry], even when we were going inside, I was comfortable. And I was getting enough that I stopped going to the other ones.” (6d, −) “When I gotta go to the table, I don’t like going to him. So I be trying to hurry up and get past him, so once I get past him, I feel a relief. But when I’m going to him, it’s like, he makes me feel bad. Like, oh my god, I am about to feel like a hungry person.” (6e, −) “The last time I went, [a volunteer] was pretty vocal and was saying, “You came already,” like kind of loud. And “You won’t be able to come back until the next month.” I mean, I need food, and he just made me feel really bad… like I was trying to cheat the pantry. I didn’t even go back after that…You know, it was just really embarrassing.” (6f, −)
7)	Clients are largely supportive of multilingual pantry services.	“There are times when people don’t go, those who speak other languages, because they don’t feel comfortable. They feel sort of excluded or as though they were being treated differently.” (Interview in English) (7a, −) “It’s like [staff/volunteers] are saying, ‘Hey, why do you even come here if you’re not from here?’… Because they don’t pay attention, or they don’t make an effort to be friendly when they’re helping you, because they think you don’t speak their language.” (Interview in Spanish) (7b, −) “Having people there that can communicate with their clientele is huge. And that’s something I see at this one that I didn’t see sometimes at the other ones.” (Interview in English) (7c, +)
8)	Long waiting times contribute to negative client perceptions and can affect food pantry access.	“It can be humiliating, because you have to be there getting in line really early to be waited on.” (8a, −) “The truth is that those two or three hours outside in the cold, or in the heat, or if it’s raining, those two or three hours can be used to pick the children up from school, clean the house, cook food, do other things that can be very useful rather than being outside… In other words, things like that really interrupt the lives of these people.” (8b, −) “Some of these people may have jobs or kids. So they cannot spend that long of time in line… some people may not come because they do not have the time to wait so long in the lines.” (8c, −)
Recipient (Client) Factors
9)	Clients are willing to provide feedback to improve pantry services.	“They respect me. They be wanting to answer cause they want to help me. That’s why if they were to ask me something, I would tell them cause I want to help them.” (9a, +) “I think just talking to the people and getting to know what the people at your pantry want. Like the communities and areas of Chicago are different.” (9b, +) “By doing this, y’all can look at the views and see what y’all wrote down. And like see what the people are saying and what like needs to be done and not.” (9c, −)
10)	Privacy may promote honest feedback from clients.	“Do so either anonymously, maybe the choice whether you want your name and phone numbers and get a call, or not. So maybe it’d be more honest.” (10a, +) “Don’t ask them questions when you are around other people. You know because it be embarrassing sometimes.” (10b, −)
11)	Clients want their feedback to lead to action and change.	“If I were to go to one of the workers, one of the people that really run the pantry not the one that volunteers…and you do something about it, that will make me want to come back.” (11a, +) “It’s okay if they say they don’t have the answer right now but they will, make sure that I get this to the right person. So they can at least get this resolved.” (11b, +)
12)	Clients can play an important role in bringing in community members who need services.	“I know that the pantry does give out flyers, and they make me feel comfortable. I don’t know what else. But I think that I think it probably takes a combination… My friend, I’ve talked to her about it and stuff. So. So I think those kinds of conversations and are very helpful.” (12a, +) “They like ‘Oh girl, let me know when you know about a food pantry’… We tell them when they need to come, what they need to be bringing with them, what times, maybe about some of the food that they be getting. Mhmm no, most of the people I know, they be welcoming the idea of a good food pantry.” (12b, +) “There was a migrant family wandering around Blue Island, and they were hungry, and they needed clothing. So I led them to the pantry. I told them, ‘You come here and no questions asked. You can come and get your food. You can come and get clothes. You can come here and come and get help.’ So wherever I’m at, I let them know about your pantry, and I let them know how good you girls are and what a wonderful job you doing.” (12c, +) “If you send me a pamphlet in the mail or something like what makes you think I’m gonna? Who is sending me this? Where is this at? I don’t wanna be bothered with this. But if somebody’s talking to me about it because they got experience, they know about it, I will go.” (12d, −/+)
Context Factors
Outer context: community members
13)	The most common reason cited for food-insecure individuals to avoid visiting food pantries was stigma.	“You aren’t going to use one if it makes you feel bad. Because life is hard enough, and going to the pantry doesn’t need to be harder.” (13a, −) “I asked her many times: ‘Why don’t you come?’ ‘Did you go?’ She always just said ‘No, no. It’s okay.’ So I don’t know if she was embarrassed or ashamed. I don’t know. So I don’t know what else the pantry could do to help her come.” (13b, −) “Maybe it’s a matter of pride. Like, ‘I’m the man of the house and I should be able to provide for my family.’” (13c, −) “Other people in the community are scared because they be feeling like people are talking about them.” (13d, −) “Although they’re poor, they also feel humiliated asking for things.” (13e, −)

(+) denotes an observation or recommendation that generally facilitates food pantry access

(−) denotes an observation that generally hinders food pantry access

Regarding the grocery choices available at food pantries, many participants were interested in foods to support general health, chronic diseases, and food allergies for themselves or for the household (Box 2.2). The most frequently mentioned medical conditions that influenced what they were seeking at food pantries were hypertension, dyslipidemia, diabetes, food allergies, and heart disease. Some participants endorsed the importance of availability of pantry foods that matched clients’ cultural backgrounds. Participants who supported culturally relevant options felt that pantries could observe their client base and customize food choices according to the cultural communities they serve; others warned that this approach could be presumptuous (Box 2.3a–b). Those who identified strongly with a particular culture or interviewed in a non-English language made more requests for specific groceries (e.g., nopales, water spinach, noodles, rice, tortillas) and expressed appreciation for seeing foods reflective of their cultural background (Box 2.3c). Many clients, including those who did not strongly identify with a particular food culture, appreciated receiving foods commonly associated with holidays, such as Thanksgiving turkeys, Christmas hams, and Three Kings Day loafs (rosca de reyes). However, clients who identified with non-Western diets also felt that there were limits to how much cultural relevance could be adopted in pantry foods (Box 2.3d). Lastly, clients reacted strongly against receiving spoiled and expired foods, with emotions ranging from disappointment to a sense of dehumanization (Box 2.4). As one participant summarized, “Don’t give us something you don’t want.”

Clients largely supported being able to choose the groceries they took home from food pantries, citing different household needs and a desire to reduce waste by not being given groceries they might not eat (Box 2.5). Multiple clients favorably described choice pantries as offering experiences akin to commercial grocery and retail stores. Some clients who had visited pantries that exclusively gave out prepacked boxes reported the experience felt dismissive: “When you go to certain ones, they just give you what they got. So, there’s no asking. It’s just ‘Here you go.’” However, one minor theme that appeared at a single study site was that clients balanced convenience and choice when deciding which pantry to visit. At this site, though clients had less choice by using the drive through, some preferred it to the in-person choice pantry, which required additional tasks (e.g., street parking, walking into the physical pantry, waiting in a sit-down area, and loading groceries). One client favored the drive-through because the prepackaged items also reflected what she would have chosen: “It’s more convenient to sit in the car and just get [groceries] put in, but it was a different experience to be able to go through and pick what you actually want yourself. But it’s still the same to me. It will be items that I probably [will choose anyway].”

Pantry encounter.

Interactions between clients and personnel during pantry visits were strong determinants of feeling stigma and deciding whether to return to a food pantry. Where clients felt treated well by the pantry personnel (paid staff and volunteers), they used positive descriptors, including “dignified,” “respectful,” “comfortable,” “nice,” “friendly,” and “welcoming” (Box 2.6a–b). Consistently positive client-personnel encounters alleviated the stigma felt by some participants. Other experiences with pantry personnel appeared to exacerbate stigma by making clients feel “bad,” “demeaned,” “uncomfortable,” “disrespected,” and “embarrassed” (Box 2.7c–f). In some cases, clients could recall the specific individual with whom they had a negative encounter, especially since these individuals were regularly staffing the pantry. Many clients who recounted a negative client-personnel interaction decided not to visit that food pantry again, though some clients felt the need to tolerate negative treatment to receive the food assistance that they needed.

While clients had mixed opinions on providing culturally relevant foods, they largely agreed that pantries should provide multilingual personnel for their clients with limited English proficiency, regardless of interview language (Box 2.7). English-speaking participants witnessed how non-English speaking counterparts struggled with basic communication and feeling excluded during pantry encounters, both of which were corroborated by participants who interviewed in Spanish or Cantonese. Participants of all languages felt that providing multilingual services, which were not consistently available, would encourage food-insecure individuals with limited English proficiency to access food pantries.

Lastly, many participants described longer than desired wait times to receive services, which negatively affected client experience. Some participants highlighted long wait times as the only negative side of an otherwise positive client experience. Long wait times could contribute to negative feelings about oneself, such as embarrassment (Box 2.8a). Participants also saw long wait times as impractical and disruptive, creating a significant barrier to pantry access among those who had competing schedules (e.g., childcare, employment) (Box 2.8b–c). A minor theme also arose around inhospitable environments where participants waited, including harsh weather when waiting outside, lack of seating for those with disabilities, and visibility to passers-by of the food pantry.

Client factors.

When discussing the idea of food pantries soliciting feedback from clients, almost all participants (96%) supported the idea of food pantries collecting client feedback. Participants saw the usefulness of client feedback in helping pantries better identify their clients’ needs and preferences (Box 2.9). Participants wanted pantries to solicit feedback on food availability (variety, quality, and amount), wait times, and customer service during the pantry encounter. Participants emphasized that collecting feedback confidentially to protect client identity and privacy might encourage more honest responses (Box 2.10). Lastly, while participants were willing to provide feedback to food pantries, they also wanted to see feedback put into action by pantry personnel (Box 2.11). The vast majority of participants (94%) preferred giving feedback by interview or survey. Respondents were evenly split between wanting feedback to be solicited by staff or volunteers or having no preference.

Participants also expressed interest in promoting food pantries where they had favorable experiences to their social networks and broader communities. Some participants mentioned talking to family, friends, and strangers whom they perceived to have food assistance needs about their preferred food pantries, including location, hours, and other details of the client experience (Box 2.12). They felt that promotion conducted by existing clients helped normalize food pantry access and bridge a gap in community outreach. Multiple interviewees in this study described being introduced to or brought initially by a family member or friend to a food pantry.

Outer context.

Most participants (69%) acknowledged knowing people who refused to visit a food pantry despite having food insecurity, with a stigma-related reason cited as the most common barrier (52% of affirmative responses). Several clients felt this stigma was rooted in implications that individuals needed charity or lacked self-sufficiency (Box 2.13). Some participants even mentioned feeling wary of or initially avoiding food pantries for the same reason: “I no longer have a lot of shame for being there. I think before people had the wrong ideas about the food pantry. But now, things have changed. I do not feel bad for using the pantry.” Other minor themes regarding why food-insecure individuals did not access food pantries were scheduling conflicts with pantry hours and perceiving themselves to have insufficient need for food assistance.

Discussion

This study highlights how experiences at food pantries can shape use of the charitable food system by households with food insecurity. Clients identified availability of healthy and high-quality foods, client-personnel interactions, and wait times as determinants of client experience most influential to pantry reach and access. Using the HEIF allowed us to center a health equity perspective while identifying determinants unique to individuals who are food insecure and access food pantries, such as encountering spoiled groceries or disrespectful treatment that may be less common in most commercial grocery settings. Greater client engagement is a potential implementation strategy for food pantries to improve client experiences and increase pantry reach and access. Client-centered strategies to improve experiences at food pantries may improve pantry reach and access by increasing comfortability, reducing feelings of stigma associated with food pantry use, and generating positive community outreach. Transformations to improve the experiences of food pantry clients may represent an important strategy to realize the potential of food pantries as sites for community-based health promotion among populations with a heavy chronic disease burden. Future research should explore the feasibility of implementing client feedback across a diverse cross-section of food pantries.

Importantly, clients were particularly concerned with pantries providing healthy options, unspoiled foods, the ability to choose groceries, and shorter wait times. In our sample, almost three in four households had medical conditions that would benefit from medically tailored diets, which clients recognized increased the need for healthier options at food pantries. Clients sometimes received expired or spoiled groceries, eliciting strong emotions of disappointment, and frustration, and a sense of dehumanization, which may only worsen feelings of negative self-worth among those who depend on food pantries. Furthermore, clients want to choose their own groceries in charitable settings, as they do in commercial settings. This allows clients the agency to make decisions that reflect their household’s various needs and preferences and helps clients reduce waste by avoiding foods they may not consume. Lastly, long wait times were a chief complaint for some clients, and they elicited negative feelings, such as embarrassment. Clients also identified long wait times as a logistical barrier for non-clients who could not take hours out of their day to wait for pantry services. These findings are consistent with prior qualitative studies of pantry clients, though interviews in this study explored these topics in greater depth.^19,20

In recent years, provision of culturally relevant foods has become a priority in the charitable food world.^21–23 Relevant research is limited, but one study reported that Spanish-speaking clients commonly identified food that was not culturally relevant and language barriers as challenges to accessing food pantries.²⁴ Programs to address cultural relevance, humility, and client outreach at food pantries have improved resource use and food security by subcultures, such as rural veterans,²⁵ indicating that cultural barriers may be overcome. Participants in the current study had mixed feelings about pantries providing culturally relevant options, with those who identified with specific cultural diets being more supportive. Clients viewed provision of holiday foods positively, whether they identified such foods as part of a culturally specific diet or not. However, the idea of multilingual services received broad support for encouraging inclusiveness at food pantries among English-proficient and non-English-proficient interviewees. It is possible that English-speaking clients see how their limited English-proficiency counterparts struggle with communication in the pantry setting whereas they do not witness their challenges with adhering to cultural diets in the home setting. Clients may further view cultural relevance as one of many household dietary considerations, including health, religion, and other values (e.g., vegetarianism). Though receiving culturally relevant foods, especially those associated with holidays, is very meaningful to some clients, food pantries may want to understand and supply foods according to the most common dietary considerations of their clients.

Historically, individuals have experienced stigma and shame for visiting a food pantry.^26,27 In this study, stigma associated with food pantry use remained a prevalent and significant barrier to food pantry access among non-clients. Some sources of stigma occurred within pantry encounters, especially in how pantry personnel treated clients. In this study, some clients recounted particularly stigmatizing interactions that led them to stop visiting a food pantry. It is likely that other client complaints, such as receiving spoiled groceries, limited English proficiency, long wait times, and lack of choice at pantries also contribute to feeling stigma. However, this also suggests that food pantries can play a role in reducing stigma; some participants mentioned that dignified and respectful interactions encouraged them to continue visiting a pantry. Clients also felt that client-led outreach to non-clients could help alleviate feelings of stigma associated with food pantry use by communicating positive and relatable client experiences and normalizing food pantry access among those with food insecurity.

Our study demonstrates that clients can contribute valuable feedback informed by their experiences to help food pantries improve services and increase reach and access. Clients largely supported providing client feedback to pantries. Developing robust client-pantry feedback models may enable those who use a service to guide improvements and deepen the engagement between pantries and the communities they serve. Food pantries who are interested in implementing such feedback models should ensure that feedback can be collected anonymously and privately. Clients also want some level of pantry accountability for seeking client feedback, so food pantries should consider focusing feedback on client experience characteristics they can change. Centering the client experience in pantry improvements can help alleviate stigma and encourage pantry access among non-clients, leading to greater reach in food assistance and pantry-based health promotion.

This study has limitations. Our sample may not be representative of all residents of Cook County who have visited food pantries, especially as our sample predominately included older adults and a disproportionately high proportion of Cantonese-speaking participants, and 69% of participants were female (though this reflects demographics seen in prior studies of pantry clients).^19,28 Each recruiting site’s client demographics are often highly related to the neighborhoods they serve, due to proximity and residential criteria; all sites had high proportions of older and female clients, and one site had a high proportion of Cantonese-speaking clients. Therefore, our sample is representative of the three sites included in this study. We used a convenience sample of adults who had visited our recruitment pantry sites at least twice in the past year, which excluded those who visited once and might not have returned for reasons that would be relevant to understanding client experience and food pantry access. Furthermore, since this study focuses on food pantry clients, it does not include the perspectives of food-insecure individuals who do not visit food pantries. By conducting remote serial interviews, eligible adults were lost to follow-up between recruitment, the first interview, and the second interview, and it is unclear if the pattern of missingness could be associated with findings. Lastly, our participating pantries were all in urban locations, which limits generalizability.

Our study strengths included recruiting participants from three different pantry sites that were geographically distant from each other within Cook County. We also offered interviews in the three most common languages represented by clientele of the participating pantry sites. Though serial interviews may have contributed to loss to follow-up, we retained 75% of participants in second interviews, and building rapport between the research team and participants likely encouraged honesty, especially around sensitive topics.

Conclusion

While food pantries may provide geographically accessible settings for future health promotion programs, different characteristics of client experience, including food availability, client choice, client-personnel interactions, and wait times, can influence food pantry reach and access. Food pantries working with their clients in feedback models and community outreach can encourage client-centered improvements in pantry experiences, reduce stigma, enhance equitable access to food assistance, and strengthen community-based opportunities for health promotion among populations that face health-related and social inequities.