Perspectives From Patients Using a Food Pantry in a Family Medicine Residency Clinic: A Qualitative Study

Recognizing and addressing social determinants of health (SDoH) is essential for promoting health equity.^{1, 2} Important SDoH include housing, transportation, education, and access to nutritious foods.¹ The Accreditation Council for Graduate Medical Education requires residents to be aware of and address SDoH.³ However, numerous barriers to addressing SDoH exist, including lack of resident training or knowledge, and lack of community resources. ⁴

Food insecurity is a major public health concern.⁵ Of people in the United States, 10.2% are food insecure,⁶ and rates of food insecurity are higher in cities and in Black and Hispanic households.⁷ Food insecurity is associated with diabetes, ⁸ obesity, myocardial infarction, and multimorbidity. ^{9, 10}

Government programs provide support to minimize hunger, but resources may be difficult to obtain.^{11, 12} Local food pantries help food insecure households by providing a short-term food supply when needed. ¹³ However, food pantry use has many barriers, and food is of inconsistent nutritional quality. ^14- 16

Primary care offices increasingly address SDoH through screening, community partnerships, patient education, and referrals. Patients are comfortable discussing SDoH during office visits.^{17, 18} Food pantry referrals are acceptable to patients,^17-19 but a disconnect often exists between primary care offices and community-based organizations. ²⁰

Some health systems directly address food insecurity.²¹ Organizations have created food pantries in hospitals or medical offices.^22-25 Data on the benefit of food pantries in primary care offices is limited, and no reports of a food pantry within a family medicine residency clinic have been published.

We established the Banner Family Food Pantry in April 2023 within a family medicine residency clinic in Phoenix, Arizona, to address an important SDoH. Residents have protected time and work with faculty and staff to collaborate with a local food bank and a local produce cooperative. From April 2023 through June 2024, the pantry provided fresh produce and healthy nonperishable food to 2,782 households and 8,505 individuals.

We designed a qualitative study using semistructured interviews to understand patients’ experiences with food insecurity and the impact of having access to healthy food in a family medicine residency clinic.

We invited English-speaking people over the age of 18 years who attended our clinic-based food pantry to an interview. The food pantry is open to community members, but most users are clinic patients. We asked attendees their zip code and their household size. The University of Arizona Institutional Review Board approved the study (00002615).

One of us (L.N.S.) conducted semistructured interviews with a convenience sample of pantry visitors in May and June 2023 who requested food while L.N.S. was present. All patients consented to interviews. One interview was conducted over the phone. The interview guide, created after a literature review, is shown in Table 1. The interviews ranged from 4 to 26 minutes.

We audio recorded, transcribed, and analyzed the interviews using the editing organizing style.²⁶ We selected the editing organizing approach because it is a commonly used method for analyzing short interviews to understand the rich experience of participants. We (L.N.S. and S.R.B.) listened together to the recordings for initial deep engagement and reflection. We then individually read through each interview and highlighted noteworthy segments most relevant to understanding the experience of those with food insecurity. We handwrote comments (reflective observations) ²⁶ in the margins of the transcripts to explain segment relevance. We compared our margin comments and identified patterns to formulate themes.

The 21 patients interviewed came from 14 zip codes and lived in households of one to eight people. We found four main themes: (a) barriers to accessing healthy food, (b) prioritization of food for family members, (c) life-changing events leading to food insecurity, and (d) the value of obtaining healthy food from the office. We highlight exemplary quotes in Table 2.

Three main barriers are apparent for people attempting to access healthy food: cost, transportation, and time. Food costs are a major concern. Interviewees noted that healthy food is often more expensive. Another common challenge facing food insecure patients visiting the pantry is lack of transportation. Additionally, healthy eating takes a substantial time commitment. Many participants demonstrated substantial knowledge of the benefit of healthy foods and enjoy eating healthy foods but often lack resources to obtain and prepare it.

Respondents emphasized the prioritization of family members. Family members often are caring for others, including parents, partners, children, and grandchildren. Interviewees described putting the food needs of family members before their own.

Many patients visiting the food pantry were experiencing challenging life-changing events that changed household food needs, including death of family members, worsening health, job changes, disability, changes in government benefits, or loss of housing.

The interviews demonstrated the benefit of obtaining food at a primary care office. An in-clinic food pantry provides both accessibility and convenience, while also aligning with food suggestions from their doctor.

Patients using a food pantry in a primary care office noted numerous barriers to accessing healthy food, including transportation, cost, and time. Patients appreciated a food pantry at the primary care office because it showed care by the clinic for the patients, was convenient, and sent positive messages of health and the importance of healthy eating.

Minimal literature is published on food pantries in primary care offices, and limited data is available regarding perspectives of patients using this service. One hospital-based program found that patients expressed feeling comfortable, trusting the food, having high satisfaction with food quality, finding it convenient, lacking stigma, and helping them eat more fruits and vegetables.²³ At a food pantry in a pediatric primary care office, families felt positively about the program and reported an increased trust.²⁴ One publication detailed the logistics of creating a food pantry at a federally qualified health center (FQHC) but did not describe the patient experience. ²⁵

A key contribution of our study is the use of qualitative methodology to gain an improved understanding of why patients use an office-based food pantry. Understanding why patients use a pantry could help others design innovations and interventions to address food insecurity. While more research is needed to understand how a colocated food pantry might improve patient health and well-being, our findings imply that a food pantry in a primary care clinic addresses an important SDoH by removing barriers to healthy food access. Involving resident learners in the maintenance of a food pantry also contributes to SDoH education.

Health systems can help alleviate food insecurity by directly providing healthy food to patients in need. Our study shows that a food pantry in a primary care office reduces barriers, builds relationships with patients, and improves the availability of healthy food. We highlighted the benefits and added to the lessons learned²⁵ to assist others who are considering a primary care-based food pantry.

Our study has several limitations. We interviewed only English-speaking patients, which limits the generalizability to all populations. Our small convenience sample of patients may introduce selection bias and might not be representative of other primary care patients experiencing food insecurity. Additional research at multiple sites could help validate our findings. We could have improved the trustworthiness of our qualitative findings by corroborating our themes with perspectives from additional study participants.

Food insecurity is associated with poor health outcomes, and food insecure patients in a primary care office have many barriers to obtaining healthy food. A colocated food pantry in a family medicine residency clinic directly intervenes to improve an important SDoH and is well-received by patients. Primary care offices may benefit from the addition of integrated food pantries.

• Arizona Health Equity Conference, Phoenix, AZ, September 21, 2023.

• Society of Teachers of Family Medicine Medical Conference on Medical Student Education, February 8, 2024.