Date of Award

2022

Document Type

Project

College/School

College of Nursing

Degree Name

Doctor of Nursing Practice (DNP)

Project Mentor

Dr. Gayle Robinson

Abstract

In the unhoused population, food access is a basic human need important not only for adequate nutrition, but also reducing feelings of food insecurity. Enhanced shelters are well poised to impact food access by providing meals and storage options for shelter residents. However, food hoarding behaviors, food safety concerns, and limited budget add complication to this problem. Shelter policies that optimize the availability of meals, food storage, and kitchen use have the potential to positively impact food security, but must be balanced with the individual needs of the shelter. It is important for enhanced shelters to identify best practices and policies to enhance food access, but little research has examined this topic. By addressing food access, we hope to enhance food security with a goal of mitigating food hoarding behaviors. Thus, the purpose of this policy evaluation project was to identify and prioritize policy solutions for food access and develop a strategy for policy adoption in the enhanced shelter environment.

Using the CDC Policy Analytical Framework, this project prioritizes policy options through three main aims. The first project aim refines the problem of food access from the perspective of stakeholders through a qualitative analysis of expert and staff interviews, and a resident focus group. The second aim identifies, describes, assesses, and prioritizes policy options for food access through a survey of representatives from local enhanced shelters. The third aim identifies strategies for policy adoption and presents findings to stakeholders through a policy brief.

The first aim of the project involved a total of three expert interviews, two shelter staff interviews, and one shelter resident focus group consisting of 15 individuals. Six common themes gleaned from expert and staff interviews, and resident focus group included: “food safety,” “pests,” “behaviors,” “feelings,” “meal types,” and “kitchen access.” We received a response rate of 33% for survey completion, with approximately 30 enhanced shelters in King County meeting criteria to participate in the survey and 10 shelters completing the survey in its entirety. Four major policy themes emerged, including “kitchen access,” “meals,” “personal storage,” and “shared storage.” Top policy choices included access to kitchen 24 hours a day, increasing the number of kitchen appliances, allowing room storage of shelf stable items and produce, limiting appliance use in rooms, allowing both shared refrigerator and dry storage options, labeling all foods, utilizing storage bins, shared responsibility for food disposal, and allowing at least 2 square feet of shared storage space per resident.

Feelings connected with food insecurity such as “safety,” “control,” “dignity,” “shame,” and “worry” are often closely tied to behaviors such as stealing, hoarding, and wasting food items. Thus, targeting policy options to help reduce feelings associated with food insecurity may help with undesirable behaviors from residents. Several policy improvements were identified for The Oaks Enhanced Shelter, as well as an assessment of feasibility in moving these policies forward. Lastly, findings were described in a policy brief which was presented to stakeholders. Key recommendations included: 1) Consider implementing top policy choices, 2) Address feasibility and barriers to expanding policy options, 3) Recognize and address feelings and behaviors related to food insecurity.

Despite the complicated nature of policy development in enhanced shelters, by targeting policy directed at reducing feelings of food insecurity, barrier identification, and policy feasibility, it is possible to create an environment where food access is promoted. At the local level, the findings of this project could be useful as King County’s “Health Through Housing Initiative” moves forward. Overall, this policy evaluation project has led to a greater understanding of perceived barriers to food access in enhanced shelters in King County Washington, as well as best policy options to promote food access.

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