Meta-synthesis of findings from evaluations and qualitative interviews of work involving community food and its impact on mental health and wellbeing

Abstract

Background Improving mental health and diet are important components of the public health agenda in the UK. Community organisations have an important role to play in promoting mental health and wellbeing, and a number of community-based food projects are specifically designed to address this issue. However, impact assessment for such projects is difficult, and in-depth, high-quality evaluation data linking project activities to health outcomes is lacking. Aims and objectives This study aimed to summarise findings from Scottish evaluations of community food work on mental health and wellbeing. Method The project was undertaken in three different phases that had different methods. Phase 1 was a prospective evaluation of one community-based food project’s work, called Eat Well – Keep Active, run by the CHANGES Community Health Project. All participants who took part in the course were asked to complete a paper survey at the beginning of the course (baseline) and at six weeks. Various types of statistical analyses were then used to assess change in mental wellbeing and in eating habits. Phase 2 entailed qualitative interviews with key staff from seven community-based food projects and two Community Food and Health (Scotland) staff. The interview transcripts were qualitatively analysed to draw out key themes around how and why community food projects and their evaluations work. In Phase 3, a meta-synthesis of self-evaluations from eight community food projects was undertaken. Information from each of the reports was extracted to compare and summarise the project and participant characteristics, evaluation tools used, and outcomes measured by each project. Summary of main results Nearly all of the community-based food projects reported improvements in participants’ mental health and wellbeing. This was measured through a wide range of indicators and by a variety of tools, most qualitative in nature. Interviews with project staff suggested that the mechanism by which mental health and wellbeing benefit as a result of these projects may be related to social connectedness and support, rather than purely dietary (biochemical) mechanisms. The interviews also revealed that because outcome evaluation is not often built into the projects offered by mental health charities, securing the time, expertise, and funding for evaluation is a major barrier. Conclusions Community-based food programs offer participants the opportunity to develop skills, confidence, and social connections, in addition to learning about and making nutritious food, but current standard evaluation tools may fail to capture many important aspects of change in the lives and behaviours of community-based food project participants with mental health problems. This work highlights a key opportunity for community-academic partnerships, through which rigorous alternatives to quantitative questionnaires can be developed for use in community-based mental health work.