Abstract
BACKGROUND: Capacity-oriented approaches have the potential to reduce food insecurity (FI) and promote nutrition and health equity in low-resource settings. OBJECTIVE: The objective of this study was to identify multilevel capacities in San Diego County, CA that key informants from diverse food- and nutrition-related stakeholder agencies perceived to be helping to address FI. DESIGN: Trained qualitative interviewers conducted face-to-face, semi-structured interviews (30-60 minutes) with key informants. The Socioecological Model and a capacity-oriented approach informed interview guides. PARTICIPANTS/SETTING: Participants were key informants (n = 23) from diverse purposively sampled stakeholder agencies (n = 16) providing food or nutrition services and programs across San Diego County. Interviews were conducted between April 2019 and December 2021. ANALYSES PERFORMED: Interviews were audio-recorded, transcribed verbatim, and checked for accuracy. The research team conducted thematic content analysis to identify themes. RESULTS: Two interrelated themes, within-agency capacities and across-agency partnerships, collectively appeared to influence each individual agency's ability to provide tailored, holistic care to their clients and, thus, expand each agency's reach and impact to address the 4 domains of food security (ie, quantity, quality, psychological, and social). Multilevel (ie, individual, interpersonal, organizational, and macro) within-agency human, social, and cultural capital (eg, volunteers, staff-client relationships, and cultural competency) positively influenced the reach and impact of the individual agencies by enabling them to provide clients with personalized, holistic care. Alongside within-agency capacities, multilevel (ie, interpersonal, organizational, community, and macro levels) across-agency partnerships allowed individual agencies to address FI more effectively and holistically by connecting clients to other services (eg, housing and mental health) related to the circumstances of FI. CONCLUSIONS: In San Diego County, multilevel capacities in the form of within-agency capacities and across-agency partnerships collectively influenced the effectiveness of stakeholder agencies in addressing the 4 domains of FI among at-risk households. Future research should consider how to evaluate the impact of these existing capacities on FI.