Understanding factors affecting engagement with food-related services in areas of deprivation: a mixed methods study

Abstract

Poor dietary health is disproportionately higher in low-income adults, who often face multiple barriers to accessing affordable, nutritious food. Food-related services aim to address these challenges, but engagement remains inconsistent. Understanding the drivers of (non)engagement is critical to improving service design and delivery. This mixed-methods study explored factors influencing engagement with food-related services among low-income adults living in deprived areas. A cross-sectional survey (n = 77) measured capability, opportunity, and motivation to engage with services using the COM-B (capability, opportunity, motivation – behaviour) model. Semi-structured interviews (n = 20) were analysed thematically to explore service users’ lived experiences. Survey findings indicated that perceived capability and opportunity, but not motivation, were positively associated with service engagement. In contrast, qualitative data revealed that motivation was often present but disrupted by external barriers, such as stigma and unmet needs. Future interventions should prioritise equitable access, dignity-preserving practices, and responsiveness to user needs to reduce barriers and enhance engagement.