Implementation Determinants of Nutrition Interventions in the Charitable Food System in the United States: A Scoping Review.

Abstract

This scoping review aims to describe the characteristics of nutrition interventions in the charitable food system (CFS), and to map knowledge gaps on the barriers and facilitators to implementing these interventions. Originally an emergency food source, the CFS has become the main food source for the food-insecure population in the United States. Nutrition interventions in this setting have proliferated; however, knowledge of their implementation remained fragmented. A search was conducted on November 22, 2023, in 7 databases (PubMed, Web of Science Core Collection, CAB Abstracts, BIOSIS Previews, PsycINFO, CINAHL, Scopus) and 4 gray literature sources (ProQuest Dissertations and Theses Global, PubAg, Healthy Eating Research Database, and Feeding America). Backward and forward citations of all included studies were screened for relevance. Studies were excluded if they were conducted outside the United States, did not involve the CFS, or did not address implementation. There were no restrictions on research design or publication year. Findings on implementation determinants were summarized based on the Consolidated Framework for Implementation Research. A total of 79 studies and 71 distinct interventions were included. Over half of the interventions took place in urban areas. Food banks and pantries were the most common settings. Most interventions were multicomponent, featuring nutrition and health education, behavioral economics, produce prescriptions, food provision, and nutrition policy and guideline modifications. Common implementation barriers were related to limited resources at CFS organizations and intervention participant characteristics. Common facilitators included partnerships and connections, meeting participants' needs, and alignment between the intervention's mission and that of the CFS organizations. Further research is needed to address knowledge gaps in underexplored implementation determinants, such as intervention deliverers' needs, intraorganizational communication, and external pressures. Additionally, there is a need to examine the implementation of nutrition interventions in rural areas and soup kitchens.