Multilevel Factors Influencing Food Purchasing Decisions Among Families With Low Incomes During the COVID-19 Crisis: A Qualitative Study.

Background: The COVID-19 crisis caused large-scale changes to the US food landscape, including food availability and prices, shopping practices, and food assistance programs. Understanding how these changes converged to influence food choices among families is critical for program and policy design to support children's healthy development.

Objective: To explore food purchasing and feeding practices among low-income caregivers of young children during the COVID-19 crisis and economic recovery, including changes in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) and neighborhood characteristics.

Method: This qualitative research conducted focus groups via videoconference with caregivers of young children with low incomes. Focus groups were stratified by WIC participation and language (English/Spanish).

Participants and setting: Eligible participants were adult primary caregivers of a child younger than age 5 years who is a primary care patient at 1 of 2 participating pediatric health care systems, residents of Pennsylvania, fluent in English or Spanish, and were WIC eligible. Nine focus groups were held (7 English and 2 Spanish; N = 51 participants) during April to July 2023.

Statistical analyses performed: Focus group transcripts were analyzed with a combination of a priori and inductive codes, guided by grounded theory, resulting in a consensus-created coding scheme applied by 2 coders.

Results: Three major themes developed: the COVID-19 crisis exacerbated existing food purchasing challenges and added new challenges; neighborhoods, shaped by structural barriers, do not adequately meet families' food needs; and administrative burdens continue to inhibit WIC use, although pandemic-related changes to WIC were beneficial.

Conclusions: Complex interactions between the food system, federal assistance program participation, and individual needs add burden to families struggling to make food purchasing choices. Results support the development of solutions to preserve families' agency to enact their beliefs and needs around healthy eating while accessing food assistance programs and managing the lasting economic impacts of the pandemic.