Understanding the eating behaviours of low-income families during the cost-of-living crisis: Informing future interventions

Abstract

Establishing healthy dietary behaviours in childhood is critical for long-term growth and development. However, the Cost-of-Living Crisis in the UK has substantially increased food insecurity and diet quality, with food prices rising 25% from 2022 to 2024. This left 4.3 million children in relative poverty in 2024. This has increased demands on food charities supporting low-income families. This PhD thesis addresses key gaps in the literature, including (1) A lack of behaviour change interventions for low-income families, (2) Limited understanding on the impacts of the Cost-of-Living Crisis on dietary interventions, (3) Lack of real-time perspectives and experiences on children’s eating behaviours from charity stakeholders and parents in low-income families. Therefore, this thesis aimed to identify evidence-based proposals for future interventions to promote healthy eating behaviours in children from low-income families during the Cost-of-Living Crisis, through application of the Behaviour Change Wheel and the Theoretical Domains Framework. Study 1 comprised of a systematic review of existing digital interventions targeting child dietary behaviours in low-income families. Using the Behaviour Change Intervention Ontology, five eligible studies were synthesised, identifying key characteristics. The most common Behaviour Change Techniques used amongst the five studies were Goal Setting (k=4), Problem Solving (k=3), Instruction on how to perform a Behaviour (k=3) and Prompts and Cues (k=3). This review highlighted core characteristics and gaps within existing child dietary interventions. Study 2 and 3 explored experiences of stakeholders in 12 food charities (n=22) and parents in low-income families (n=23) using qualitative interviews and dyads. Following an interpretivist methodological approach, a combination of inductive and deductive coding and using reflective thematic analysis was conducted. Findings were mapped to the Theoretical Domains Framework to identify behavioural determinants influencing charity support and parental feeding practices. Across stakeholder and parent perspectives, key barriers and facilitators centered on ‘Physical Opportunity’; resources and environmental constraints, ‘Social Opportunity’; community networks and reducing stigma, ‘Psychological Capability’; knowledge, child involvement and adaptive strategies, and ‘Reflective Motivation’; communication and reaching populations directly, are all required to support child healthy eating during economic crises. Integrating findings across all three studies, the Behaviour Change Wheel was applied to identify intervention functions, policy categories, Behaviour Change Techniques, and mode of deliveries, which inform future intervention design. This thesis demonstrates how combining enablement and service provision with practical social support and flexible delivery modes may strengthen both parental capacity and food support systems. This research contributes a novel, theory-driven, multi-level approach to designing dietary interventions for children in low-income families, highlighting the importance of behavioural and systemic adaptation during periods of economic crisis in the UK.