Understanding factors affecting engagement to food services in deprived areas; a mixed methods study

Abstract Background Individuals living in socioeconomically deprived areas face persistent barriers to healthy eating, including limited food access, high costs, and reduced availability. Community-based food services (e.g., food banks, community cafés, cooking programmes) aim to mitigate these barriers and improve diet, yet engagement with these services remains inconsistent and often low. This study aimed to identify and understand the factors that affect engagement with community food-related services within areas of multiple deprivation, using a COM-B (Capability, Opportunity, Motivation - Behaviour) model survey and qualitative interviews. Methods A mixed-methods design was employed. A COM-B-informed survey (n = 77) assessed how behavioural drivers (capability, opportunity, and motivation) predicted service engagement. Multiple linear regression was used to analyse survey data. In parallel, semi-structured interviews were conducted with 20 participants to explore the lived experience of food service users. Interviews were analysed thematically. Results Multiple linear regression analysis indicated that capability (β = 0.438, p = 0.011) and opportunity (β = 0.441, p = 0.012) significantly predicted service engagement, whereas motivation (β = 0.111, p = 0.691) did not. Thematic analysis identified four qualitative themes: (1) gratitude and reliance on services; (2) fairness and equity; (3) dignity and stigmatisation; and (4) a mismatch between provision and need. Conclusions While the survey suggested opportunity and capability are important predictors of service use, qualitative data highlighted the role of motivation, particularly in relation to perceived dignity, fairness, and usefulness of services. Efforts to increase uptake must therefore go beyond structural barriers and meaningfully address users’ values and lived realities. Key messages • Theories from behavioural science can offer valuable, unique insight into factors affecting engagement with food services. • Policy makers should aim to improve access and user capability to improve engagement with food services in deprived areas.