Reflections from implementing a community-based food aid randomised controlled trial

Abstract Background Food support provided from food banks is limited. Some UK food banks are piloting the provision of cash or supermarket payment cards to people accessing their services, but little is known about the impacts of this alternative provision. Randomised controlled trials (RCT) are the gold standard for evaluation but this study design is challenging in a food bank setting. The aim of this study is to report fieldwork implementation reflections from an RCT conducted in a North-West London food bank serving a diverse, disadvantaged community to aid development of future trial protocols. Methods Participants were randomised to control (6 standard food parcels provided once a week) or intervention (the choice to receive a supermarket payment card instead) group. Online questionnaires measure food insecurity, mental wellbeing, and nutrition intake amongst other outcomes at baseline, 3 weeks and 6 weeks. Interviews captured participant experiences and outcomes. In-depth researcher fieldwork reflections captured insights of researcher and participant experiences of trial implementation. Reflections were coded using thematic analysis to consolidate findings on trial implementation into key themes. Results Nine core themes emerged from the results, centred around three overarching meanings. These findings highlighted 1) the importance of training and mentoring for researchers delivering trial activities, tailored to working in a food bank setting, to support their professional practice and wellbeing; 2) ways of providing a safe, dignified, non-biased and non-judgemental trial environment for participants; and 3) the need to work around resource and logistical constraints to maintain a high standard of trial delivery in a food bank setting. Conclusions These insights contextualise the RCT results and offer learnings that can be implemented in design and delivery of future community-based trials with disadvantaged communities receiving food aid. Key messages • Implementing an RCT to evaluate outcomes amongst people experiencing food insecurity requires consideration of numerous challenges. • Reflective fieldnotes are a critical tool for contextualising trial findings and capturing participants’ experiences beyond pre-specified quantitative and qualitative outcomes.