A qualitative exploration of the impact of COVID-19 on food decisions of economically disadvantaged families in Northern Ireland
BMC Public Health volume 21, Article number: 2291 (2021)
The first UK-wide lockdown to prevent the spread of COVID-19 had a serious financial impact on low-income households, a population already in higher risk of food insecurity and poor dietary choices. Qualitative data on the impact of COVID-19 lockdown on food decisions of UK families are scarce. This study aimed to explore how the measures to control the spread of COVID-19 influenced the food-related decisions of socioeconomically deprived families in Northern Ireland.
A qualitative study captured data from online individual interviews. Participation was open for parents of children 2–17 years old living on a tight budget in urban and rural areas of Northern Ireland. A sampling matrix enabled equal representation of single- and two-parent households, as well as parents of younger children (<12y) and adolescents (≥12y). Data were collected by using the methods of Photovoice and mapping exercise. Data were analysed through a thematic approach.
Twelve online interviews were conducted and five distinct themes were identified reflecting families’ food-related decisions that were affected by the COVID-19 lockdown: 1) food planning; 2) food purchasing; 3) meal preparation; 4) eating and feeding behaviours and 5) eating food prepared outside the house.
The restrictions put in place to inhibit the spread of COVID-19 influenced all aspects of dietary decisions of low-income families. Changes observed during this period included frequent consumption of homemade meals, but also increased unhealthy snacking. Infrequent food shopping encouraged good meal planning, but was also a barrier to securing adequate fresh food. Food-related support including school meal assistance contributed to families’ food security, particularly those of single parents.
In the UK since the first cases of COVID-19 infection were identified in late January 2020 , the outbreak of COVID-19 has escalated into a major public health crisis . The nationwide lockdown, enforced at the end of March 2020 in response to the virus outbreak, involved the closure of ‘non-essential’ businesses, cessation of social events and social-distancing measures [3,4,5,6]. Vulnerable groups with underlying conditions were also encouraged to shield at home.
Apart from the serious health implications, the COVID-19 pandemic had an impact at a social and economic level. In a survey of non-COVID patients living in England, Wales and Scotland various sources of anxiety were mentioned including: uncertainty regarding finances and employment; and access to and availability of food . In June 2020 in the UK around 300,000 people were removed from their post because of the COVID-19 pandemic and received no pay . These individuals were more likely to be in occupations that require a minimum level of education. This means that households of individuals with lower educational attainment and income were very likely to be financially burdened by lockdown.
To fully understand the implications of COVID-19 for low-income households, one also needs to consider that the economically disadvantaged families are also more likely to have a lower quality diet [9,10,11], which in turn, renders them vulnerable to the COVID-19 virus . Inequalities in nutritional intake due to income are well reported in the literature and socioeconomic deprivation is associated with energy-dense, nutrient-poor diets. In Northern Ireland particularly, where intakes of total and saturated fat are already increased compared to the rest of the UK, low-income households tend to consume fewer fruit and vegetables and have lower intakes of dietary fibre and some vitamins and minerals when compared to higher-income families [13, 14]. Specifically for children, there is a significant increase in intake of total fat and high-sugar drinks and snacks with decreasing household income . Habitual diets high in energy, saturated fats and refined carbohydrates contribute to the prevalence of obesity and type-2 diabetes , both of which are significant risk factors of COVID-19 pathology and mortality [16, 17]. Additionally, considering the limited access to fresh food due to shielding and food insecurity often experienced by economically disadvantaged households [18, 19], the period of the pandemic has potentially further exacerbated the nutritional problems experienced by these families.
A substantial amount of research has been published about the effects of the COVID-19 pandemic on food-related decisions (food planning and purchasing, meal preparation) in the UK and globally with most of the existing data being quantitative rather than qualitative [20,21,22,23]. Qualitative data provide a rich description of individuals’ perceptions and experiences, such as those in relation to health behaviours and eating habits . Therefore, employing a qualitative methodology is highly appropriate to explore how COVID-19 and the measures to control its spread influenced the food decisions of low-income households.
The objective of this study was to explore the impact of COVID-19 lockdown on food-related decisions as experienced by economically disadvantaged families in Northern Ireland. Gaining a good understanding of the nutritional challenges that low-income families faced during the first nationwide lockdown (Mar – Jul 2020 ) is vital to develop appropriate interventions to meet their needs in the aftermath of the pandemic.
The present qualitative study arose from a larger project that aimed to explore the environmental factors that drive food choices in low-income families with children on the island of Ireland. Data presented in this paper however, have been collected exclusively in Northern Ireland.
Northern Ireland, the smallest of the four UK countries, has a predominantly white population (98% based on 2011 census data) ; and even though it is possible that the area has become more ethnically diverse since 2011, the current proportion of non-white residents is still expected to be very low. The number of people in poverty in Northern Ireland has significantly fallen in the past decade ; however, the proportion of children living in low-income families remains high, with this proportion being one out of three in some parts of the country .
Ethical approval for this study was obtained by the Research Ethics Committee of Faculty of Medicine, Health & Life Sciences, Queen’s University Belfast.
Participation was open to parents or guardians of children in preschool, primary and post-primary school age (2–17 years), as specified by the original project protocol. Both mothers and fathers were invited to take part. Recruitment focused on families that self-identified as living on a tight budget and lived in rural and urban areas in Northern Ireland. All participants needed to own a smartphone to be able to engage in the Photovoice and mapping exercise. Families with children who had a clinical diagnosis affecting eating (e.g. gastrointestinal conditions or diabetes) were excluded, as their experiences regarding food decisions during the COVID-19 lockdown would differ from the families of interest for this study. Families with children with well-managed food allergies were included.
The sample size was determined a priori with parents from 12 distinct households required. This number was deemed necessary to ensure different types of families could be included. A stratification process was followed so that the final sample included equal numbers of single parents and parents living with a partner, as well as equal numbers of parents with children 2–12 and 12–17 years old.
As part of the recruitment process the research team utilised a list of known contacts (i.e. gatekeepers) who worked in community organisations in Northern Ireland and interacted with low-income families. The gatekeepers extended the call for recruitment to their service users by posting in social media or forwarding the study information to further gatekeepers who worked with the target population. All parents who came forward were asked to confirm whether they were on a tight budget during the lockdown.
A first one-to-one discussion was conducted by phone to describe the purpose of the study and what participation required and capture participant’s demographic information. Data collection methods were as follows:
For this study, participants were instructed to take photographs that represent factors influencing their food choices during the COVID-19 pandemic and present these photographs during the online interviews. Participants could capture images of food promotions (offers and advertisements), food shopping (shopping lists, receipts, shopping bags), meal preparation (food being cooked/served), or anything else they felt impacted their food decisions. They were encouraged to take 1–2 photos with their phone every day for 1 week and were also given the option of receiving a reminder text. They were also advised to avoid taking identifiable images of people.
Photovoice gives participants the opportunity to capture their own images and through them record their environment and share their personal experiences ; experiences that are often under-represented in research due to its difficulty to ‘reach’ low-income settings. Moreover, by ‘putting’ cameras in the hands of participants Photovoice reduces the power differential between researcher and participant . Photovoice has been a valuable data collection method to understand individuals’ dietary experiences [30, 31], as well as for studies using remote methods during the pandemic [32, 33].
To complement Photovoice, an additional interactive approach was utilised. Participants were invited to draw their local food environment and to include shops they use and do not use. These included supermarkets, small food retailers, restaurants and take-away shops. In this way, parents could depict their local area, draw attention on particular features and places and elaborate on the relationships between these places and their food decisions .
After giving detailed guidance on the above methods a follow-up interview was arranged for the following week based on families’ availability. Participants were instructed to share their photographs and map with the research team via email prior to the interview. Interviews were conducted online through the Teams software (Microsoft Corporation, Redmond, Washington, US). All photographs submitted included content about food and were discussed during the interview. Additionally, the map was used to discuss the strategies families employed to navigate their food environment and how the local food environment influenced their food choices during lockdown. A topic guide was used to guide the photo-elicited interviews (see Supplementary File). All interviews took place in June 2020 and were moderated by a researcher (ES, dietitian) with previous experience in qualitative interviews. All participants consented to being included in the study by signing a form which was emailed to them. As a token of appreciation for their time participants received a £35 One-4-all shopping voucher.
Interviews were recorded and transcribed verbatim with the relevant functions offered by Teams. Transcripts were checked for inaccuracies and to gain familiarity with the data. A thematic analysis approach was used, as described by Braun & Clark . A researcher (ES) read all transcripts line-by-line and allocated codes without trying to impose a pre-existing coding frame using NVivo 12.0 (QSR International, Doncaster, Australia). Codes were then grouped together based on similarities and differences forming a set of preliminary themes (descriptive themes). Some codes were dropped at this stage, as they could not be assigned to any groups. The research team considered the original research question and inferred the impact of the COVID-19 pandemic on families’ food decisions as it was captured by the descriptive themes. During this process a new set of final themes (analytical themes) were generated that directly addressed the study question. The creation of descriptive and analytical themes was supervised and agreed by the other co-authors.
A total of 375 parents got in touch through email to express their interest in finding out more about the study. The research team shared the Participant Information Leaflet with them and explained the purpose of the study and what participation entailed. From those who read the study information the first 12 parents who verbally confirmed living on a tight budget with a child 2–17 years were recruited in accordance with the stratification process. Figure 1 offers a detailed flowchart of the participant inclusion and exclusion process.
All participants except one were the biological parents of the children in their household. One participant was the biological mother of two children and a stepmother to a further child. There was only one father in the sample. Several more eligible fathers expressed interest in the study, but only after their strata was complete and, thus, they were not selected. Participants were predominately white and looked after the family as their full-time occupation. Most families were receiving financial assistance from the government and had three or more children. Participants’ characteristics can be found in Table 1.
The method of Photovoice was well understood among the participants and all of them provided photographs before their interview. There was a great variance in the number of photographs sent by the participants, which ranged from two to 17. The majority of participants’ photographs portrayed meals served for their family, followed by packaged foods purchased, food store prices and receipts.
Five distinct themes were found within the data. Each one addresses a stage of the decision-making process in relation to food (planning, shopping, preparing, eating at home and eating outside the home) and discusses the impact of lockdown. A list of the themes and sub-themes, when applicable, can be seen in Fig. 2. Some allocated quotes can be seen in Table 2. A number of photographs that were discussed as part of the Photovoice exercise and reflect some of the main themes/subthemes can be seen in Fig. 3.
This theme discusses participants’ considerations when deciding the type and amount of foods they purchased for their family during the first lockdown. Diverse thoughts were voiced, concerning participants’ perceptions around diet and wellbeing, food-related support and food availability during the period of lockdown.
Perceptions around food and health
Most parents explained that ensuring a healthy diet for their family was a priority. Their food planning aimed to provide an all-inclusive balanced diet which would keep their children and, when applicable, their partner strong and healthy. Fruit and vegetables were, for some of them, an important component of a healthy diet too and therefore, they always featured in their food shopping lists. In contrast, a few parents voiced that the choice of foods was mainly based around their children’s preferences.
Food-related support, such as food donations and help with food shopping, was stated to be crucial, especially among single parents. During the lockdown period in particular, food assistance offered by friends and extended family members was much appreciated, given the financial constraints experienced by the majority of families.
As part of discussions around food-related help, school meal assistance was also addressed. Most families that took part had children who were eligible for free school meals and, while schools were closed, they received financial help in the form of a biweekly bank transfer. Although all parents agreed that this initiative was extremely helpful, they also acknowledged that their family’s food needs had increased since they were staying indoors and the additional money was not sufficient to cover the increased requirements. Two families reported they received a box of food items from their local youth club on a weekly basis. This help was also welcomed.
Food availability in lockdown
A number of participants touched on the reduced variety of food products in supermarkets at the beginning of lockdown. The majority of them explained that the reduced food availability did not affect their families’ diet. On the other hand, some admitted that shortage of food was a major concern of theirs and few even engaged in panic-buying. Few participants recounted that their children had to do without some of their favourite meals due to the low food availability and closure of restaurants. Two mothers felt that their children had to witness the closed food outlets and limited stock on supermarket shelves to grasp the situation.
One participant criticised panic-buying behaviours and highlighted the need to be considerate of people who cannot access food due to limited availability. Two participants however emphasised the value of maintaining a well-stocked pantry at all times, irrespective of lockdown.
Participants went into great detail when talking about their food shopping habits and their experiences in stores (or online shopping). Food cost and price reductions since the start of COVID-19 restrictions were also discussed.
Going food shopping
The outbreak of COVID-19 and the relevant restrictions had a major impact on parents’ shopping habits. For those who kept going to the supermarket, as opposed to having food delivered, the frequency and duration of shopping trips decreased because of fear of being exposed to the virus. Parents explained that more planning went into food shopping to ensure that their food basket covered their family’s dietary requirements for longer.
Visiting food outlets less often had an impact on the amount of fresh food products purchased. One mother pointed out that her family’s consumption of fresh fruit and vegetables decreased due to her infrequent shopping trips. Similarly, a mother admitted that the reduced access to fresh vegetables prevented her from cooking healthy meals as part of her weight management programme.
In terms of choosing supermarket or when to go shopping, the length of queues was considered to be a determining factor. Participants observed that some of their local supermarkets were very busy which motivated them to seek an alternative food shopping route or to schedule their shopping trip at less busy times. Unfortunate experiences at store queues or within stores were described to give further rise to fear when shopping.
A different perspective was expressed by two mothers. Their shopping trips and experiences did not change throughout lockdown and they maintained the same frequency of visiting the food stores. One of them shared that the need to feed four children gave her no other choice.
Furthermore, participants observed certain adaptations in the environment of supermarkets in line with social distancing and safety measurements. These included placing hand-sanitizers and employing strategies to avoid over-congregating, such as monitoring the number of people that enter the shop. Such adaptations were reported to increase confidence in shopping.
Home food deliveries
Online food shopping and home deliveries were extensively discussed in the interviews. A number of supermarket chains provided the option for individuals to go online and order food items. Several mothers talked about taking advantage of this service in an effort to minimise their trips outdoors. One mother, who had already been familiar with supermarket food delivery services, described them as a ‘necessity’ during lockdown.
Despite the convenience of home food deliveries, a number of problems were reported. To use the service, customers had to book a delivery slot first which, according to participants’ experiences, would invariably be 2–3 weeks away. As a result, effort went into assembling a shopping basket that contained food items that would last until the next order comes within a few weeks. In certain cases, participants admitted they could not use the service, as all delivery slots were booked out. Participants explained they also had to deal with incomplete food deliveries. As a consequence of long waiting times and limited supermarket stocks, food orders reached customers without certain items. Furthermore, relying on specific supermarket chains to get foods delivered meant that customers had to accept their prices, even though they knew that other supermarkets had more competitive prices in some products. One mother observed that the cost of the food delivery service was also a barrier, as she noticed a two-fold increase in the price over lockdown (from £3 to £6).
Shopping from local small food stores
Participants talked about the food shops they had in their local area and their role in food shopping since the COVID-19 restrictions were put in place. Conversations revealed mixed feelings in relation to shopping from these stores.
After the re-opening of local businesses, some of the stores could accommodate a certain number of people at a time and, hence, waiting time to get in increased. Similarly to the situation with supermarkets, participants explained that the long queues formed outside prevented them from shopping in these stores, even if they used to in the past. In terms of buying meat, it was generally agreed that the quality of meat products purchased from the local butcher was higher compared to those available in supermarket. However, due to long queues, along with supermarkets’ lower prices, participants opted for supermarket meat rather than from the local butcher. Moreover, there were also parents who avoided visiting shops overall and relied exclusively on food deliveries.
On the other hand, there were mothers who believed that local stores were important in the COVID-19 era, particularly for families that lived far from big supermarkets and did not want to travel far to purchase food items that their family needed on a daily basis. Some also conveyed that food products locally available were of better quality and, as restrictions eased and store queues became shorter, they intended to shop more often from small shops in the neighbourhood. A few mothers felt more supported by the local businesses than big supermarkets, as their local stores offered home food deliveries that reached families quicker compared to supermarket chains.
Price of food retailers
A few participants highlighted that supermarkets had increased the prices of food products and that the number of food offers was reduced since the restrictions were put in place. Some parents expressed frustration over the additional cost of their habitual shopping basket, as this was a difficult time for their families’ finances. However, one mother showed understanding of the circumstances of food retailers who had to increase their prices to make up for their increased expenses. Two women admitted that they had not noticed any difference in the price of food retailers ever since lockdown restrictions were enforced.
Food offers was a topic that repeatedly came up in the discussions. Deals and reduced-to-clear items seemed to be a part of families’ diet before, as well as during the pandemic. A tendency to stock up on regularly bought foods, when they were on offer, was also reported.
Particularly since lockdown the difficult financial circumstances had given food offers a more prominent place in families’ shopping priorities. Parents used the extra time due to furlough or loss of work to time their shopping when the daily stock clearance took place. One mother explained that the reliance on reduced-to-clear foods prevented her from ordering home food deliveries, even though she acknowledged the safety of having food delivered at home during the pandemic.
Lockdown seemed to have a positive impact on cooking, as most interviews showed. Parents who had been furloughed or worked from home talked about the additional available time which urged them to cook more from basic ingredients, as well as to plan and to try more time-consuming recipes. Cooking home-made foods was also encouraged by the closure of take-away restaurants and the limited access to ready-made foods and snacks.
On the other hand, lockdown did not provide everyone with more time to cook. A single father of four admitted that having all children at home limited his available time and as a result, he resorted more to ready-made meals.
During lockdown, some of the parents, mostly those with older children, described that their children were becoming more involved in the meal preparation, such as heating ready-made meals for themselves or helping their parents by assisting in the kitchen e.g. chopping. This often led to increased mess in the kitchen.
Eating and feeding behaviours
This theme addresses changes in families’ eating habits and parental feeding practices, as outlined and experienced by the participants during the course of lockdown.
Family mealtimes and food habits
Interviews revealed several changes in families’ food habits. Parents who did not go to work during lockdown discussed the lack of structure within their day with one of them recounting skipping main meals as a result of it. The timing of meals was different too, as children did not go to school and followed an unpredictable daily routine.
Home schooling and staying at home seemed to encourage consuming more food in the form of snacking and this was voiced by the majority of participants. Snacks were mostly described to be confectionary and high-sugar drinks. Feelings of boredom and of ‘being stuck’ triggered by staying at home were quoted by a few of the participants as the reasons for increased snacking.
Apart from the higher consumption of snacks, families’ intake in other food groups seemed to remain roughly the same throughout lockdown. One mother however, mentioned consuming lower amounts of fresh fruit and vegetables because she was not going as often for grocery shopping. The same participant also highlighted that her family’s meat consumption had decreased since the COVID-19 outbreak, as she avoided going to her local butcher and supermarket’s meat was not of the same quality and taste. Minimizing the number and frequency of shopping journeys were the reasons for both changes. For some parents staying at home meant that they had more time to sit down with their families and share a meal.
Parents’ feeding behaviours
During lockdown some parents explained that they had to engage in certain feeding behaviours that varied from those employed in the past. One of them was giving in to children’s food requests to placate them under the unusual circumstances of lockdown. It was pointed out that children would ask for snacks or their favourite meals more frequently as a result of being at home longer or being pressured by schoolwork assigned online. This often seemed to go hand in hand with following a more flexible and lenient parenting style overall.
On the other hand, a few mothers mentioned that the additional time spent at home and closure of fast-food outlets offered a window of opportunity to introduce them to new eating experiences and deal with food refusals. One mother expressed concern over her daughters’ low body weight and explained that this motivated her to take advantage of the extra time to make sure they ate enough.
Eating food prepared outside the house
Most families bought food prepared outside the house prior to COVID-19 restrictions. Eating-out habits involved visiting fast food restaurants and ordering takeaways with a frequency varying from once a week/fortnight to regularly within the week. Some families maintained the habit of ordering takeaways during the course of lockdown and sometimes this was described as a reward for the family being stuck at home or children doing schoolwork. Two mothers mentioned that they continued ordering from their local takeaways in an effort to support local businesses. Ordering affordable take-away meals was particularly important for a single father during lockdown, since they kept all his four children pleased.
Several families on the other hand, discussed how they had to cut down on their fast food and takeaway intake due to closure of their local restaurants. A few parents saw it as an opportunity to reduce their unhealthy eating-out habits and to start cooking more. This situation also benefited families’ finances, as ordering food cost them significantly more than cooking meals at home, as parents came to realise. This was particularly evident for the families who heavily relied on take-away foods in the past. Takeaways were not part of family’s regular diet in three households, so their limited availability due to lockdown had no impact on their dietary habits.
As restrictions on food restaurants were easing during the course of the interviews, it was pointed out that the main fast food chains were re-opening and this was met with great enthusiasm from the children. However, the long queues outside the restaurants often discouraged parents from purchasing food from there. One mother talked about the importance of being alert and mindful of COVID-19-related restrictions. She expressed limited trust in the safety of food provided by restaurants which led to reluctance in ordering food for her family from outside.
This qualitative study presents parental perspectives of the impact of COVID-19 lockdown on food decisions among low-income households. The restrictions put in place to inhibit the spread of the virus had an impact on all aspects of dietary-related practices from food planning and shopping to cooking and eating. The following paragraphs discuss the main diet-related changes as these were described by the study participants.
Parents’ desire to provide their families with a nutritious and balanced diet, in conjunction with the additional time available throughout lockdown, encouraged the preparation of home-made meals. Additionally, the closure of restaurants and fast food chains, as well as the realisation that infrequent takeaways helped with family expenses, further contributed to the increased intention to cook from raw ingredients. This is in agreement with survey data from the island of Ireland, Great Britain and Italy showing that individuals cooked and consumed more in-home meals in the lockdown period than prior [20, 21, 36]. Pre-COVID qualitative explorations with low-income parents have shown that in the UK lack of time was a barrier to cooking from raw ingredients [37, 38]. Additionally, issues of peer pressure among children, particularly older children, to consume fast food have also been highlighted [37, 39]. In this sample, lockdown eliminated both of these barriers, i.e. lack of time (for some parents) and peer influence, leading to more home-made meals. This is undoubtedly a positive consequence of lockdown, as consumption of home-made meals is associated with better nutritional outcomes compared to ready-made food. Previous research suggests that individuals who cook frequently are more likely to follow healthy dietary patterns and to meet the recommendation of fruit and vegetable consumption, when compared with those who frequently consume ready-made foods [40,41,42]. On the contrary, diets characterised by frequent consumption of fast food and ready-made meals are associated with increased caloric intake that can, in the long term, contribute to positive energy balance and overweight [43, 44].
On the other hand, an increase in unhealthy snacking was reported for both parents and children. Frequent consumption of confectionary and sugar-sweetened drinks was self-justified, because they were seen as a reward for intense school work or a way to avoid boredom and calm stress and other negative feelings triggered by isolating at home. High consumption of unhealthy sweet and savoury snacks was also seen among overweight and normal weight adults in Italy, Poland and Ireland, as recorded by observational data [45,46,47]. This trend in snacking behaviours was also seen in a study that surveyed 800 respondents in the Unites States in June 2020, where emotional eating triggered by stress during the first COVID-19 was associated with choosing foods based on convenience and sensory appeal  This shift in eating habits is not surprising, as previous research work suggests that individuals are more likely to resort to comfort foods, when they experience negative emotions and/or they feel the need to reward themselves . Increased desire for high-sugar and saturated foods can lead to increased energy intake paired with low intake of essential nutrients, which holds long-term health and weight implications [50, 51] and therefore, should be at the forefront of dietary recommendations during and after the COVID-19 era.
Although levels of concern for virus transmission risk seemed to widely vary, parents generally adhered to the COVID-19 restrictions and conveyed reluctance to leave the house, which determined to a large extend their food shopping patterns. On one hand, fewer shopping trips and longer waiting times for food deliveries motivated parents to plan their families’ food demands more efficiently. Better food planning during lockdown, also seen in another UK report of qualitative data , could be established as a habit that over time can have further positive implications e.g. avoiding impulse buying, reducing food waste. However, infrequent shopping trips and reliance on supermarket home deliveries were also presented to compromise home food availability in fresh food products (e.g. fruit, vegetables and fresh meat) with potentially negative effects on dietary quality. Data from a low-income and vulnerable population living in England also highlighted challenges associated with trips to the supermarket and securing good food availability with online shopping . The effect of these challenges on families’ dietary intake is yet to be fully understood and requires further investigation.
Financial constraints experienced by low-income families in this study were exacerbated during lockdown by loss of work and, in some cases, by perceived elevation in supermarket prices. Indeed, survey data from Northern Ireland indicate that during the course of the first lockdown 18% of households experienced an income decrease of 24% or higher and that the proportion of people experiencing symptoms of food poverty reached 20%; a proportion that was 8% before the COVID-19 pandemic . In terms of food cost, analysis of the average UK grocery prices shows a price increase shortly after lockdown was enforced which persisted in the following weeks . Rise in food prices alongside the cost and perishability of healthy foods (e.g. fruit and vegetables), with the latter having already had a negative impact on food shopping choices of low-income parents in the UK [37,38,39], led parents from this sample to search for ways to budget when food shopping. As a result, food offers and reduced-to-clear items had a prominent place in families’ shopping basket. At the same time, the school meals payment scheme and food donations were perceived to lessen families’ expenditure on food and to considerably contribute towards their food security. This finding is not surprising at a time where food banks across the UK saw a rise in demand and low-income families were most in need of them . Additionally, it is debatable whether increased reliance on reduced-to-clear foods can secure dietary diversity for the family meals and whether it raises concerns around food safety, especially if appropriate food storage methods are not applied.
Present findings indicate that families experienced lockdown in distinct ways depending on their type and size, which seemed to influence the way family members modified their food behaviours. For instance, even though lockdown generally encouraged more cooking and shared family mealtimes, this was not the case for single parents with many children who were home-schooling, as parenting during lockdown did not seem to allow time for home-made food preparation. Instead, they sought more convenient food choices they knew their children like, such as ready-made meals. Distinct influences of COVID-19 on dietary behaviours of single-parent households have been previously highlighted in a survey of 13,829 Australians, which showed that those living with children and without a partner were particularly likely to report overeating . Even though this type of influence did not emerge in the present paper, it indicates that single-parent families may have found it more challenging to adopt a healthy diet during the COVID-19 lockdown/s compared to parents living with partner. Among families with adolescents, parents observed their children’s independence in the kitchen and their ability to prepare basic meals with minimal adult supervision. Older children’s involvement with food preparation allowed parents more time to devote to younger children’s diets or to other parenting tasks. Additionally, although the level of funding for the school meal assistance was less than ideal, the scheme was a valuable help for all low-income households and, along with food donations seemed to be an essential help for single-parent families to remain food secure.
Although the study sample consisted of mostly white parents (apart from one Asian mother), participants came from diverse backgrounds in terms of nationality, location of residence (urban/rural) and age and number of children. Thus, it is envisaged that the study findings reflect the experiences of most parents of white ethnicity who live in economically disadvantaged households. Food insecurity was not an emerging theme in this study contrary to what was expected, considering that in the latest ‘Food and You’ survey 12% of households in Northern Ireland were classified as marginally food secure . In addition, the sample was female-dominated and included only one father. This could be seen as an important limitation, as nowadays food decisions fall more within the sphere of responsibility of males than two decades ago . However, studies in the UK and US highlight that within shared households a higher proportion of women is responsible for food shopping and preparation, and therefore, a female-dominated sample may offer a more accurate reflection of food decision-making in UK households [58, 59]. As part of the adaptations in research methods during the pandemic, all interviews took place online, as opposed to face-to-face. In this way, certain elements of in-person interactions (e.g. body language) that facilitate rapport and encourage probing were lost, which has been previously reported with online interviews . Nevertheless, video-conferencing platforms have been widely used as part of work and home-schooling during the COVID-19 pandemic and all parents included in this study were familiar with using such technologies without reporting technical difficulties. Employment of web conferencing technologies also enabled us to engage with geographically dispersed individuals in urban and rural area in Northern Ireland. Finally, the participatory photo-elicitation method employed in this study added strength in the data collection process, as they encouraged a good level of involvement from all study participants and added important insights into nutrition-related challenges of low-income families, which may have been overlooked by a traditional semi-structured interview schedule. Participants photographed similar situations with very few of them diverting from the common topics. For example, only one mother sent us pictures of adjustments made by her local supermarket for COVID-19 and of her walk to the supermarket; and only one mother captured a take-away meal she had with her family. Despite the uniformity of topics across participants’ photographs, these photographs acted as triggers to narrate personal stories that shed light into their family’s food-related decisions. As previously highlighted in a systematic review on the use of the Photovoice in public health research , Photovoice is a flexible tool to generate photo-elicited discussions in relation to health and dietary behaviours. Moreover, its use is not restricted by participant characteristics (e.g. financial status or literacy level) .
Overall, this qualitative study revealed that food decisions of low-income families were heavily affected during the period of COVID-19 lockdown. Parental perspectives voiced in this study generally align with changes in dietary behaviours observed across the UK, such as increased preparation and consumption of homemade food, as well as frequent unhealthy snacking. Store queues and long-awaited home food deliveries motivated good meal planning, but also made access to fresh and nutritious food difficult. Food donations offered by the closer and wider social circle, along with monetary assistance replacing school meals, proved to be crucial for parents who had to minimise cost and feed their family within a limited budget. This study adds to the growing body of research on dietary behaviours during the COVID-19 pandemic by providing an insight into the nutritional challenges experienced by low-income families. It also highlights that further food-related support is required from local and government-led initiatives to mitigate the increased risk of food insecurity among economically disadvantaged families.
Availability of data and materials
The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.
Statista. Number of new coronavirus (COVID-19) cases in the United Kingdom (UK) since January 2020. 2020; Available at: https://www.statista.com/statistics/1101947/coronavirus-cases-development-uk/#statisticContainer. Accessed 10 Aug 2020.
Public Health England. Coronavirus (COVID-19) UK Summary data. 2020; Available at: https://coronavirus.data.gov.uk/. Accessed 10 Aug 2020.
Cabinet Office. Staying at home and away from others (social distancing). 2020; Available at:https://www.gov.uk/government/publications/full-guidance-on-staying-at-home-and-away-from-others. Accessed 10 Aug 2020.
Northern Ireland Executive. Coronavirus - Regulations and recovery plan. 2020; Available at: https://www.nidirect.gov.uk/information-and-services/coronavirus-covid-19/regulations-and-recovery-plan. Accessed 10 Aug 2020.
Scottish Government. Coronavirus (COVID-19): Scotland's route map - what you can and cannot do. 2020; Available at: https://www.gov.scot/publications/coronavirus-covid-19-what-you-can-and-cannot-do/. Accessed 10 Aug 2020.
Welsh Government. Coronavirus legislation and guidance on the law. 2020; Available at: https://gov.wales/coronavirus-legislation-and-guidance-law. Accessed 10 Aug 2020.
Academy of Medical Sciences. Survey results: Understanding people’s concerns about the mental health impacts of the COVID-19 pandemic. London: MQ: Transforming Mental Health and the Academy of Medical Sciences; 2020.
Office for National Statistics. Labour market overview, UK: August 2020. 2020; Available at: https://www.ons.gov.uk/employmentandlabourmarket/peopleinwork/employmentandemployeetypes/bulletins/uklabourmarket/august2020. Accessed 10 Aug 2020.
James WP, Nelson M, Ralph A, Leather S. Socioeconomic determinants of health. The contribution of nutrition to inequalities in health. BMJ. 1997;314(7093):1545–9.
Darmon N, Drewnowski A. Does social class predict diet quality? Am J Clin Nutr. 2008;87(5):1107–17.
Liu J, Rehm CD, Onopa J, Mozaffarian D. Trends in Diet quality among youth in the United States, 1999-2016. JAMA. 2020;323(12):1161–74.
Naja F, Hamadeh R. Nutrition amid the COVID-19 pandemic: a multi-level framework for action. Eur J Clin Nutr. 2020;74(8):1117–21.
Bates B, Lennox A, Prentice A, Bates C, Page P, Nicholson S, et al. National Diet and nutrition survey rolling Programme (NDNS RP). Results from years 1-4 (combined) for Northern Ireland (2008/09-2011/12). A Survey Carried Out on Behalf of the Food Standards Agency in Scotland and Public Health England. Available at: https://fsa-catalogue2.s3.eu-west-2.amazonaws.com/ndns-ni-full-report.pdf. Accessed 26 Oct 2021.
Bates B, Lennox A, Prentice A, Bates C, Page P, Nicholson S, et al. National Diet and Nutrition Survey Rolling Programme (NDNS RP). Results for Years 5 to 9 (combined) of the Rolling Programme for Northern Ireland (2012/13–2016/17) and time trend and income analysis (Years 1 to 9; 2008/09–2016/17). A Survey Carried Out on Behalf of the Food Standards Agency in Scotland and Public Health England. Available at: https://www.food.gov.uk/sites/default/files/media/document/national-diet-and-nutrition-survey-northern-ireland-y5-9-full-report_2.pdf. Accessed 26 Oct 2021.
Cordain L, Eaton SB, Sebastian A, Mann N, Lindeberg S, Watkins BA, et al. Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr. 2005;81(2):341–54.
Bornstein SR, Dalan R, Hopkins D, Mingrone G, Boehm BO. Endocrine and metabolic link to coronavirus infection. Nat Rev Endocrinol. 2020;16(6):297–8.
Kassir R. Risk of COVID-19 for patients with obesity. Obes Rev. 2020;21:e13034.
Purdam K, Garratt EA, Esmail A. Hungry? Food insecurity, social stigma and embarrassment in the UK. Sociology. 2016;50(6):1072–88.
Loopstra R, Tarasuk V. Severity of household food insecurity is sensitive to change in household income and employment status among low-income families. J Nutr. 2013;143(8):1316–23.
Di Renzo L, Gualtieri P, Pivari F, Soldati L, Attina A, Cinelli G, et al. Eating habits and lifestyle changes during COVID-19 lockdown: an Italian survey. J Transl Med. 2020;18(1):229. https://doi.org/10.1186/s12967-020-02399-5.
Murphy B, Benson T, McCloat A, Mooney E, Elliott C, Dean M, et al. Changes in Consumers' Food Practices during the COVID-19 Lockdown, Implications for Diet Quality and the Food System: A Cross-Continental Comparison. Nutrients. 2020;13(1). https://doi.org/10.3390/nu13010020.
Bentall RP, Lloyd A, Bennett K, McKay R, Mason L, Murphy J, et al. Pandemic buying: testing a psychological model of over-purchasing and panic buying using data from the United Kingdom and the Republic of Ireland during the early phase of the COVID-19 pandemic. PLoS One. 2021;16(1):e0246339.
Ingram J, Maciejewski G, Hand CJ. Changes in Diet, sleep, and physical activity are associated with differences in negative mood during COVID-19 lockdown. Front Psychol. 2020;11:588604.
Zoellner J, Harris JE. Mixed-methods research in nutrition and dietetics. J Acad Nutr Diet. 2017;117(5):683–97.
The Independent. Coronavirus: Timeline of key events since UK was put into lockdown six months ago. 2020; Available at: https://www.independent.co.uk/news/uk/home-news/coronavirus-uk-timeline-lockdown-boris-johnson-pubs-test-and-trace-vaccine-b547630.html. Accessed 10 Aug 2020.
Northern Ireland Statistics and Research Agency. Census 2011, Key Statistics for Northern Ireland. 2011. Available at: https://www.nisra.gov.uk/sites/nisra.gov.uk/files/publications/2011-census-results-key-statistics-northern-ireland-report-11-december-2012.pdf. Accessed 26 Oct 2021.
Francis-Devine B. Poverty in the UK: statistics. House of Commons Library Briefing Paper: Number 7096. Available at: https://researchbriefings.files.parliament.uk/documents/SN07096/SN07096.pdf. Accessed 26 Oct 2021.
UK Department for Work and Pensions. Official Statistics: Children in low income families: local area statistics 2014 to 2020. Published 25 March 2021. Available at: https://www.gov.uk/government/statistics/children-in-low-income-families-local-area-statistics-2014-to-2020. Accessed 26 Oct 2021.
Wang C, Burris MA. Photovoice: concept, methodology, and use for participatory needs assessment. Health Educ Behav. 1997;24(3):369–87.
Power EM. De-centering the text: exploring the potential for visual methods in the sociology of food. J Study Food Soc. 2015;6(2):9–20.
Mills S, White M, Wrieden W, Brown H, Stead M, Adams J. Home food preparation practices, experiences and perceptions: a qualitative interview study with photo-elicitation. PLoS One. 2017;12(8):e0182842.
Doyumğaç I, Tanhan A, Said Kiymaz M. Understanding the Most Important Facilitators and Barriers for Online Education during COVID-19 through Online Photovoice Methodology. Int J Higher Educ. 2021;10(1):166–90.
Liegghio M, Caragata L. COVID-19 and youth living in poverty: the ethical considerations of moving from in-person interviews to a Photovoice using remote methods. J Women Soc Work. 2020;36(2):149–55.
Emmel N. Participatory Mapping: An innovative sociological method; 2010.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101.
Thompson C, Hamilton LK, Dickinson A, Fallaize R, Mathie E, Rogers S, et al. The impact of covid-19 and the resulting mitigation measures on food and eating in the East of England: Interim report. 2020.
Hart KH, Herriot A, Bishop JA, Truby H. Promoting healthy diet and exercise patterns amongst primary school children: a qualitative investigation of parental perspectives. J Hum Nutr Diet. 2003;16(2):89–96.
Withall J, Jago R, Cross J. Families’ and health professionals’ perceptions of influences on diet, activity and obesity in a low-income community. Health Place. 2009;15(4):1078–85.
Hardcastle SJ, Blake N. Influences underlying family food choices in mothers from an economically disadvantaged community. Eat Behav. 2016;20:1–8.
Larson NI, Perry CL, Story M, Neumark-Sztainer D. Food preparation by young adults is associated with better diet quality. J Am Diet Assoc. 2006;106(12):2001–7.
Garcia AL, Vargas E, Lam PS, Shennan DB, Smith F, Parrett A. Evaluation of a cooking skills programme in parents of young children--a longitudinal study. Public Health Nutr. 2014;17(5):1013–21.
Brown BJ, Hermann JR. Cooking classes increase fruit and vegetable intake and food safety behaviors in youth and adults. J Nutr Educ Behav. 2005;37(2):104–5.
Lin BH, Guthrie J, Frazão E. Away-from-home foods increasingly important to quality of American diet. Food and Rural Economics Division, Economic Research Service, U.S. Department of Agriculture. :Agriculture Information Bulletin No. 749; 1999.
Poti JM, Popkin BM. Trends in energy intake among US children by eating location and food source, 1977-2006. J Am Diet Assoc. 2011;111(8):1156–64.
Pellegrini M, Ponzo V, Rosato R, Scumaci E, Goitre I, Benso A, et al. Changes in Weight and Nutritional Habits in Adults with Obesity during the "Lockdown" Period Caused by the COVID-19 Virus Emergency. Nutrients. 2020;12(7). https://doi.org/10.3390/nu12072016.
Sidor A, Rzymski P. Dietary Choices and Habits during COVID-19 Lockdown: Experience from Poland. Nutrients. 2020;12(6). https://doi.org/10.3390/nu12061657.
University College Dublin (UCD). The National COVID-19 Food Study. In: Collaboration with Dublin City University; 2020.
Shen W, Long LM, Shih CH, Ludy MJ. A Humanities-Based Explanation for the Effects of Emotional Eating and Perceived Stress on Food Choice Motives during the COVID-19 Pandemic. Nutrients. 2020;12(9). https://doi.org/10.3390/nu12092712.
Verhoeven AA, Adriaanse MA, de Vet E, Fennis BM, de Ridder DT. It's my party and I eat if I want to. Reasons for unhealthy snacking. Appetite. 2015;84:20–7.
Larson N, Story M. A review of snacking patterns among children and adolescents: what are the implications of snacking for weight status? Child Obes. 2013;9(2):104–15.
Hess JM, Jonnalagadda SS, Slavin JL. What is a snack, why do we snack, and how can we choose better snacks? A review of the definitions of snacking, motivations to snack, contributions to dietary intake, and recommendations for improvement. Adv Nutr. 2016;7(3):466–75.
Connors C, Cohen M, Canavan S, Day N, Sheppard C. Consumers and the Food System Under Covid-19; A Bright Harbour Collective Report for the Food Standards Agency.2020. Available at: https://www.food.gov.uk/sites/default/files/media/document/fsa-food-systems-2020-_-v2.1-1_0.pdf. Accessed 10 Aug 2020.
Furey S, Caraher M, Finlay E, Leeson P, McFarlane G, Taylor A. Food insecurity and COVID-19: summary results to Department for Communities, Northern Ireland. 2020. https://pure.ulster.ac.uk/en/publications/food-insecurity-and-COVID-19-summary-results-to-department-for-co
Institute for Fiscal Studies. Grocery prices rose by 2.4% in a month at the beginning of lockdown, fuelled by a fall in promotions. 2020; Available at: https://www.ifs.org.uk/publications/14881. Accessed 10 Aug 2020.
The Trussell Trust. End of Year Stats. 2020; Available at: https://www.trusselltrust.org/news-and-blog/latest-stats/end-year-stats/#total. Accessed 10 Aug 2020.
Owen AJ, Tran T, Hammarberg K, Kirkman M, Fisher J. COVID-19 restrictions impact research group. Poor appetite and overeating reported by adults in Australia during the coronavirus-19 disease pandemic: a population-based study. Public Health Nutr. 2020;25:1–7.
Fuller E, Bankiewicz U, Davies B, Mandalia D, Stocker B. The Food and You Survey. Wave 5. Northern Ireland Report. 2019.
Flagg LA, Sen B, Kilgore M, Locher JL. The influence of gender, age, education and household size on meal preparation and food shopping responsibilities. Public Health Nutr. 2014;17(9):2061–70.
Lake AA, Hyland RM, Mathers JC, Rugg-Gunn AJ, Wood CE, Adamson AJ. Food shopping and preparation among the 30-somethings: whose job is it? (the ASH30 study). Br Food J. 2006;108(6):475–86.
Archibald MM, Ambagtsheer RC, Casey MG, Lawless M. Using Zoom Videoconferencing for Qualitative Data Collection: Perceptions and Experiences of Researchers and Participants. Int J Qual Methods. 2019;18(1–8):160940699874596.
Catalani C, Minkler M. Photovoice: a review of the literature in health and public health. Health Educ Behav. 2010;37(3):424–51.
Martin N, Garcia AC, Leipert B. Photovoice and its potential use in nutrition and dietetic research. Can J Diet Pract Res. 2010;71(2):93–7.
The authors would like to thank all parents who participated in the interviews, as well as all the organizations who helped disseminate the call for participation (Barnardo’s NI, Parenting NI, Children and Young People’s Strategic Partnership). The present study arose from a larger project which was funded by SafeFood.
The work was completed with financial support from internal funds of Queens University Belfast.
Ethics approval and consent to participate
This study was conducted according to the guidelines laid down in the Declaration of Helsinki and all procedures involving research study participants were approved by the Research Ethics Committee of Faculty of Medicine, Health & Life Sciences, Queen’s University Belfast. Additionally, written informed consent was obtained from all participants.
Consent for publication
The authors declare that they have no competing interests.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
About this article
Cite this article
Spyreli, E., McKinley, M.C., Woodside, J.V. et al. A qualitative exploration of the impact of COVID-19 on food decisions of economically disadvantaged families in Northern Ireland. BMC Public Health 21, 2291 (2021). https://doi.org/10.1186/s12889-021-12307-1