| Summary: | The rising demand for foodbanks and increasing hospital admissions as a result of 'malnutrition' are a reflection of growing food insecurity in the United Kingdom (UK). The adverse impact of this on dietary quality, health and general wellbeing is a growing public health concern. This programme of research aimed to explore why people use foodbanks, the factors that influence their quality of diet, and some of the ways to improve the diet of foodbank users. Mixed-methods were used incorporating interviews with foodbank users (N=18) and personnel (N=12) from 10 London foodbanks. Furthermore, foodbank (N=270) and Advice Centre (AC) (N=245) users from three London boroughs were surveyed about what led to their referral to foodbank, and the relationship of food insecurity, social support, competing expenditure and access to cooking or chilled storage facilities to their dietary quality. Interview data suggested that income crisis degraded the diet of foodbank users who used extreme coping strategies to maintain food sufficiency, in the face of competing expenditures, lack of social support and access to cooking and chilled food storage. Interviews with foodbank personnel suggest that future interventions should consider using foodbank as a point of contact to improve the diet of its users. This would involve meeting the needs of both foodbank users and volunteers, as well as working with agencies across other sectors such as policymakers and community members. Survey data showed that compared to local people attending AC, foodbank users had poorer dietary quality. This can be seen by a greater proportion of participants classified as having 'not good' overall dietary patterns, and lower consumptions of 'healthy' foods (e.g. oily fish, fruit, vegetables) (P < 0.001). Furthermore, compared to AC users, foodbank users were more likely to experience severe food insecurity and greater financial strains. They were also more likely to experience adverse life events, lower social support, and had greater competing expenses and difficulties accessing cooking facilities. Of these, the adverse effect of income crisis on users' quality of diet (P < 0.001) was mediated by food insecurity.
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