Impact of the Social Café Meals program: a qualitative investigation

Additional keywords: corporate social responsibility, food relief, food security, social exclusion.

Food insecurity, or the inability to access adequate, safe and nutritious food (Australian Institute of Family Studies Child Family Community Australia 2011), has short- and long-term effects on both physical and mental health (Blaylock and Blisard 1995; Booth and Smith 2001; Burns 2004) and is a powerful marker of social exclusion (McGlone et al. 1999). Social exclusion has been defined as the factors that make it difficult for individuals to participate completely in society (Berkman and Kawachi 2000; Australian Government 2009) or ‘being excluded from the life of society and treated as less than equal’ (World Health Organization 2003, p. 16). Being socially included is a priority of the Australian government (Australian Government 2012) as those who are socially excluded experience higher mortality from most causes and are more likely to experience hunger (Berkman and Kawachi 2000; World Health Organization 2003; Martin et al. 2004; VicHealth 2005).

Internationally, a range of strategies are in existence that aim to alleviate and prevent food insecurity and promote social inclusion, for example, meals on wheels (Roy 2006), community kitchens (Furber 2010) and community gardens (Kantor 2001). Social Café Meals Programs (SCMP) are an initiative aimed at reducing food insecurity and social exclusion. SCMP provides community members with an incentive and opportunity to dine at one of several designated cafés for a subsidised price. Eligible community members are those assessed as being food insecure and socially isolated by community health workers. The assessment includes a purposive selection of validated questions from community indicators Victoria (The McCaughey Centre VicHealth Centre for the Promotion of Mental Health and Community Wellbeing University of Melbourne 2012) and the National Nutrition Survey (Rutishauser et al. 2001). Generally, members are entitled to two-to-three subsidised meals per week for a maximum value of $10 and are only charged $2.50, with the remaining $7.50 paid for by the community organisation. Each time the members purchase a meal from a café on the program it is recorded on their membership card. The programs are typically funded by the Victorian community health promotion program, federal home and community care program or philanthropic organisations.

To our knowledge there are nine varied models of the program operating throughout Victoria, Australia (Victorian Social Café Meals Network, pers. comm., 6 April 2012). The program aims to promote social interaction between members of the community and café proprietors, through the experience of sitting in a café environment and enjoying an affordable meal. It also targets food insecurity by enabling members to access meals for only a fraction of the actual cost, reducing the reliance on emergency food relief. SCMP is considered a community food program as members contribute to the cost of the meal and consume it in the café, empowering them to be involved with mainstream community. Members are able to choose any meal from the café menu.

A previous evaluation of one SCMP reported that the program was an effective way of providing affordable meals to the homeless, improving their nutritional status, frequency of eating, social exclusion and economic access to food (Astbury et al. 2004; Astbury and Elsworth 2005). Café proprietors reported personal fulfilment and that the program provided them with community recognition. There is a need to determine if these outcomes are consistent across other SCMP and thus the transferability of the program.

This research aimed to explore SCMP ability to address social exclusion and food insecurity through the lived experience of those involved with the program to inform future program delivery and contribute to the evidence base of prevention strategies to address food insecurity and social exclusion.

A qualitative-evaluation approach within a phenomenological framework was undertaken for this research. Phenomenology was chosen as the methodological framework for the qualitative analysis as it allows for judgments, perceptions and emotions to be collected about the experience of being part of the program (Dew 2007; Liamputtong 2009). The process evaluation aimed to explore the experience of participating in the program based on the perspectives of café owners, staff and program members or participants and determine any perceived impact on food-security status and sense of social exclusion for participants. The program logic used in the previous evaluation (Astbury et al. 2004) was used as a basis of the inquiry while acknowledging the limitations of qualitative methods in measuring program impact and outcomes. Purposive sampling of key personnel involved in two SCMPs operating in the inner south-eastern suburbs of Melbourne, Victoria, Australia, was employed to ensure that the café owners, staff and current program members chosen provided information-rich cases. Ethics approval was obtained from the relevant university ethics committee.

All current café owners (n = 5) involved in the two programs were approached in person and invited to participate and were asked to recommend appropriate members of their staff to participate. All currently enrolled program members (n = 30) that met the eligibility criteria were approached by program coordinators explaining the need to evaluate the program and inviting them to participate. Eligible participants were those that had been participating in the program for more than 1 month, were able to be contacted, had no history of aggression and were in a fit health state to participate in an interview. Those current members who volunteered to participate in the study were scheduled an interview.

Individual interviews were selected to examine the perceptions of SCMP members, café owners and staff to give meaning to their experiences (Liamputtong 2009). A brief, semistructured format was used. This format allowed exploration of a predetermined set of issues, provided flexibility in the deliverance of the questions, gave the interviewer opportunity to probe for richer responses and was not burdensome to participants (Draper and Swift 2011). Two sets of interview questions were developed based on program logic (Astbury et al. 2004): one for the SCMP members and one for the café staff. Both sets of questions followed a similar logic with the aim of obtaining different perspectives on the same aspects of the program while exploring social exclusion and food security issues. They explored how individuals became involved in SCMP and the duration of their involvement. Experiences of participation including social, economic and nutritional benefits, and the effect on community participation were also explored. In addition, cafés were questioned about their expectations of being involved in the program.

Six researchers, independent of the organisations responsible for running the SCMP but trained in basic qualitative-research methods, conducted the interviews to ensure objective responses were elicited. This decreased the likelihood that participants may only report positive aspects of the program in order to please the interviewer. Standardised techniques such as uniform prompting questions were employed by the researchers to ensure data collection was consistent between multiple researchers. All researchers read all interviews, as the data was collected, and cross-checked for consistency, allowing full immersion in SCMP experiences and ensuring consistency of interview technique.

Interviews were conducted between September and October 2011 by six researchers with all members and café staff who agreed to be interviewed. All interviews were conducted face-to-face and took place in the SCMP partner cafés as they provided a familiar environment and placed minimal transport burden on the research participants. Interviews were audio recorded and transcribed verbatim by the same author who conducted the interview to allow further immersion and interpretation of the data.

The qualitative data was manually analysed using a thematic-analysis approach whereby the experience of participating in the program was the focus (Liamputtong 2009). Interview transcripts were coded and then codes were grouped into categories (Liamputtong 2009). Triangulation of data analysis occurred whereby each transcript was coded by the interviewer and another researcher (LA, JO, AT, PB, EA, HM) who then came together to cross-check the codes. Codes were then grouped into categories. Synthesis and analysis of categories was then conducted with six authors to generate themes. Independently the last author (CP) cross-checked codes and categories against the interview transcripts and verified themes. Expressive quotes relevant to each theme were selected to elucidate the findings. Existing literature was used to assist in interpreting findings.

Twelve program members (five female, seven male), five café owners and one café staff member completed an in-depth interview. Other café staff were too busy to give time for the interview and the time limitations of the study also prevented their recruitment. This small sample size was considered adequate to provide answers to the evaluation questions given the limited capacity and timeframe of the study (Mason 2010). Six of the 12 program members had been on the program for less than 1 month, with the remaining six participating for an average of 3 years. The data collected revealed four key themes with subthemes relating to the lived experience of SCMP (Table 1).

Table 1.  Themes and subthemes describing evaluation of the Social Café Meals program (SCMP)

Program members reported giving higher priority to bills, medications, alcohol, smoking and other drugs over nutrition. According to members, nutrition was not the main reason for their involvement. A few of the members reported that weight management and healthy eating were important for them. They felt SCMP facilitated their ability to make healthier meal choices. This is consistent with the literature, which describes those on a low income finding cost a major barrier to healthy eating. Money put aside for food is often sacrificed for other expenses (Inglis et al. 2009; Australian Institute of Family Studies Child Family Community Australia 2011).

Some people go without food rather than give up smoking, if they’re mentally ill or disadvantaged smoking is far more important to them than food. I know just from experience of people I know and myself. (Member 5)

Most of the participants reported that by offering a meal subsidy, SCMP makes eating out more affordable, reduces the financial barriers to food security and decreases reliance on emergency food relief. This was particularly true for homeless members.

I used to go three times a week to the Salvos …  but I’ve been going there once or twice now. This has changed it a lot because I come here [café] now. (Member 3)

The members reported that eating at a café promotes greater autonomy by being able to choose what they eat, when they eat and at what pace, which is consistent with the previous evaluation (Doljanin and Olaris 2004). Individuals with a mental illness are more likely to self-report suboptimal eating behaviours. This includes having fewer than two daily meals and having difficulty obtaining and cooking food (Kilbourne et al. 2007). Those of a lower socioeconomic status are also more likely to seek energy-dense food options, focusing on quantity rather than quality of food (Drewnowski 2004; Dammann and Smith 2009; Bentley et al. 2010; Ramsey 2012). Providing subsidised meals aims to increase meal frequency and improve nutrient intake in vulnerable groups; however, this needs to be verified.

All participants highlighted several nutritional, economic, social and psychological benefits from participating in the program. Although the meal subsidy is initially the reason for members participating in the program, it emerged that the social benefits such as feeling accepted in society, being part of the community and making friends were key reasons for continuing. The members reported that being able to access the cafés gives them an opportunity for social interaction, which they otherwise would not have. SCMP provides an opportunity to enjoy a meal in a social setting with mainstream society. This was a key finding in the previous evaluation (Doljanin and Olaris 2004).

It has been shown that people with mental illnesses often experience greater degrees of social isolation due to the nature of their illness (VicHealth 2005). The social withdrawal associated with many mental illnesses reduces participation in community activities, consequently amplifying their sense of social isolation (De Silva et al. 2005). Social anxiety through fear of discrimination can lead to social exclusion as a result of decreased self-confidence (Australian Government 2009). Many of the members expressed feelings of anxiety in social settings that made initial use of the program daunting. The positive attitudes of cafés enabled these feelings to be overcome.

I feel a little bit nervous and anxious when I am by myself but not too bad and its getting better with each time that I come here [to the café]. (Member 10)

Unemployment, debt, homelessness and worsening health can result in social exclusion (World Health Organization 2003; Australian Government 2012). This was evident with many of the members reporting feeling socially disconnected, lonely and not included in normal society before joining the program. They explained that the program provides an opportunity for them to have improved confidence to get out in the community and ability to try out and experience new opportunities. This was true for members who had been part of the program for only a short time and those that had been involved long term.

Evidence suggests that targeted food and social programs have the ability to equip participants with skills and opportunities to become more involved within the community (Twiss 2003; Doljanin and Olaris 2004; Lee et al. 2010). There is a risk that these programs, when targeted to those who are marginalised, continue to isolate these individuals from the rest of society, further enhancing their exclusion. Members reported that the SCMP provides a comfortable environment that can facilitate breaking this cycle of isolation enabling them to feel accepted into society.

… being part of normality. When you’re by yourself you tend to social isolation and having a place to go where you can join in the activities with other people and feel as though you’re part of it, is very uplifting to the spirit and good for mental health and so forth. (Member 6)

All of the café owners described the value of the program to support disadvantaged members of the community. They reported gaining a sense of personal satisfaction and fulfilment by creating a better lifestyle and community for people. These community benefits were reported to be the driving force behind café participation rather than financial incentive and were also reported by the one staff member interviewed.

I like the whole idea of it helping people that are disconnected to try and sort of become involved in … what you and I and most of us … would just consider average daily life. (Café Owner 2)

Members reported feeling as if they are able to develop new relationships through participating in the program. This increased their sense of connection to their community and enhanced their interpersonal skills. The literature highlights that access to resources, opportunities for social engagement and meaningful social roles are provided through social networks. Supportive relationships also encourage healthier behaviour patterns (Berkman and Kawachi 2000; Berkman et al. 2000).

A small number of members reported that the program was a handout and that they want more than what they are being given presently, including more meals, more cafés involved and more community programs targeted at this group. Other members reported understanding that the program aims to enable them to become more immersed in the community and break out of the poverty cycle.

There are many benefits to the whole program it’s not just cheapness and nutrition, it’s getting yourself back into being part of the general activity of normal people. (Member 6)

The evidence suggests that the social inclusion created as part of this program will have positive effects on the health and wellbeing of the community (Berkman and Kawachi 2000; VicHealth 2005).

The welcoming café environment plays an important role in encouraging the continued return of members. The majority of members reported that before commencing the program the cafés were an unfamiliar and intimidating environment. They reported feeling embarrassed and that they did not belong.

When I first came here I was embarrassed because I thought I just wouldn’t be a valued customer. (Member 5)

The café staff facilitated members’ feelings of belonging to the community. Program members and café staff explained that qualities such as being open, friendly, caring, empathetic and inclusive create an inviting atmosphere in the cafés.

I’ve always wanted to make everybody feel welcome at the café … I’ve always wanted people from all walks of like to be able to come [here]. (Café Owner 1)

The members and staff reported that if staff were perceived as genuinely supportive of the program this would encourage participation. They explained that some members would recommend cafés to their peers if they had good experiences. Some members go to the café and pay full prices outside of the program.

The participants reported other aspects of the cafés that facilitate their use and return. These included the location and type of café. As the members often have no car and limited transport, the importance of the cafés being accessible by public transport and close to where they stay was highlighted. The café needed to be casual and have lenient conditions of entry, as members may not be well presented.

Some members identified predominately using a particular café as they had become comfortable there and developed rapport with the staff members and other regular customers. They explained that it becomes a safe space where they know they are accepted as part of that community setting. Many of the café owners highlighted that their role in the program is to provide good meals and encourage maximum utilisation of the program.

The environment of the cafés provides a contrast to that of emergency food-relief centres. Some members highlighted this contrast and noted feeling marginalised and uncomfortable at food halls.

When you go to a place like … [emergency food-relief meal] everyone harasses you for cigarettes, money, this that and the other and it can be quite difficult. And it can also be quite aggressive you know, when people are going off. It’s a completely different environment. (Member 9)

There is evidence to suggest that helping others elicits positive psychological benefits for the helper (Ray 1998; Dulin 2003; Schwartz 2004, 2009). Many café owners and the staff member reported a feeling of self-worth and a sense of contentment after interacting with program members and offering them an enjoyable dining experience. The café owners felt that being involved in the program enables them to give back to the community. This has been shown to improve an individual’s mood, alleviate feelings of guilt and support feelings of self-worth among givers (Ray 1998; Dulin 2003; Schwartz 2004, 2009).

As soon as you help someone who really, really needs help, you’re helping two people. (Café Owner 1)

The majority of café owners explained that SCMP is a convenient and effortless way to contribute to society. They highlighted that it does not detract from business revenue or take up resources. All café owners and the staff member reported that the program was easy to operate and that they have encountered minimal problems. Although one café did express an increased effort and time spent through taking part in SCMP, they believe that the reward from participation outweighs these constraints. Some café owners reported feeling as if they are not contributing enough to the program and are wanting to give more. They expressed a strong desire to give back to the community and an interest in providing a monetary donation to the program.

The profile of corporate community investment has been raised in Australia over the past few years. Most businesses see community investment as a key component of their business and many budget specifically for investment in community activities or programs. There is a need for greater acknowledgement of corporate community investment and social responsibility as core business of companies (Business Council of Australia 2007). Based on these findings SCMP may be an effective corporate community-investment strategy for food businesses.

Most café owners expressed interest in being recognised for their community contribution, either to assist in generating revenue or to increase awareness of their good deed. This is in line with the literature, which describes how people who give donations generally prefer their actions to be known by others (Bennett 2007; Bekkers and Wiepking 2011). Some café owners reported that being part of the program increased their sales as program members were coming in during quiet periods.

All café owners and the staff member involved appeared to value community involvement and giving back to the community. Some wanted to become involved as the target group were already present in their clientele or they knew someone who was disadvantaged. They reported that the broader community recognises their café’s contribution to those less fortunate in society and rewards these efforts with increased business and publicity. Choosing cafés that can align themselves with the vision of the program appears to be important and may be instrumental in the sustainability and expansion of the program.

The findings of this qualitative investigation were limited in that the interviews were brief and conducted by inexperienced researchers and therefore may have not captured the depth and breadth of the lived experience. Providing training to the researchers in in-depth interviewing techniques attempted to enhance rigor. The potential lack of data saturation is also acknowledged as a limitation (Liamputtong 2009; Mason 2010). The busy environment of cafés may have also impacted on the quality of data from the café owners and staff as some appeared distracted and had limited time to give to the interview. Rigor was enhanced through triangulation of data analysis. This qualitative investigation would be strengthened with quantitative data on the impact of the program on levels of food insecurity and nutritional intake.

This evaluation of SCMP provides insights for this program as an initiative to reduce food insecurity and social exclusion. Employing strategies to assist members to feel more comfortable to attend the cafés is important to optimise outcomes. Cafés enjoy being part of the program as a sign of their commitment to the community. SCMP may be considered as an effective public-health strategy for those with or at risk of food insecurity.