Author Identifiers

Lucy Meredith Butcher
ORCID: 0000-0002-2960-3281

Date of Award

2021

Degree Type

Thesis

Degree Name

Doctor of Philosophy

School

School of Medical & Health Sciences

First Advisor

Professor Amanda Devine

Second Advisor

Associate Professor Therese O’Sullivan

Third Advisor

Associate Professor Maria Ryan

Fourth Advisor

Dr. Johnny Lo

Abstract

Introduction Access to a sufficient quantity of nutritious food is considered a human right and is essential for the prevention of disease. Despite this, a significant proportion of people, both in Australia and globally, do not have enough safe and nutritious food to eat and are considered food insecure. Australia’s prevalence and determinants of food insecurity are under investigated due to inadequate national surveillance. The accuracy and level of detail provided by the single item measure employed by the Australian Bureau of Statistics (ABS) to assess national food security has been widely criticised. Therefore, the aims of this thesis are (1) to investigate an alternative set of questions to the current method to estimate national food insecurity prevalence; and (2) to explore associated factors including socio-demographic variables and purchasing and consumption behaviours of food insecurity that may potentially be unique to the Australian context.

Methods A mixed methods research approach consisting of two stages was applied. Stage one comprised of the administration of two online cross-section surveys. Included within each survey was the short form Household Food Security Survey Module, 12 socio-demographic variables and multiple consumption and purchasing behaviours items. Surveys were completed by Australian adults (n = 2,334) residing in one of five Australian states (New South Wales, Victoria, South Australia, Western Australia and Queensland) and IBM SPSS Statistics for Windows Version 25 was employed to statistically analyse the responses. Stage two encompassed an in-depth investigation of food security drivers and a comparison of the perceived importance of these drivers by individuals at high risk of household food insecurity and stakeholders working to resolve the issue. Semi-structured interviews (n = 3) and focus groups (n = 7) were conducted with high-risk individuals (n = 34) and key stakeholders (n = 13). Thematic analysis was undertaken using QSR NVivo Version 11.

Results Findings from both research stages supported the concept that food insecurity was an issue in Australia. Approximately one-third (36%) of survey respondents were classified as food insecure by the short form Household Food Security Survey Module. A substantially smaller proportion (16%) of the respondents were considered food insecure when the ABS single item measure was applied to the same study population. Age (p < 0.001), marital status (p = 0.005), household income (p < 0.001) and education (p < 0.001) were significant independent predictors of food security. Food insecure respondents were less likely to self-report understanding the information on food packaging (p < 0.001), find information on food labels useful (p = 0.002) or be influenced by product nutrition information (p = 0.002). Food insecure respondents were more likely to frequent fast food venues (p = 0.002), takeaway food outlets (p p p = 0.043) and fresh, pre-prepared produce (p = 0.002) when cooking, whereas food insecure respondents were more likely to prepare food using frozen, pre-packaged products (p < 0.001). No significant differences were found between food security status and the enjoyment and social bonding derived from cooking. Thematic analysis in stage two of the thesis generated 329 (209 at-risk and 120 stakeholder) coded statements from 47 people (34 at-risk and 13 stakeholder) related to food insecurity drivers. Although limited income was considered the primary driver of food insecurity, there were notable deviations between at-risk participants and stakeholders in the perceived importance of other drivers, particularly around the price of food, motivation and the lack of food literacy.

Conclusions The significance of this thesis is the contribution to the empirical evidence base concerning the measurement and determinants of food insecurity in an Australian context. The results provide an insight into the use of an alternative food security measure in multiple Australian localities in a large sample population. This is an area not routinely explored in the current literature and is one that provides a novel approach to understanding this complex issue. These new findings will be beneficial to governments and social service providers to customise strategies to the needs of identified vulnerable groups, thus maximising the use of limited resources. A more comprehensive and contemporary understanding of food insecurity, aided by the results of this thesis, creates an advocacy platform to address the inequality of food security evident in Australia. As food insecurity is a global phenomenon, these findings will also have applications for health professionals internationally.

Available for download on Thursday, April 20, 2023

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