Effectiveness of Nonprofits on Factors That Influence the Social Aspects of Well-Being in Food Deserts

EFFECTIVENESS OF NONPROFITS ON FACTORS THAT INFLUENCE THE SOCIAL ASPECTS OF WELL-BEING IN FOOD DESERTS

ROXANNE JIMÉNEZ Doctor of Management Nonprofit Research Fellow Fowler Center for Business as an Agent of World Benefit Fellow Doctor of Management Design & Innovation Fellow

Submitted in partial fulfillment of the requirements for the degree of

Doctor of Philosophy

Weatherhead School of Management

Designing Sustainable Systems

CASE WESTERN RESERVE UNIVERSITY

May 2021

CASE WESTERN RESERVE UNIVERSITY

SCHOOL OF GRADUATE STUDIES

We hereby approve the dissertation of

Roxanne Jiménez

candidate for the degree of Doctor of Philosophy*.

Committee Chair

Chris Laszlo, Ph.D., Case Western Reserve University

Committee Member

Dave Aron, M.D., M.S., Case Western Reserve University

Committee Member

Eileen Doherty-Sil, Ph.D., Case Western Reserve University; University of Pennsylvania

Committee Member

Yunmei Wang, Ph.D., Case Western Reserve University

Date of Defense

March 16, 2021

*We also certify that written approval has been obtained

for any proprietary material contained therein.

Dedication

With love and devotion, I dedicate this dissertation in memory of my grandmother

Aurea P. Palmer

Table of Contents

List of Tables ...... x List of Figures ...... xi Acronyms ...... xii Abstract ...... xv CHAPTER 1: INTRODUCTION AND RESEARCH OVERVIEW ...... 1 Introduction ...... 1 Research Motivation ...... 2 Specific Aims and Research Questions ...... 3 Research Design and Methodology ...... 6 Summary and Results of Each Study ...... 8 Organization of Remainder of Dissertation ...... 10 CHAPTER 2: BACKGROUND, LITERATURE REVIEW, AND THEORETICAL FRAMING...... 11 Background ...... 11 Food Deserts ...... 11 Defining Food Deserts ...... 12 Access to Healthy and Affordable Foods ...... 14 Food Deserts: Public Health Disparities ...... 16 Literature Review and Theoretical Framing ...... 18 Social Aspects of Well-Being ...... 19 Nonprofit Organizational Effectiveness Theory ...... 23 Social Innovation Theory ...... 25 Complexity Theory ...... 30 CHAPTER 3: WHAT FACTORS INFLUENCE A FOOD DESERT RESIDENT’S WELL-BEING? (STUDY 1) ...... 32 Preface...... 32 Introduction ...... 32 Research Question ...... 35 Literature Review...... 37 Social Cognitive Theory ...... 38 Motivation Theory ...... 39 Research Design and Methodology ...... 40 Methodology ...... 40 v

Sample...... 40 Data Collection ...... 41 Data Analyses ...... 42 Findings...... 42 Discussion ...... 49 Implications...... 53 Academic Implications ...... 53 Practitioner Implications ...... 54 Future Research ...... 54 CHAPTER 4: ARE NONPROFIT ORGANIZATIONS EFFECTIVE IN HELPING FOOD DESERT RESIDENTS ON THE SOCIAL ASPECTS OF WELL-BEING? (STUDY2) ...... 56 Preface...... 56 Introduction ...... 56 Theoretical Background and Hypotheses ...... 58 Problem of Practice ...... 59 Lack of Access to Healthy Food ...... 59 Malnutrition ...... 62 Social Interaction ...... 63 Nonprofit Organizational Effectiveness ...... 64 Research Design and Methods ...... 65 Methodology ...... 65 Construct Operationalization ...... 65 Dependent Variable ...... 65 Moderating Variable ...... 65 Independent Variables ...... 66 Control Variables ...... 66 Survey and Scale Development ...... 67 Data Collection ...... 67 Data Screening ...... 68 Case and variable screening...... 68 Measurement Model ...... 69 Exploratory Factor Analysis (EFA) ...... 69 Confirmatory Factor Analysis (CFA) ...... 70 vi

Model Fit ...... 70 Reliability and Validity ...... 71 Common Method Bias (CMB) ...... 72 Structural Model ...... 74 Results and Findings ...... 75 Findings...... 79 My Supported Hypotheses ...... 81 My Unsupported Hypotheses ...... 82 Practical Implications...... 84 Limitations ...... 85 Future Research ...... 85 Nonprofit Effectiveness Measured by Capacity-Building ...... 85 Food Access, Food Environments ...... 86 Nonprofit organizations’ Collaborative Partnerships with the Public and the Private Sector on the Social Aspects of Well-Being ...... 87 Conclusion ...... 88 CHAPTER 5: THE PARADOX OF THE CORONAVIRUS WITHIN FOOD DESERTS: FACTORS THAT INFLUENCE THE SOCIAL ASPECTS OF A RESIDENT’S WELL-BEING DURING THE PANDEMIC (STUDY 3) ...... 89 Preface...... 89 Introduction ...... 89 Literature Review...... 96 Self-Determination Theory ...... 96 Competence...... 97 Autonomy ...... 98 Relatedness ...... 98 Sensemaking Theory ...... 99 Methods...... 101 Methodological Approach ...... 101 Sample...... 101 Data Collection ...... 102 Data Analysis ...... 103 Findings...... 103 Discussion ...... 112

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The Role of NPOs during the COVID-19 Virus ...... 113 COVID-19 as a Paradox ...... 113 Increased Physical Activity...... 114 Healthier Diets and Eating Practices...... 115 Limitations ...... 116 Implications and Future Research ...... 117 Implications for Academia ...... 117 Implications for Practitioners ...... 117 Future Research ...... 117 CHAPTER 6: CORE AND INTEGRATED FINDINGS ...... 119 Core Findings ...... 119 Integrated Findings ...... 123 Integration 1 ...... 124 Integration 2 ...... 125 Implications for Practice ...... 126 Implications for Theory ...... 131 Limitations ...... 132 Future Research ...... 133 Conclusion ...... 135 Appendix A: Study 1 Summary of Research Questions* ...... 136 Appendix B: Map of New York City Food Desert ...... 137 Appendix C: Map of Orange County, NY Food Desert ...... 138 Appendix D: Study 1 Coding ...... 139 Appendix E: Photo of a Typical Convenience Store (Bodega) in New York City ...... 140 Appendix F: Food System Complexity Map ...... 141 Appendix G: Study 1 Interview Protocol and Questions ...... 142 Appendix H: Study 2 Construct Table ...... 144 Appendix I: Study 2 Final Pattern Matrix...... 147 Appendix J: Study 2 Initial CFA Model ...... 148 Appendix K: Study 2 Model Common Method Bias Using Common Latent Factor ...... 149 Appendix L: Study 2 SEM Causal Latent Model ...... 150 Appendix M: Study 2 Final SEM Model ...... 151 Appendix N: Study 3 - Extended Sample Information ...... 152 Appendix O: Study 3 Research Interview Protocol and Questions ...... 153 viii

Appendix P: Study 3 Interview Statements (Extracted from Study 2) ...... 155

List of Tables

Table 1: Overall Research Study Summary: Study Phase and Method, Research Questions, Sample, and Motivation ...... 5 Table 2: Summary of Interview Sample: Overview of the Target Diversity of the Sample ...... 40 Table 3: Correlation Table ...... 70 Table 4: Construct CFA Convergent Validity and Reliability...... 71 Table 5: Model Fit (CMB with CLF): Comparison of Nested Models ...... 73 Table 6: Chi-Square Difference Test: For Common Method Bias ...... 74 Table 7: Direct Relationship Hypotheses ...... 76 Table 8: Moderation Hypothesis ...... 77 Table 9: Sample – Food Desert Residents ...... 102 Table 10: Research Study Summary with Results ...... 120

List of Figures

Figure 1: Sequential Mixed-Methods Exploratory Design ...... 8 Figure 2: USDA Food Access Atlas Map Food Deserts Located in the U.S. Are Highlighted Green ...... 13 Figure 3: Theoretical Framework ...... 19 Figure 4: Food Desert Experience ...... 37 Figure 5: Theoretical Model ...... 59 Figure 6: Final Model ...... 75 Figure 7: Leddy et al. (2020) Social and Structural Impacts of COVID-19 ...... 91 Figure 8: NPO City Harvest’s Food Distribution During the COVID-19 Pandemic ...... 93 Figure 9: Food Desert Resident’s Quotes on Finding Nonprofit Organizations Effective with the Social Aspects of the Well-Being and by Providing Access to Healthy Foods ...... 105 Figure 10: Food Desert Resident’s Quotes on Improved Relationships ...... 107 Figure 11: Food Desert Resident’s Quotes on COVID-19 and Their Well-Being ...... 108 Figure 12: Food Desert Resident’s Quotes on Increased Physical Activity ...... 110 Figure 13: Food Desert Resident’s Quotes on Healthier Eating Patterns ...... 112 Figure 14: Environment, Living Conditions, and Everyday Life in Food Deserts ...... 126 Figure 15: Know Your Client Model NPO Effectiveness on the Social Aspects of Well-Being in Food Deserts ...... 128 Figure 16: United Nations Sustainable Development Goals (SDG) ...... 131 Figure 17: Cleveland Roots Partnerships Help Food Desert Residents in Cleveland, Ohio ...... 134

Acronyms

ACC Access AGFI Adjusted Gross Fit Index BLM Black Lives Matter CCDC Chinese Center for Disease Control and Prevention CFA Confirmatory Factor Analysis CFI Comparative Fit Index CLF Common Latent Factor CMB Common Method Bias COVID-19 Coronavirus Disease of 2019 DBA Doctor of Business Administration EDU Education EFA Exploratory Factor Analysis ERS Economic Research Service FIF Food is Free Project FWB Food Well-Being GFI Goodness of Fit Index HHS United States Department of Health and Human Services HUD United States Department of Housing and Urban Development KMO Kaiser-Meyer Olkin Measure of Sampling Adequacy MAIA Master of Arts in International Administration (program at the University of Miami in Coral Gables, Florida) MAL Malnutrition NCCS National Center for Charitable Statistics NGO Non-Governmental Organization NPE Nonprofit Organizational Effectiveness (Study 2) NPO Nonprofit Organization(al) PERMA Positive emotion, Engagement, Relationships, Meaning, Accomplishment QUAL Qualitative QUAN Quantitative RMSEA Root Mean Square Error of Approximation SARS-CoV-2 Severe Acute Respiratory Syndrome Coronavirus 2 SCT Social Cognitive Theory SDG United Nations Sustainable Development Goals SDT Self-Determination Theory SEM Structural Equation Model SI Social Innovation Social Interaction (Study 2) SNAP Supplemental Nutritional Assistance Program SWB Subjective Well-Being USDA United States Department of Agriculture VIF Variable Inflation Factor WELL Well-Being

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Acknowledgments

Knowing how to think empowers you far beyond those who know only what to think. — Neil deGrasse Tyson

It is with deep gratitude that I acknowledge the following teachers, family, and friends for their contribution, guidance, and support during my Case Western Reserve

University Doctor of Business Administration (DBA) journey.

 I would like to thank Dr. Linda Belgrave for being my good choice architect and giving me the nudge I needed to apply to the DBA program. I was a student in one of her graduate courses at the University of Miami; Dr. Belgrave is an alumna of Case Western University and a native of Cleveland. Shortly after joining the DBA program, I learned that Dr. Belgrave has co-authored with Kathy Charmaz on Grounded Theory. This is a strong example of “there are no coincidences.”

 A very special thank you to Dr. Bradford McGuinn and Dr. Edmund Abaka for supporting me when I applied to the DBA program. I am grateful for the opportunity to have had you as instructors when I attended the Master of Arts International Administration (MAIA) program at the University of Miami. You set a very high bar in my academic experience.

 I am so thankful to those who participated in my research. Without the participation of individuals who reside in food deserts, I would not have a dissertation. I am grateful for their help and their inspirational life stories.

 I have had the privilege of working with one of the best committees for the past four years: my committee chair, Chris Laszlo, and committee members David Aron, Eileen Doherty-Sil, and Yunmei Wang. I have been overwhelmed by their generosity and kindness, humbled by their knowledge and intellect, and fueled by their passion and commitment to guiding me during my research.

 Attending the DBA program has been the pinnacle of my academic educational experience. The education, guidance, and support I received are truly unsurpassed. Thank you, Professors: Anthony Jack, Chris Laszlo, David Aron, Eileen Doherty-Sil, Gene Pierce, Jagdip Singh, James Gaskin, Kalle Lyytinen, Lori Kendell, Mohan Reddy, Pete Moore, Phil Cola, Richard Boyatzis, Stephan Liozu, Youngjin Yoo, and Yunmei Wang. A special thank you to Angela Crawford and Dale Hartz, who supported me during the budding stages of my research.

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 I owe deep gratitude to James Gaskin, Yunmei Wang, Phil Cola, Bill Brake, Lori Kendell, Jagdip Singh, and Sherry Sanger for their incredible instructions on Statistics. In one year I went from a fear of to a love of a topic. Many thanks to all of you.

 Thank you, Kalle Lyytinen, Sue Nartker, Marilyn Chorman, Rochelle Muchnicki, and Phil Cola, for your stellar example on management and leadership skills. You are the heart and soul of the DBA program. You are in the business of helping others, changing lives, and improving the world through the work of DBA students. I am inspired to do the same.

 I want to thank my DBA19-PhD 20 Cohort for their wondrous role in this chapter of my life. I also appreciated the opportunity to develop friendships outside of the cohort with Lucia, Jennifer, Samantha, Samira, and Stormy, along with many others.

 I also would like to thank Kevin Cavanagh for his honesty and feedback in reviewing my dissertation. Thank you, Richard F., Kirk, and Roni, for your generosity. Also, thank you, Alexis Antes, for helping me polish my dissertation.

 I am blessed and thankful for my family for their continued love and support in my endeavors.

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Effectiveness of Nonprofits on Factors That Influence the Social Aspects of Well-Being in Food Deserts

Abstract

ROXANNE JIMENEZ

Purpose: This paper aims to increase knowledge on the effectiveness of nonprofit organizations (NPOs), provide managers with tools to assess their service delivery of programs, and promote effectiveness at the organizational level to help identify and espouse best practices. There is a gap in the literature with regard to the factors that influence the effectiveness of NPOs in addressing the social aspects of well-being for individuals residing in food deserts.

Design/methodology/approach: This mixed-methods research design examined the daily lives of food desert residents and how they achieve well-being. The research gained insight into the factors that influence a resident’s well-being and whether or not residents found NPOs effective in helping them with the social aspects of well-being. The research examined how food desert residents achieved well-being before and during the

COVID-19 pandemic and if residents found NPOs effective in helping them with the social aspects of their well-being before and during COVID-19.

Findings: Findings affirm that the social lives of food desert residents have a strong positive effect on their well-being. Findings also show that NPOs were effective in helping food desert residents with their malnutrition. This research indicates that food desert residents found NPOs effective during the COVID-19 pandemic helping with the xv

social aspects of their well-being and with access to healthy food. In sum, these three studies offer knowledge into how NPOs can increase their effectiveness in helping food desert residents’ social aspects of their well-being.

Originality/value: Research is limited on what constitutes NPO effectiveness and the approaches to measure it. This research extends NPO Effectiveness Theory and

Complexity Theory to understand complicated environments.

Keywords: nonprofit organizational effectiveness; food desert(s); social aspects of well- being; social innovation; complexity; COVID-19

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CHAPTER 1: INTRODUCTION AND RESEARCH OVERVIEW

Introduction

Man Can Not Live by Bread Alone … (Matthew 4:4)

Despite the multitude of nonprofit organizations (NPOs) focused on food insecurity providing access to food social services in the U.S., there remains a lack of meeting basic needs in this country. Now, with the occurrence of the COVID-19 pandemic, America’s most pressing social issues have intensified, causing a greater demand for the delivery of services from NPOs to help those who lack access to basic needs (Beaton, 2020; Hyndman, 2020; Shi, Jang, Keyes, & Dicke, 2020). Improved NPO effectiveness can help with challenges meeting basic needs, addressing food and diet deficiencies, getting help to those when needed (Bauman, 1999), and combating social segregation (Lloyd, Tse, & Deane, 2006).

According to the National Center for Charitable Statistics (NCCS), 1.5 million

NPOs within the U.S. were registered with the IRS in 2016 (McKeever, 2020). The

NCCS also reported that the nonprofit sector contributed $1 trillion to the U.S. economy in 2016 and had a revenue of $2 trillion (McKeever, 2020). In 2018, donations to NPOs from individuals, businesses, and foundations totaled $428 billion (McKeever, 2020).

About 220,000 NPOs in the U.S. specifically target social services. The NCCS categorizes these NPOs as Health (38,853), Other Health Care (31,799), Human Services

(111,797), and Other Public and Social Benefit (38,071) (McKeever, 2020).

Although NPOs have missions that address social issues (Bach-Mortensen &

Montgomery, 2018; do Adro & Leitão, 2020), complex problems such as food deserts persist in the landscape of the U.S. (Fernhaber, Wada, Napier, & Suttles, 2019; Haysom 1

et al., 2019; Parkinson et al., 2017; Worosz, Farrell, & Jenda, 2020). Complex problems are severe social and organizational problems that require non-traditional countermeasure approaches because of the severity of the problems (Rittel & Webber, 1973). One strong example is food deserts, neighborhoods in which residents face extreme barriers to accessing affordable and healthy food while also experiencing social segregation (Allcott et al., 2019; Hamidi, 2020; Kelli et al., 2017). These daily palpable challenges of residing in food deserts affect the residents’ well-being (Oviedo & Sabogal, 2020; Sano,

Mammen, & Houghten, 2020; Wright, Donley, Gualtieri, & Strickhouser, 2016).

There is a gap in the literature: lack of examination of the social aspects of a food desert resident’s well-being and what role NPOs play in improving this aspect of the residents’ lives. Understanding the factors that promote the effectiveness of NPOs on the social aspects of well-being for food desert residents can help make strides into improving a resident’s well-being and their potential to flourish. Thus, the overarching research question of this dissertation is: What factors influence the effectiveness of nonprofits in addressing the social aspects of well-being for individuals residing in food deserts?

Research Motivation

This dissertation seeks to understand the phenomenon of food deserts and the relationship to the well-being of food desert residents. Furthermore, it considers the implications of NPO effectiveness in food deserts on improving food desert residents’ lives, specifically in the social aspects of well-being. Finally, it seeks to provide empirical evidence on the importance of the social aspects of well-being (Keyes, 1998) and the

need for NPOs to recognize that importance when working to build sustainable systems in communities they serve.

Building the delivery of services of NPOs increases their effectiveness in helping those who desperately need their help (Williams-Gray, 2016). I began this research before the COVID-19 pandemic, which has intensified food desert residents’ need for assistance and which has also demonstrated the importance of the effectiveness of NPOs’ service delivery of programs. NPOs provide assistance while food desert residents are challenged with health problems and socio-economic problems brought on by COVID-

19. The importance of NPO effectiveness has been seen during the pandemic where

NPOs have provided food desert residents access to healthy food (Cohen, 2004). Through

Study 2 and Study 3, I assess the impact of NPOs on food desert residents’ well-being, on the social aspect of such well-being. By asking questions about the effectiveness of NPOs from the clients’ perspective, my dissertation sheds light on how NPOs can build sustainable systems in areas that lack access to basic needs.

Specific Aims and Research Questions

By definition, food desert residents are faced with issues such as lack of access to healthy food, limited mobility, and social segregation simply because of where they reside. The aim of this dissertation is twofold: To critically review the social aspects of food desert residents’ well-being and to examine the degree to which NPOs are effective in helping food desert residents’ social aspects of well-being. Clarifying the role of NPOs within food deserts may help improve their effectiveness (Bryson, 2018).

Three separate studies were conducted to discover this information. Each study collected and analyzed data on factors that influence a resident’s well-being; the

combined studies build upon each other in phases (Table 1). Each phase consists of separate research questions. The initial study provided a framework on the importance of a resident’s social life and how it influences their well-being.

In Study 1, I wanted to investigate how food desert residents lived their lives in their environment to understand how they achieve well-being with all of the challenges they face on a daily basis. My research question for Study 1 was, “What factors influence well-being in residents of food deserts?” Understanding what factors help food desert residents with their well-being can help NPOs with their delivery of service programs to have a greater impact on the lives of food desert residents.

In Study 2, I investigated the role of NPOs in food deserts to examine if NPOs were effective in helping food desert residents with the social aspects of well-being. To be able to do this, I asked the following research question, “Are nonprofits organizations effective in helping food desert residents on the social aspects of well-being?” Empirical data from the second study examined the variables associated with a resident’s well-being and if NPOs play a moderating role. Gaining knowledge on how effective NPOs are in food deserts from the perspective of food desert residents gives a point of reference for

NPOs to either build upon or innovate the delivery of services.

Study 3 occurred during the pandemic and sheds light on food desert residents’ well-being before and during COVID-19 and whether or not residents found NPOs effective with helping them with the social aspects of their well-being during the pandemic. Study 3 included two research questions, “During the COVID-19 pandemic:

What factors influence well-being in residents of food deserts? Are nonprofit organizations effective in helping food desert residents on the social aspects of well-

being?” Together, these questions from the studies provide the groundwork and schema of my dissertation; the framework of my dissertation is made of study phases as shown in

Table 1.

Table 1: Overall Research Study Summary: Study Phase and Method, Research Questions, Sample, and Motivation

Study Phase and Research Question Sample Motivation Method Phase 1 – What factors influence 20 Food Desert The aim of this initial study Qualitative well-being in residents Residents within sought to understand how food of food deserts? New York City desert residents achieved well- Grounded and Orange being by using identified patterns Theory, Semi- County, NY of access. Structured Interviews Phase 2 – Are nonprofit Food Desert The purpose of this study was to Quantitative organizations effective in Residents within understand the factors that make helping food desert the United States NPOs effective in helping food Anonymous residents with the social desert residents with the social Surveys aspects of well-being? 392 Respondents aspects of well-being.

Triangulation No research question. This is a Bridging of themes for the Phase combination of interpretation and explanation of Phase 1 and qualitative and quantitative data. Integration 1 of Phase 2. data through triangulation

Meta-inference results of Phase 1 and 2 Phase 3 – During the COVID-19 40 Food Desert This study was conducted to Qualitative pandemic: What factors Residents within examine food desert residents’ influence well-being in the United States social aspects of well-being residents of food during the COVID-19 pandemic. deserts? Are nonprofit It examines the relationship organizations effective in between the COVID-19 pandemic and a resident’s well-being. It helping food desert also examines the role of NPO residents on the social effectiveness on the social aspects aspects of well-being? of well-being within a food desert.

Integration 2 No research question. This is a A review of findings from all combination of three Phases. all Phases:1–3.

Research Design and Methodology

My research used mixed-methods that combine qualitative and quantitative approaches (Creswell & Plano Clark, 2018). By combining my qualitative and quantitative collection and data analysis into a single program of study, I aim to establish a greater breadth and depth of understanding and corroboration of the data (Johnson,

Onwuegbuzie, & Turner, 2007). Using a mixed-methods approach to understand the complexities of the research enables the discovery of factors that influence a food desert resident’s well-being. A mixed-methods approach allowed for this discovery (Creswell &

Plano Clark, 2018; Teddlie & Tashakkori, 2009).

A sequential mixed-methods exploratory design provided a way to integrate qualitative and quantitative methods to answer my dissertation’s research question, as shown in Figure 1 adapted from Creswell (2003). I wanted to understand the viewpoints of food desert residents, so I implemented my first study. These viewpoints would help with creating the quantitative study by providing insights and knowledge on the subject of NPO effectiveness (Johnson et al., 2007). The integration of diverse methods provides a greater understanding of research allowing for adaption as it evolves between phases.

Specifically, this approach allowed for Study 3, which took into account the occurrence of the COVID-19 epidemic, thereby providing a deeper learning experience (Bazeley &

Jackson, 2013).

The first phase of the research design was a qualitative study (QUAL) using

Grounded Theory (Charmez, 2014). Grounded Theory (Charmez, 2014) methods are comprised of consistent comparison and theoretical sampling. Data is collected and analyzed simultaneously, and further data collection is derived from theory as it is

constructed (Glaser & Strauss, 2017). Qualitative research is also suited for understanding the inner experience of the participants, exploring how meanings are formed and transformed, and to importantly, discover relevant variables that later can be tested through quantitative forms of research (Corbin & Strauss, 2015).

To examine the lives of food desert residents, I asked 20 residents open-ended questions and noted their responses. These responses were analyzed and provided a framework to understand the factors contributing to a resident’s well-being. I used this framework of information to work on the second phase.

The second phase of research is a quantitative study (QUAN). I used a survey to examine if NPOs were effective in helping food desert residents’ social aspects of well- being. The number of responses totaled 392, and I used the analyzed data to gain insights into the effectiveness of NPOs moderating access to healthy food, malnutrition, and social interaction. The findings from my second phase provided new information and confirmed findings.

In the third phase, a qualitative (QUAL) study, I used the second phase to create the interview questions. I interviewed 40 food desert residents to examine their daily lives and understand the factors that influence the social aspects of well-being during the pandemic. I also investigated the effectiveness of NPOs concerning helping food desert residents’ social aspects of well-being during the pandemic.

Figure 1: Sequential Mixed-Methods Exploratory Design

Adapted from Creswell (2003).

Summary and Results of Each Study

In Study 1, I gained an understanding of how food desert residents achieved well- being by asking questions about their daily lives. I used Social Cognitive Theory and

Motivation Theory as a lens to analyze the data. I found that residents traveled at least one-hour round trip to make their food purchases. Residents also spoke of traveling a great distance to a market because they appreciated the variety of products their supermarket provided versus shopping in their neighborhood. Another finding was that food desert residents enjoyed the social aspects of their supermarket: Engaging with other customers and those who worked at the supermarket. While residents reported their travel to supermarkets, none spoke of planning their food purchases or of meal planning.

Study 2 segued from Study 1, I understood the importance of the social aspects of well-being for food desert residents. In this study the construct Nonprofit Organizational

(NPO) Effectiveness was used to provide a context of historical and current definitions of

the effectiveness of NPOs. Also, the meaning of the Well-being construct was succinctly defined to include social aspects. From Study 1’s emergent finding, I investigated NPO effectiveness on the social aspects of a food desert resident’s well-being. My findings were that social interaction had a strong effect on a resident’s well-being. While NPOs were effective in helping food desert residents mitigate their malnutrition, surprisingly, they were not effective in helping food desert residents with the social aspects of their well-being.

For Study 3, a new context was incorporated into the theme of my studies, the

COVID-19 pandemic. To better understand the COVID-19 crisis and its implications on a food desert resident’s social aspects of well-being, I used Self-Determination Theory

(SDT) and Sensemaking Theory as a lens while conducting research. I interviewed food desert residents on the social aspects of their well-being and their thoughts and opinions on NPO effectiveness during the pandemic. To understand any influence, the pandemic had on food desert residents’ lives, I asked them to compare their lives before and during the pandemic. Findings were that residents improved the social aspects of their well- being and lived a healthier lifestyle by eating healthier foods, exercising, improved relationships with loved ones, and took the time to concentrate on themselves. Contrary to Study 2, the sample of residents found NPOs effective in helping with the social aspects of their well-being and helping them access healthy food. Study 3 findings were surprising given the context of COVID-19 in the study. There were exacerbated challenges of food insecurity, malnutrition, and health issues, at the time of my interviews, during the COVID-19 pandemic. With all of the challenges brought on by

COVID-19, residents reported improved social aspects of their well-being.

Organization of Remainder of Dissertation

This dissertation shows how NPOs can be effective in the areas that lack access to basic needs and that they can help individuals within these areas with the social aspects of their well-being. It shows the factors that influence the social aspects of well-being, and that help NPOs can ascertain models that help curtail these problems found in too many communities within the U.S.

The dissertation is organized as follows after the Introduction: First, Chapter 2, a literature review is used to guide the studies and dissertation, inclusive of a theoretical framework that provides insight into data analysis. Second, this is followed by Chapters

3, 4, and 5, which include three phases or studies: Study 1, Study 2, and Study 3. These studies analyzed what influence’s food desert residents’ social aspects of well-being and

NPO effectiveness in helping these residents. Third, Chapter 6 includes core and integrated findings, a discussion section inclusive of limitations and implications. Last,

Chapter 6 also includes future research and the conclusion of the dissertation.

CHAPTER 2: BACKGROUND, LITERATURE REVIEW, AND THEORETICAL FRAMING

Background

So I grew up in [a food desert], people might refer to us as trailer trash or government housing trash. And eventually low-income… Like you just had to make everything last, put water in the eggs so that there’s more called an egg. I heard when I got older, like in a restaurant, it’s called an egg wash, we just did it. We only ate vegetables out of a can. (Study 3, Participant 32)

Food Deserts

Within the U.S., 23.5 million Americans reside in food deserts (Alston, 2020;

Samani, 2020; Ver Ploeg et al., 2009). One of the main challenges for food desert residents is accessing healthy and affordable foods. The 2015–2020 United States

Department of Health and Human Services (HHS) and United States Department of

Agriculture (USDA) Guidelines for Americans suggest that a healthy diet is composed of fruits, vegetables, and low-fat dairy products (health.gov, 2015). In this dissertation, the causes and consequences of a lack of access to healthy foods are examined to grasp a resident’s experience of residing in a complex environment.

A food desert is complex because often there is a disconnected agreement on how to solve the problems found in food deserts. This is caused by the lack of knowledge of the problems, thus causing open-ended tactics as solutions (Crowley & Head, 2017;

Roberts, 2000). Food deserts are complex due to the assemblage of stakeholders, with competing interests, found in food deserts (Jordan, Kleinsasser, & Roe, 2014; Roberts,

2000). Out of the sundry listing of stakeholders, this dissertation focuses on residents of food deserts and the nonprofit organizations (NPOs) that serve them, with an attention to

the ever-changing complexities that interconnect these stakeholders (Roberts, 2000;

Waddock, Meszoely, Waddell, & Dentoni, 2015).

The interconnected stakeholders found at the local level of food deserts consist of fast food retailers and other food distributors, consumers or food desert residents, NPOs: anti-hunger advocates and emergency food relief providers, community-based organizations or soup kitchens, government policymakers, schools, and other members of the regional community (Santo & Moragues-Faus, 2019: 81). Hester, Bradley, and

Adams (2012) state stakeholders take the center place of systems problems. Each stakeholder mentioned is overlapping consumers, clients, or suppliers (Hester et al.,

2012). Reviewing the relationships of these stakeholders provides important contextual information regarding underlying challenges for food desert residents and the NPOs that try and help them with the social aspects of their well-being.

Understanding the landscape of food deserts provides knowledge on the complex problems that challenge a resident’s well-being in relation to their food environment

(Ares et al., 2016; Connors, Bisogni, Sobal, & Devine, 2001; Grunert, Dean, Raats,

Nielsen, & Lumbers, 2007; Uhlmann, Lin, & Ross, 2018). This knowledge can provide clarity on issues and help inform NPOs on what social initiatives are needed to ameliorate a food desert resident’s well-being.

Defining Food Deserts

For the purpose of this research, I am using the USDA’s definition of food deserts, defined as “regions of the country [that] often feature large proportions of households with low incomes, inadequate access to transportation, and a limited number of food retailers providing fresh produce and healthy groceries for affordable process”

(USDA, 2011). The USDA also defines food deserts as areas where residents live one mile or more away from a supermarket (USDA, 2019), shown below in the USDA’s

Food Access Atlas Map (Figure 2). This interactive map highlights food deserts at the national, state, and regional levels. Figure 2 shows the prevalence of food deserts found at the national level in the U.S.

The term food deserts was coined in Scotland during the 1990s (Beaulac,

Kristjansson, & Cummins, 2009). The terminology was created to described deficient access to an affordable and healthy diet. Since the 1990s and into the 2000s, research publications continue to increase on the subject. Due to its popularity, the term has become bog-standard. While the subject of food deserts is more mainstream, the factors that cause food deserts are ill-defined. Due to this lack of a universal definition, the metaphor “food deserts” has morphed into an indistinct term sometimes used for food insecurity within certain areas of the U.S. (Apparicio, Cloutier, & Shearmur, 2007).

Figure 2: USDA Food Access Atlas Map Food Deserts Located in the U.S. Are Highlighted Green

Access to Healthy and Affordable Foods

A study by Zenk et al. (2005) studied the accessibility of supermarket chains in regard to racial composition and poverty. The researchers used a geographic information system to measure block distance to a supermarket for roughly 869 neighborhoods within

Detroit, Michigan. The findings show that those residing in African American communities lived 1.1 miles farther from a supermarket than those in white neighborhoods (Zenk et al., 2005). Morland, Wing, and Roux (2002) studied local food environments and the linkage between local food environments and the residents’ dietary intake. They studied ten heart disease risk communities through questionnaires (Morland et al., 2002). Their conclusions suggest an association between local food environments:

One’s accessibility to supermarkets and residents having a healthier life.

The distance to supermarkets is one of the strongest indications of classifying an area as a food desert (Thomas, 2020; Tobia, 2020). Morris, Neuhauser, and Campbell

(1992) examined food security in America. The objective of the study was to determine urban and rural supermarkets and food availability within the area. Findings were that healthy foods were less available, and when available, were priced considerably higher up to 33% (Morris et al., 1992).

Researchers have studied low socio-economic areas and the distance to supermarkets from such locations and that the areas studied were predominately made up of African American residents (Baker, Schootman, Barnidge, & Kelly, 2006). Baker et al.

(2006) studied poverty and race in regard to access to foods which restricted an individual’s diet. These researchers were compelled to study this topic given the surge in obesity and other chronic diseases across the country. They audited supermarkets and

fast-food vendors to gather data on available food choices to local residents. The researchers concluded that low-income areas without access to healthy food options were more likely to develop health ailments and chronic diseases.

Cotterill and Franklin (1995) used zip codes to present a national evaluation of the lack of access to supermarkets in urban areas. Their research provides an in-depth analysis of the urban grocery gap and provides a listing of demographic and supermarket descriptive statistics and various data which list stores per capita in major cities. Shaffer

(2002) chronicles the gap between the number of available supermarkets in low socio- economic neighborhoods versus middle-upper income neighborhoods. Amongst academic findings were, “the higher the concentration of Whites in a community, the greater number of supermarkets, while high concentration of African-Americans and

Latinos tend to result in access to fewer supermarkets” (Shaffer, 2002: 11).

Andrews, Kantor, Lino, and Ripplinger (2001) studied federal and local initiatives to help communities with their food insecurities. This study included a USDA Economic

Researchers (ERS) survey of 34 large food retailers and discount stores authorized to accept Supplemental Nutritional Assistance Program (SNAP) payments located within

Washington, DC. Findings showed there is a pricing flux within various zip codes and the availability of healthy foods as well. The authors concluded that lower-income neighborhoods have higher prices than supermarkets located in more affluent areas.

Jetter and Cassady (2006) studied the availability and cost of standard market basket foods vs healthier market basket foods via surveys conducted within Los Angeles and Sacramento. The researchers selected 25 stores within neighborhoods that ranged in income; the survey was conducted three times between September 2003 and June 2004.

They concluded that low-income, low-access neighborhoods lacked the availability of healthy food options as small grocery stores had a higher cost for healthy food basket items. The researchers maintain that current food environments of low-income low- access neighborhoods impact the consumer’s accessibility to healthier foods. The Mari

Gallagher Group found that Chicago had the least access to healthy foods with the highest level of health disparities (Gallagher, 2006).

Various research examines low-income, low-access areas and their access to quality and healthy foods. Overall, research studies show vulnerable and disenfranchised neighborhoods fared poorer compared to middle to higher-income neighborhoods in terms of access to quality and healthy foods (Baker et al., 2006; Glanz, Sallis, Saelens, &

Frank, 2007; Horowitz, Colson, Hebert, & Lancaster, 2004; Jetter & Cassady, 2006;

Sloane et al., 2003).

Food Deserts: Public Health Disparities

Wright and Aronne (2012) state a food desert is a “built environment,” suggesting that food deserts are designed to encourage overeating by ingesting high caloric foods and extremely large portions (Ells et al., 2006; Wright & Aronne, 2012). The food environment and lack of access to healthy foods within food deserts equate to higher rates of obesity within these areas (Drewnowski & Darmon, 2005). Demographic factors are an important component of obesity rates, as well as an individual’s economic/financial status (Drewnowski & Darmon, 2005).

Residents of food deserts far too often are confined to purchasing a bulk of their food within their neighborhood due to a lack of mobility (Shannon, 2016; Widener &

Shannon, 2014). Many residents cannot afford a car, and there is limited public

transportation (Abel & Faust, 2018) they can take to a supermarket to purchase fresh, wholesome foods (Block & Kouba, 2006; Gallagher, 2014; Kolak et al., 2018; Lewis et al., 2005).

Residing within a food desert fetters a resident’s ability to access healthy food, thus having a negative effect on their well-being (Larson, Story, & Nelson, 2009;

Michimi & Wimberly, 2010; Walker, Keane, & Burke, 2010; Zenk et al., 2005). These findings add weight to the unpropitious situation of those residing in food deserts as they often experience malnutrition with or without hunger. This is primarily due to the energy- dense foods that make up a majority of their diet (Camp, 2015). This is noteworthy because it supports the claims that the current 23.5 million food desert residents in the

U.S. suffer from nutritional deprivation partially as a result of their geographical location

(Bodor, Rose, Farley, Swalm, & Scott, 2008; Gustafson et al., 2011; Jeffery, Baxter,

McGuire, & Linde, 2006).

The implications of a diet devoid of healthy food is adverse to achieving good health and causes diet-related illnesses, such as cancer (Gallagher, 2006), hypertension, diabetes (Horowitz et al., 2004), cardiovascular risk (Seligman, Laraia, & Kushel, 2010), obesity (Larson et al., 2009), morbidity, depression, and increased smoking and alcohol consumption (Macintyre, 2007). More alarming is the domino effect that the lack of access to healthy foods has on a food desert resident. As a food desert resident’s diet becomes poorer, that individual is less likely to engage in physical activity, hence exacerbating any current or future health disparities, leading to poor well-being (Egger &

Swinburn, 1997; French, Story, & Jeffery, 2001; Macintyre, 2007). Once food desert residents develop and are encumbered by a health disparity, their local markets often only

offer foods that present a barrier to gaining good health; most of the markets within food deserts sell processed foods that are high in sugar, salt, and fat.

Literature Review and Theoretical Framing

I used theories to review and understand the role of Nonprofit Organizational

(NPO) effectiveness on the social aspects of well-being within food deserts. I used these interacting theories to gain a greater understanding of the phenomenon of complex social systems, and the connectivity of the stakeholders found in food deserts (Barrat,

Barthélemy, & Vespignani, 2008; Bertin & Jensen, 2019). The theoretical framework

(Figure 3) for this dissertation provides knowledge that leads to comprehension of how

NPO delivery of services can help improve the lives of food desert residents. Each theory provides a lens to grasp the daily lives of food desert residents and better scholarship on interpreting the qualitative and quantitative data in my studies.

Adapted from Black (2016), Figure 3 includes Complexity Theory, Social

Innovation Theory, Nonprofit Organizational Effectiveness Theory, and Social Aspects of Well-being Theory. Feedback loops connect the theories. These feedback loops show the two-way relationships of the theories and how to understand the daily lives of food desert residents and how they achieve well-being. I also used feedback loops to display how system changes, improvements, or new solutions might be identified (Sahin et al.,

2020). The multiple relationships provides a space for adaptability in my research. These theories can be seen as a duality component, having quantum-mechanical properties where theories provide insights into the seemingly nonlinear narratives of the food desert residents. Other theories seem to weave in and out of each other in the research to provide a deeper understanding of the systems that make up a food desert.

Figure 3: Theoretical Framework

Adapted from Black (2016)

Social Aspects of Well-Being

Well-being cannot exist just in your own head. Well-being is a combination of feeling good as well as actually having meaning, good relationships…. — Martin E.P. Seligman

In recent decades, there has been a growing body of research on well-being

(Diener, Suh, Lucas, & Smith, 1999; Dodge, Daly, Huyton, & Sanders, 2012; Keyes,

Shmotkin, & Ryff, 2002; Statham & Chase, 2010). Well-being is defined as having quality of life, which includes good health and social relationships (de Chavez, Backett-

Milburn, Parry, & Platt, 2005). Within the context of this study, examining a food desert resident’s daily life, well-being is understood to be essential for human flourishing 19

(Khaw & Kern, 2014). Fredrickson and Losada (2005) explain, “To flourish means to live within an optimal range of human functioning, one that connotes goodness, generativity, growth, and resilience” (p. 1). Seligman (2011) lists five elements or pillars in defining well-being: Positive emotion, Engagement, Relationships, Meaning, and

Accomplishment (PERMA). Three properties must exist for each element to count as an element: (1) It contributes to well-being; (2) Many people pursue the element for its own sake, not merely to get any of the other elements; and (3) It is defined and measured independently of the other elements (exclusivity) (p. 16). Seligman (2011) goes on to explain each pillar in his PERMA model in more detail:

1. Positive emotion. The first element in well-being theory is positive emotion a cornerstone of well-being theory [measuring] happiness and life satisfaction (p. 16).

2. Engagement. Engagement is assessed only subjectively (i.e. “Did time stop for you?” “Were you completely absorbed by the task?” “Did you lose self- consciousness?”) (p. 16).

3. Relationships. Relationships include feelings of integration with a society or a community, feelings of being cared for by loved ones, and being satisfied with one’s social network.

4. Meaning. Meaning [is defined as] (belonging to and serving something that you believe is bigger than the self) (p. 17).

5. Accomplishment. Making progress towards one’s goals and achieving superior results can lead to both external recognition and a personal sense of accomplishment.

Seligman’s (2011) PERMA model of flourishing also includes both hedonia (e.g., pleasure, enjoyment, comfort, absence of distress) and eudemonia (e.g., growth, meaning, authenticity, excellence) (Huta & Waterman, 2014). Most other well-being models include only one or the other (Goodman, Disabato, Kashdan, & Kauffman, 2018a). Using

both hedonia and eudaimonia is important because it provides researchers with more than one indicator when measuring well-being. Theorists argue this is the best way to capture the meaning of well-being because it uses multiple indicators from different domains

(Forgeard, Jayawickreme, Kern, & Seligman, 2011; Kern, Waters, Adler, & White, 2015;

Miller & Foster, 2010). For example, Ryff and Keyes (1995) have six domains, and

Huppert and So (2013) suggest ten domains.

As the appropriate type of well-being model used in research is best decided by the researcher (Biswas-Diener, Kashdan, & King, 2009; Goodman et al., 2018a;

Kashdan, Biswas-Diener, & King, 2008), I used Seligman’s (2011) PERMA model of well-being to interview food desert residents on their life satisfaction, happiness, and other positive emotions that provide greater outcomes for relationships, and physical health before and during the COVID-19 pandemic. By using well-being within my research, I am able to survey food desert residents’ self-perceptions of having a good life or quality of life (Diener, Oishi, & Lucas, 2003), life decisions (Angner, 2009), and their overall psychological or subjective well-being (SWB) (de Chavez et al., 2005). In my research, quality of life is understood to be “a dynamic interaction between the external conditions of an individual’s life and the internal perceptions of those conditions” (de

Chavez et al., 2005: 74). Therefore, I used Seligman’s (2011) well-being measurement to understand how food desert residents internalize their environment and understand the role of NPOs in helping residents achieve well-being.

Food desert residents who often experience positive emotions, quality relationships with others, and having a purpose in life are more likely to be healthier as positive emotions advance physical health (Ryff & Singer, 1998; Salovey, Rothman,

Detweiler, & Steward, 2000). Regardless of social class, health status, and other economic and social classifications, researchers have found that there is an association between feeling good and living longer (Levy, Slade, Kunkel, & Kasl, 2002; Moskowitz,

2003; Ostir, Markides, Black, & Goodwin, 2000). Positive emotions produce health and produce well-being (Fredrickson, 2001) and the ability to flourish (Seligman &

Csikszentmihalyi, 2000). Researchers have also found that people who have stronger support systems have greater well-being and are less likely to be vulnerable to poor health and disease (Khaw & Kern, 2014).

A person’s social relationships influence their achievements and well-being (Zhu,

Woo, Porter, & Brzezinski, 2013). Social networks consist of relationships that provide an individual with support and influence life satisfaction outcomes (Perry & Pescosolido,

2010). Thus, social relationships have a positive influence on a person’s well-being

(Cohen, 2004; Goodman, Doorley, & Kashdan, 2018b; Kansky & Diener, 2017); social relationships help with a person avoiding stress and high-risk situations, and help (e.g., a ride to a supermarket or hospital) (Lin, 2002; Rook & Charles, 2017) during the pandemic (Ellis, Dumas, & Forbes, 2020; Yang et al., 2020b).

The external conditions of a food environment also affect an individual’s well- being (Grunert et al., 2007; Schnettler et al., 2013). This is especially relevant for food desert residents because the foods available within their neighborhoods are mostly unhealthy, which directly influences their physical health (Dye & Blundell, 2002), mood, emotions, social relationships, and general life judgments (Ares, De Saldamando,

Giménez, & Deliza, 2014; Canetti, Bachar, & Berry, 2002; Macht, 2008; Rozin, 2015).

My research examines food desert residents’ food shopping and consumption tendencies as research implies a correlation between well-being and the consumption of healthy foods compared to fast foods (Ares et al., 2015; Chanfreau et al., 2008). Food desert residents face a teeming amount of challenges to living their daily lives and achieving well-being. Examining how NPOs can help residents in these two areas provides direction to helping 23.5 million Americans take steps from having basic needs to flourishing.

Nonprofit Organizational Effectiveness Theory

Everybody can be great because everybody can serve. — Dr. Martin Luther King Jr. (1968)

Nonprofit Organizational (NPO) effectiveness is defined as components that facilitate such an organization’s ability to fulfill its goals (Eisinger, 2002; Herman &

Renz, 1998, 1999, 2008; Mitchell, 2013). Assessment of NPO effectiveness is abstruse due to the obscurity of measurements needed to evaluate effectiveness (Liket & Maas,

2015). Thus, financial indicators are the most relied upon method of evaluating NPO effectiveness (Bhattacharya & Tinkelman, 2009; Gordon, Knock, & Neely, 2009;

Tinkelman & Donabedian, 2007). In this study, a review of NPO effectiveness is conducted by asking food desert residents if the NPOs that serve them are helping with the social aspects of their well-being.

Within the last two decades, there has been an increased debate about the measurement of NPO effectiveness (Herman & Renz, 1999, 2008; Willems et al., 2012)

(Lecy, Schmitz, & Swedlund, 2012). According to Paynter and Berner (2014), NPOs are essential for combating food access issues and alleviating hunger. Billions of dollars are spent every year by the federal government in an attempt to alleviate hunger (Berner & 23

O’Brien, 2004; Borders & Lindt, 2009; Eisinger, 2002). Food pantries, which are heavily relied upon by food desert residents for food access, make up 63.7% of all 501(c)(3) public charities (Blackwood, 2012; Paynter & Berner, 2014). However, the problems of perceived social isolation, lack of mobility, and lack of food access persist in food deserts. The research of this thesis is imperative because the service of NPOs within food deserts can alleviate malnutrition, provide greater access to healthy foods, and become a source of social connectedness for residents in these areas.

The NPOs’ role in helping individuals in a social and welfare capacity has been rapidly increasing (Boris & Steuerle, 1999; Boris & Steuerle, 2006; Salamon, 1995;

Smith & Lipsky, 1993). Therefore, it is important to examine if they are capable and effective at their job (De Vita & Capitani, 1998; Eisinger, 2002; Liket & Maas, 2015).

My study examines the outputs of NPOs on the social aspects of well-being and the subjective perceptions of those outputs of food desert resident stakeholders (MacNell,

Elliott, Hardison-Moody, & Bowen, 2017; Walker, 2009; Yao, Hillier, Wall, & DiSantis,

2019).

During the COVID-19 pandemic, NPOs have taken on the onerous duty to help with providing food and needed supplies to attenuate the impact of COVID-19 within communities around the U.S. The ramifications of COVID-19 have impinged upon the health and well-being of individuals (Akingbola, 2020) within the U.S. Food deserts communities are most impacted by COVID-19 due to the health and socioeconomic inequities that persist within these areas (Azar et al., 2020; Dyer, 2020; Garcia, Homan,

García, & Brown, 2020). The COVID-19 pandemic has shown how food desert residents, mostly minorities, are far more likely to contract COVID-19 and have higher mortality

rates (El-Khatib, Jacobs, Ikomey, & Neogi, 2020; Ferdinand & Nasser, 2020). COVID-

19 has exposed the underpinnings of a resident’s lack of availability to healthy food has caused a higher death rate within communities that suffer from adverse social determinants of health (Tai, Shah, Doubeni, Sia, & Wieland, 2020). The urgency of this pandemic has exacerbated social challenges and calls for action on improved methods to address and meet these challenges (Desa & Jia, 2020; Von Krogh, Kucukkeles, & Ben-

Menahem, 2020). One way we can address these challenges is by analyzing the issue through Complexity Theory (Mitchell, 2009).

Social Innovation Theory

What then is the work of the social innovation movement?... The work is to resist and subvert the dictatorship of no alternatives. To do so in the direction of an enhancement of agencies in all domains of social life. — Roberto Mangabeira Unger

A laconic statement on the concept of Social Innovation (SI) is that it is not new; although SI has been around since the beginning of mankind, only recently has it been included in social sciences (Cajaiba-Santana, 2013). Mulgan (2006) defines SI Theory as a burgeoning pursuit of new ideas that seek to improve the well-being of people, their communities, and society. These new ideas encompass new actions, systems, and services focused on new social processes and new social outcomes (Mulgan, 2006).

Within this paper, the concept of SI Theory allows insights into how NPOs can effectively help food desert residents on the social aspects of their well-being and renew nonprofit programs that focus on the improvement of processes and outcomes.

Knowing the factors that foster or hinder NPO effectiveness from creating systematic change, for example, to mitigate the consequences of having poor well-being

due to residing within a food desert, is tangible with the practice of SI Theory (Moore,

Riddell, & Vocisano, 2015). Dawson and Daniel (2010) contend that SI Theory is made up of compositional factors concerned with people and their communities by meeting societal problems and enhancing societal well-being (p. 10). They argue that SI Theory can lead to social change (Cooperrider & Pasmore, 1991; Howaldt, Kopp, & Schwarz,

2015; Mulgan, Tucker, Ali, & Sanders, 2007). According to Mumford (2002), SI Theory generates new ideas that foster social interactions and activities which lead to meeting common goals. Stanford University’s Center for Social Innovation defines SI as “Any novel and useful solution to a social need or problem, that is better than existing approaches (i.e., more effective, efficient, sustainable, or just) and for which the value created (benefits) accrues primarily to society as a whole rather than private individuals”

(Phills, Deiglmeier, & Miller, 2008: 36).

SI Theory provides a theoretical lens when trying to understand societal concerns of residing within a food desert and how that impacts a resident’s well-being. It also defines the expected outcomes of organizations that strive to have a positive impact on society. The multi-disciplinary adoption of SI Theory creates a challenge in that much of the literature lacks precision as there are contending definitions (Jenson & Harrisson,

2013). This is because SI Theory encompasses many disciplines other than sociology, science, and technology; some of the other disciplines include urban and regional development (Klein, Fontan, & Harrisson, 2013), public policy (Klein et al., 2013;

Neumeier, 2012; Pot & Vaas, 2008), management (Drucker, 1987; Mulgan et al., 2007), social psychology (Mumford, 2002), and social entrepreneurship (Lettice & Parekh,

2010; Mulgan et al., 2007). However, while literature is disjointed among different fields,

within the past two decades, social scientists have used SI as term for new ideas, designs, solutions to structural and systemic issues (Nicholls, Simon, & Gabriel, 2015). Thus, SI

Theory helps understand and identify factors that lead to the creation of processes that can help NPOs deliver solutions within food deserts and help improve the well-being of residents of food deserts.

Dawson and Daniel (2010) state any event that occurs within a complex social system is multi-faceted and that SI Theory provides four elements that help manage complexity. Within the context of my studies, this translates to SI Theory having elements that NPOs can draw upon to manage programming that promotes well-being within food deserts. The proposed four elements are:

1. people

2. the challenge (which may be a problem or an opportunity)

3. the process (by which the challenge is negotiated and understood)

4. the goal (resolution of challenge toward to the objection of increased well- being) (Dawson & Daniel, 2010: 16).

There are three levels of SI identified by Nicholls et al. (2015). They state that the first level, Incremental Innovation, expeditiously addresses social needs by providing goods and services. The authors give examples of organizations that provide Incremental

Innovation to address dire socio-economic needs. This perspective suggests that SI promotes opportunities. The second level, Institutional Innovation, supersedes existing socio-economic structures to induct new social outcomes. The authors provide the example of Fairtrade and mobile banking to illustrate how systems have been mollified to address social needs. Last, Disruptive SI aims for system changes. The authors stress

systematic changes can be witnessed in social movements that highlight and reframe social issues experienced by disadvantaged groups. A recent example of Disruptive SI occurred during the COVID-19 pandemic by those who rallied that Black Lives Matter

(BLM); the BLM movement started within the U.S. and made an impression with people in communities around the world who joined the rally for basic human rights.

The SI incentives change process is needed to remedy serious problems, problems that have been persistent and resistant to current methodologies (Santoro, Ferraris, &

Vrontis, 2018). Westley and Antadze (2010) state that SI is the process for generating change through the introduction of new products and programs. They expand on

Mumford’s (2002) definition by stating that “such successful social innovations have durability and broad impact” (p. 2). SI is an effective tool for creating change because it challenges the establishment: established rules and routines, established models of business, government, society, and the established systems and economics of all areas of society (Jonker, 2012). SI is distinctive as it assuages the needs that are not met by institutions or the market. It also begets new avenues for production and the roles people play in successfully meeting those needs (Neumeier, 2017).

Murray, Caulier-Grice, and Mulgan (2010) derived key development stages of SI from design thinking; these developmental stages enhance Mumford’s (2002) perspective on SI’s broad impact. Murray et al. (2010) state SI first moves from a type of prompt to a proposal, next to prototyping, then to sustainability, and last to scale. The six stages identified by Murray et al. (2010) provide a road map of ideas from beginning to impacts.

The authors stress that the process of SI is not always in sequence, rather some ideas may

jump from one stage to another, and within stages, feedback loops may occur (Murray et al., 2010). Murray et al. (2010) define each phase as:

1. Prompts, inspirations and diagnoses. In this stage we include all the factors which highlight the need for innovation….

2. Proposals and ideas. This is the stage of idea generation….

3. Prototyping and pilots. This is where ideas get tested in practice….

4. Sustaining. This is when the idea becomes everyday practice. identifying budgets, teams and other resources… (p. 12).

5. Scaling and diffusion. At this stage there are a range of strategies for growing and spreading an innovation…. (p. 13).

6. Systemic change. This is the ultimate goal of social innovation. Systemic change usually involves the interaction of many elements: social movements, business models, laws and regulations, data and infrastructures, and entirely new ways of thinking and doing. (p. 13).

There are drivers that create prompts for SI. As Moulaert, MacCallum, Mehmood, and

Hamdouch (2013) state, SI commences when exclusion, segregation, and opportunities for improved living conditions are unmet by institutionalized public or private actions. SI is a response to the world’s complex problems (Bason, 2018; Murray et al., 2010), such as a global pandemic and its long-term consequences; lack of access to basic needs, such as healthy food; and pervasive reductions of well-being within communities due to inequality (Nicholls et al., 2015). These problems consist of systems that contain an eminent and acute degree of uncertainty where change is a non-linear process. I used

Complexity Theory to understand these systems and to be able to build knowledge on the interconnected relationships between SI and complex social systems (Domanski,

Howaldt, & Kaletka, 2020; Fisk et al., 2019; Westley, 2008; Westley & Antadze, 2010).

Complexity Theory

Vision without systems thinking ends up painting lovely pictures of the future with no deep understanding of the forces that must be mastered to move from here to there. — Peter Senge

Complexity Theory reconstructs how we reflect about and examine the social and natural world by providing an understanding of the dynamic of complicated situations

(Cairney, 2012; Van Slyke, 2007). Mitchell (2009) defines complex systems “as large networks of components with no central control and simple rules of operation give rise to complex collective behavior” (p. 13). Mitchell (2009) also states complex systems are networks consisting of interacting parts and that internal and external environments influence network processing of information and signaling. Complex systems change behavior to improve survival and success. This is done through adaption of learning that leads to change. I use this framework to examine and understand the different dynamics of the factors that promote NPO effectiveness on the social aspects of well-being for individuals.

Most often, NPOs work on exigent problems that are contemporaneous in nature;

Complexity Theory allows for a review of NPOs’ processes and provides a lens for examining the lived experience of food desert residents and how they achieve well-being.

Food deserts are complex environments (Abel & Faust, 2020; Sadler, Gilliland, & Arku,

2016; Slater, Epp-Koop, Jakilazek, & Green, 2017), understanding complex systems helps to analyze a resident’s response to their external and internal environment. It helps to critically review the relationship between the environment and the social aspects of well-being. It provides important contextual information on how social interactions or lack of affect a resident’s well-being. It also presents some fundamental ideas underlying 30

how to analyze any emergent behavior of food desert residents, revealing social complexities within the qualitative data analysis (Sager & Andereggen, 2012).

CHAPTER 3: WHAT FACTORS INFLUENCE A FOOD DESERT RESIDENT’S WELL-BEING? (STUDY 1)

Does anybody really care? Do they? We’re here suffering and all we’re asking is that you listen to us. — Mary Bell, food desert resident (Vaughan & Owens, 2015)

Preface

The initial component of this research examined the daily lives of food desert residents. I used Grounded Theory (Charmaz, 2014; Charmaz & Belgrave, 2015; Strauss

& Corbin, 1997) to understand their life by asking questions about their experiences, thoughts, and feelings. I interviewed residents of food deserts to better comprehend the challenges of residing in a food desert and to gain insight into how these challenges can be mitigated within the U.S. This knowledge could better equip nonprofit organizations

(NPOs) to help food desert residents achieve well-being. The findings from this study led to the exploration and research question of my second study.

Introduction

In recent years within the U.S.—often referred to as the “land of plenty”—the paradox of food deserts can be found across a broad spectrum of communities. Residing within a food desert can challenge residents’ daily lives to achieve well-being (Bublitz,

Hansen, Peracchio, & Tussler, 2019). I was motivated to conduct this study because food deserts seemed to be an anomaly, especially when you consider their occurrence within the U.S., the largest economy in the world. At the time of this writing, the U.S. has a nominal gross domestic product (GDP) that accounts for one-fourth of the world’s economy (bea.gov). And yet, food deserts are prevalent in the world’s richest country

(Beaulac et al., 2009; Hamidi, 2020; Hossfeld, Kelly, & Waity, 2018; Walker et al.,

2010). This seeming paradox led me to investigate how residents of food deserts live their daily lives and understand how they achieve well-being given the challenges experienced in these environments. Alston (2020) found that residing in a food desert can have negative socio-economic and health outcomes of living there.

Mary Bell,1 a lifelong resident of Hampton, Virginia, lives in a food desert

(Vaughan & Owens, 2015) and is among the 23.5 million people who reside within an area either lacking or devoid of fresh foods (USDA, 2011). Ms. Bell has lived most of her life within her community, and she struggles to find fresh foods to feed herself and her grandchildren. The neighborhood in which she raises her grandchildren is quite different from the one Ms. Bell experienced during her youth. Ms. Bell laments, “we need more grocery stores in these neighborhoods … It used to be where we had grocery stores right around the area, where we could walk out not even three blocks and get to the grocery store, now there’s a convenience store on the corner where we use to have a supermarket”

(Vaughan & Owens, 2015). Moreover, she struggles with health ailments that have forced her to walk with a cane. Ms. Bell’s low income restricts her ability to purchase a car; therefore, she relies on public transportation to get to the nearest supermarket that offers nutritional foods for her family. The carfare used for her shopping trips depletes her already stretched budget, and her shopping trips are too few, given her limited mobility. Ms. Bell must rely on convenience stores located within walking distance to her home to feed her family. Convenience stores offer little to no fresh foods for their patrons, and if nutritional foods are offered for sale, the price tends to be expensive or

1 Name changed to protect identity. Ms. Bell’s thoughts and experiences are featured in the Living in a Food Desert documentary by Vaughan and Owens (2015). 33

have higher food prices than supermarkets (Block & Kouba, 2006; Bodor et al., 2008;

Chung & Myers Jr, 1999; Laska, Borradaile, Tester, Foster, & Gittelsohn, 2010).

Residents of food deserts, without a means of transportation, have a poor variety of food vendor options, such as convenience stores, fast-food restaurants, or gas stations (Beaulac et al., 2009; Cummins, 2014; Lucan et al., 2020).

Ms. Bell’s story gives awareness to challenges of those individuals living in a food desert, as they often lack the time and money (Allcott, Diamond, & Dubé, 2017;

Gordon et al., 2011) to make timely trips (Blanchard & Lyson, 2002; Dutko, Ver Ploeg,

& Farrigan, 2012) to supermarkets and tend to rely on foods that are readily available to them within walking distance (Gordon et al., 2011; Widener et al., 2017; Widener &

Shannon, 2014). There is a strong connection between a food desert food environment and health outcomes (Courtemanche & Carden, 2011). This is because foods that are available in food deserts are mainly processed foods with additives (Walker et al., 2010).

While this allows for a longer shelf life, these foods generally include too much sugar, salt, and fat (Seymour, 2017). The consumption of processed foods from convenience stores and fast-food restaurants, while inexpensive to purchase, comes at the steep cost of poor nutrition (Allcott et al., 2019; Ver Ploeg et al., 2009). A poor diet, is often linked to malnutrition, obesity (Alston, 2020; Chen, Jaenicke, & Volpe, 2016), cardiovascular disease (Kelli et al., 2017), diabetes (Berkowitz et al., 2018), and hampered well-being.

One major consideration for this dissertation is the construct of well-being. I choose well-being to examine and understand a food desert resident’s self-reporting on their health, relationships, life satisfaction, and happiness. With all of the challenges that residents like Mary Bell encounter in their daily life, I sought knowledge on the direct

and moderating factors that influence a food desert resident’s well-being. I did this to clarify the role nonprofit organizations (NPOs) can play in helping influence these range of factors.

The literature has drawn considerable attention from NPOs, policymakers, and academia as food deserts are more prominent in low-income, low-access areas. This means there is a lack of fresh foods available, and there is an overabundance of fast-food restaurants within these areas. Further research is needed on this topic (Beaulac et al.,

2009; Gordon et al., 2011; Walker et al., 2010) given the severity of the implications such as lack of access to healthy fresh foods, the side effects of illnesses and disease when one lacks a healthy diet, and diminished well-being due to social isolation (Leigh-Hunt et al.,

2017; Zavaleta, Samuel, & Mills, 2017). While much of the available literature focuses on food environment (Cummins & Macintyre, 2006; Glanz, 2009; Lake & Townshend,

2006; Yang, Wang, & Qiu, 2020a) and lack of access to healthy foods (Walker et al.,

2010), few studies examine the people living in food deserts. There is a need to examine those who live in food deserts, specifically those trying to achieve well-being.

Research Question

Grounded Theory (Charmaz, 2014; Corbin & Strauss, 2015; Glaser & Strauss,

2017) was used to investigate and better understand a food desert resident’s lived experiences and what influences their well-being. By doing so, I was provided a foundation on understanding the daily life experience of food desert residents. This allowed for an understanding of the factors that challenge or positively support a resident’s well-being. This knowledge provided greater insight into how nonprofit organizations (NPOs) might help food desert residents, given the challenges they face on

a daily basis. This is shown in Figure 4. Consequently, the research question for Study 1 is: What factors influence well-being in residents of food deserts?

Thompson, Smith, and Cummins (2018) state that lack of access to food, a point of issue for food desert residents, contributes to hypertension and liver disease having a negative impact on an individual’s health and well-being. Thompson et al. (2018) also state that well-being challenges exist within low-income, low-access neighborhoods, such as food deserts, these challenges “are perceived by both experiencing them and the health and social professionals who treat them” (p. 1). Mobility plays a significant role in a food desert resident’s access to food (Chen & Kwan, 2015; Coveney & O’Dwyer, 2009; Dutko et al., 2012; Shannon, 2015). As a result, food residents with poor mobility experience social isolation (Preston & Rajé, 2007). This is a substantial consequence of residing in a food desert because an individual’s social interaction with others positively influences their well-being (Allen & Farber, 2020; Appau, Churchill, & Farrell, 2019; del Río &

Alonso-Villar, 2014).

The challenges and daily life experiences of residing in a food desert are captured in Figure 4. The factors in Figure 4 show the complexity of residing in a food desert.

Complexity Science provided a way to understand the systems that make up a food desert and the factors of residing in one. Each of the components interacts with each other creating layers of complexity. For example, a food desert resident’s limited mobility crosses over to influence their access to food and dietary habits. It also interacts with a food desert resident’s socio-economics as they might have limited or no transportation to seek employment or travel to a job. By using Complexity Theory, I can understand all of

the smaller systems of a food desert, which lends to understanding food deserts as a larger system.

Figure 4: Food Desert Experience

Photograph by Audra Melton, Source: Burns (2014).

Literature Review

Both Social Cognitive Theory and Motivation Theory are used in Study 1 (and

Study 2) to understand the lived experiences of food deserts and provide a better enucleation of the data. I decided to take a deeper dive into SCT for Study 1 (and Study

2) because it helps identify and understand a food desert resident’s reaction to the external influences of a food desert environment. The use of SCT, coupled with

Complexity Theory, also provides insights into the causalities of residing in a food desert.

Motivation Theory added another layer of understanding of a resident’s belief system and

drivers while residing in a food desert. Using this theoretical framework, I intended to identify factors that influence a food desert resident’s well-being. By understanding this knowledge, those who try and help residents of food deserts are better equipped to have a successful social impact within these areas.

Social Cognitive Theory

Social Cognition Theory (SCT) is defined as a theory of human behavior with erudition stemming from a social context. SCT stems from three factors that influence human functioning: behavioral, environmental, and social (Bandura, 1986). Schunk and

Usher (2019) state, “Social Cognitive Theory emphasizes the idea that much human learning and behavior occurs in social environments. By interacting with others, people acquire knowledge, skills, strategies, beliefs, and attitudes” (Schunk & Usher, 2019: 11).

The main constructs of SCT are self-efficacy and motivation (Stajkovic & Luthans,

2002). This theory was used as a lens during the research to examine the lives of individuals residing in a food desert. Stajkovic and Luthans (2002) mention the importance of Bandura’s interpretation of SCT, “…the core of SCT: 1) Symbolizing, 2) forethought, 3) vicarious learning, 4) self-regulation and 5) self-reflection” (p. 126). As self-efficacy is equated with self-esteem, the SCT lens was important to use in this dissertation to evaluate a person’s statement of self-worth and happiness to understand their well-being.

The use of an SCT lens was also imperative to review an individual’s motivations while residing in a food desert (Stajkovic & Luthans, 2002). SCT is exigent in this dissertation because it provides a background on understanding behavior at the individual level (Glanz, Rimer, & Viswanath, 2008). This translates into being able to understand

the perspectives of food desert residents when they express their thoughts about residing in food deserts. SCT allows for the interpretation of how food desert resident’s behavior is influenced by their environment (Baranowski, Perry, & Parcel, 2002; Kelder,

Hoelscher, & Perry, 2015).

Motivation Theory

In this dissertation, I used Motivation Theory because it helped me understand decision-making during the challenges food desert residents face in their daily lives

(Braver et al., 2014). Graham and Weiner (2012) state Motivation Theory allows for the study of an individual’s behavior, mainly why individuals behave a certain way and what triggers, directs, and either sustains or ends the behavior.

Motivation Theory is a concept that refers to the external and internal factors that prod an individual into action (Locke & Latham, 2004). According to Locke and Latham

(2004), motivation allows for the procurement of new skills that allow for three types of action, “direction (choice), intensity (effort), and duration (persistence)” (p. 388). This translates into understanding the factors that help food desert residents achieve well- being by exploring the choices they made in food purchases, the effort residents made to travel to a supermarket outside of their neighborhood, and the persistence to socially engage with others at these supermarkets.

By using Motivation Theory, I was able to interpret motivational factors of a food desert resident’s food choice (Kaya, 2016) and understand the underlying triggers for a resident’s food preference (Köster, 2009; Singer, Vasco, Parmesan, Thomas, & Ng,

1992). By using both Motivation Theory and Social Cognitive Theory, I was better positioned to gain knowledge on how food desert residents process their environment, set

and achieve goals (Schunk & DiBenedetto, 2020), and learn (Gopalan, Bakar, Zulkifli,

Alwi, & Mat, 2017).

Research Design and Methodology

Methodology

Grounded Theory (Corbin & Strauss, 2015) was used to conduct this research.

The purpose of this qualitative approach is to understand the phenomenon of the well- being of residents of food deserts via semi-structured interviews with individuals who live in areas classified or experienced as food deserts. This was done by asking questions that prompt the individuals to speak about their lived experience (Glaser & Strauss,

2017).

Sample

This research conducted interviews with 20 individuals who have lived within a food desert in New York City (Appendix B) and within Orange County, New York

(Appendix C) for longer than six months; people living in a homeless shelter were excluded. Orange County, NY, is located between 50–100 miles north of New York City and is considered part of the greater metro area of New York City. Table 2 highlights the demographics of the sample.

Table 2: Summary of Interview Sample: Overview of the Target Diversity of the Sample

Gender White Non-White Location: NYC Orange County, NY

Male 3 7 4 6

Female 2 8 4 6

Total 5 15 8 12

Data Collection

Data was collected by reaching out to nonprofit organizations (NPOs), food banks, and city government departments to obtain information on potential interview candidates. Potential candidates were initially contacted in person, by telephone, or via email. I conducted some interviews at Harlem Grown (harlemgrown.org), an NPO located in Harlem, New York City. Harlem Grown is an urban farm that holds volunteer and gardening sessions for residents from throughout New York City.

The data collection started in July 2017, with interviews continuing throughout

November 2017. Interviews were conducted in person. All subjects were advised of strict precautions to protect their privacy, and they were also asked to sign a form agreeing to participate in the interview. Each interview was audio-recorded. All participants were informed that they could exit the interview at any given time and that all of the data collected would be kept confidential.

Interviews lasted approximately 60 minutes and were conducted in a conversational format—this format allowed participants to share lived experiences related to the research topic. Before any recordings were conducted, participants were informed of the protocol of the interview. After that, the interviewees indicated they understood the protocol and signed an authorization form. Once signatures were obtained, the interview began.

Recordings are stored in a password-protected computer, and the interviews were transcribed. All transcribed records and recordings of the interviews will be destroyed no later than six years after being captured. The research was conducted in accordance with the Belmont Report (United States National Commission for the Protection of Human

Subjects of Biomedical and Behavioral Research, 1978); all research plans were submitted in advance to the Institutional Review Board of Case Western Reserve

University.

Data Analyses

Data analysis began during the first interview and continued throughout the data collection period. It began with initial coding, a cycle of coding in which data is grouped and examined closely for differences (Saldaña, 2016). Next, theoretical coding was used to identify all of the codes and themes. Finally, axial coding, explored how all of the codes related to one another which enabled me to derive meaning and analyze the findings (Saldaña, 2016). The movement between data coding and reviewing literature was a developing process, which forced me to remain flexible and open throughout the research.

Findings

By using Complexity Theory in my dissertation, I was able to accurately observe how food desert residents grappled with residing in a food desert and all of the complexity that entails. A Complexity Theory lens provided a way for me to understand that a food desert is a system comprised of many other complex systems. Most importantly, Complexity Science lends itself to understanding human systems (Kern et al., 2019). This allows for the understanding of the mechanisms underlying human development. Complexity Theory helped identify the key variables affecting food desert residents in regard to their ecosystems, the organizations that serve them, and their built food environments. The findings in this study provided a foundation to ascertain the complexities of living in a food desert and how residents achieve well-being. Individuals

who reside in food deserts experience complexity due to the multiple systems that comprise these areas, such as social systems, a network of relationships among individuals, groups, and organizations (Luhmann, 1995; Schweitzer, 2002); food systems

(Appendix E); infrastructure systems (Mihyeon Jeon & Amekudzi, 2005); health care systems (Aron, 2020, Chapter 1: 3-19); economic systems (Helbing, 2009; Holling, 2001;

Schweitzer, 2002); political systems (Cairney, 2012); and education systems (Mason,

2008; Osberg & Biesta, 2010). Through my data analysis, concepts and frameworks emerged to understand how food desert residents achieve well-being. Reviewing the data through a complexity lens helped me interpret the responses of food desert residents on how they feel about their environment and if it produces any of their consequent behavior. Study 1 found four emerging themes based on the lived experience of residents.

Finding 1: A food desert environment influences a food desert resident’s food choice.

 Out of 20 respondents, 17 did not report the purchase of healthy foods such as fruits and vegetables.

 Food desert residents are constrained when it comes to purchasing healthy and affordable food.

 Residents are influenced by their local food environment; whose factors influence their food shopping decisions.

I used Social Cognitive Theory (SCT) to uncover my first finding: Consistent with prior research, food environments influence a food desert resident’s food purchases

(Larson et al., 2009; Walker et al., 2010). This dissertation defines fruits and vegetables as healthy and nutritious food. To learn more, I then examined a resident’s perceived availability of neighborhood food stores, their food purchases, and consumption of foods to understand their diet. Food deserts tend to be in low-income, low-access areas where

the demand for healthy foods is low but tends to increase when income levels increase

(Bitler & Haider, 2011). Therefore, this finding examines the absence of any purchasing or statements about consuming fruits and vegetables as an indication of a poor diet. The absence of these statements during the interviews is substantial and confirmed findings that there is a lack of access to healthy and affordable foods within food deserts. Below are selected quotes from food desert residents concerning their choice of foods.

Respondents were asked about what they ate for breakfast, lunch, and dinner.

[Breakfast] Eggs, cakes, hotcakes, and biscuit with egg and cheese. Affordable, accessible, within reach, McDonald’s. (01)

[Lunch] Regular sub sandwich. It’s affordable. It’s fresh. It’s delicious, purchased from Quick Chef. [The respondent stated food from Quick Chef, a convenient store, was] ‘nutritious’ and ‘affordable.’ (01)

[Dinner] Take out Chinese. Pork fried rice with vegetables on the side. (01)

[Breakfast] I only eat McDonald’s. (02)

[Lunch] I didn’t eat lunch. (02)

[Dinner] I made ribs. (02)

[Lunch] I ordered from Chicken [name omitted]. I had a choice of that or getting something more unhealthy because even in the neighborhood, there’s not many healthy spots. At the time, that was the healthiest thing I had to eat. There’s [name omitted], which is like the worst fast food place in the world as far as grease and just all-around nastiness. It doesn’t taste terrible, but it’s just very bad for you. I don’t think they change the oil ever. (05)

Finding 2: Social interaction with others improves a resident’s well-being. Food Desert residents want to engage with others and have the freedom to form these relationships. They also want a quality of life.

 Respondents traveled to supermarkets to socially engage with others.

 All respondents reported long commute times to supermarkets to purchase foods that were not available in their neighborhood: residents traveled to supermarkets for variety or freedom of choice, and for better quality and affordable foods. 44

Both SCT and Motivation Theory were used to understand the relevance of a food desert resident’s actions for social connectedness. Using Motivation Theory provided a lens to measure how residents satisfy their needs and wants (Taormina & Gao, 2013). I used SCT to gain greater insights into how social connectedness impacts a resident’s well-being by mitigating their loneliness (Satici, Uysal, & Deniz, 2016) and stress

(Uchino, 2006). This emergent theme is the idea that social connectedness is important to a food desert resident’s well-being. This finding is noteworthy in understanding the role that social aspects of a resident’s life play in regard to their well-being. Serino, Morciano,

Scardigno, and Manuti (2012) state that addressing an individual’s well-being is complex due to its multifarious nature. These authors also state that well-being is influenced by a

“collective life” that involves “social connectedness” (Serino et al., p. 2). Using a complexity lens provided an acumen in connecting the dots between all of the facets of a resident’s social life and their well-being. Stiglitz, Sen, and Fitoussi (2009) assert that social connectedness and relationships are important to an individual and should be considered one of the dimensions for quality of life alongside other indicators like health and environment, to name a few.

Residents also traveled to supermarkets to improve their quality of life by having the freedom to choose from a variety of products. Residents of food deserts traveled 20 to

40 minutes each way to buy groceries and other products on these trips. Some of the drivers of such commutes are that people wanted quality, choice, or lower price points when making their purchases. All interviewees mentioned a commute time of at least 20 minutes and emphasized pricing in terms of a product being “too expensive” or “it’s cheaper.” Fourteen out of 20 interviewees mentioned the terms “quality” or “variety”

during their interviews. This study found that residents of food deserts placed high regard on having a variety of products to choose from while making their purchases. Also, they traveled to markets that offered better quality products at lower price points. The following selected quotes from food desert residents discuss their experiences and thoughts about their access to food and why they commuted to supermarkets.

There isn’t a single supermarket in Long Island City! (Participant 12)

Could I walk there [to a supermarket]? You could. Would I want to? No. Because it would take a super long time and it’d be like really tiring. And plus, carrying the groceries on the way back! (Participant 16)

[When asked about the details of traveling to and from a supermarket on a bus] I could take three [shopping bags of food]. I could, so with like two, I normally stand near the door and put two in between my legs, and if I had a third one, I just hold the one. (Participant 07)

The variety and quality. A lot of the supermarkets in my area, they don’t have the best quality stuff or even really meat. And they don’t have a wide variety. I’m a person that likes a lot of variety. I like things I can’t find everywhere [in respondent’s neighborhood]. So I go [travel] to Shoprite, which is about 17 miles away. (Participant 09)

Aldi’s because of the prices and the food is good. They’re lower price and Shoprite are a little higher, but they have more products. If you need something different for your cooking, Shoprite would probably have it. (Participant 03)

Meaning the produce was never really good. It’s not fresh produce or it was beaten around. It’s just the variety. Okay this is four things we have as opposed if I went to the Upper East, these are 10 things we have. The meat was horrible; the quality was not good. That’s the point, it makes sense because it was cheap, but you knew that this was the bottom of the barrel. The neighborhood I lived in, I was aware of the fact that there was not a lot of choice. The bodegas were…. I guess all bodegas are pretty gnarly. (Participant 04)

The neighborhood store is down the street. It’s about a five-minute walk. You just buy stuff that you would need as far as canned food if you want, or if you want some water. It’s nothing really substantial. You can’t get a real meal from there. (Participant 05)

There’s transportation but it’s not affordable and it’s not accessible 24/7, people spend a lot on taxis. (Participant 01)

There’s a lack of transportation out here. Like, there’s no constant running buses, or cabs are too much money from here to there. So it’s a lot harder to get around out here. (Participant 02)

There’s no transportation system and it’s always hot in Florida. I would have to walk everywhere to get the food and I would be limited to Wendy’s and Taco Bell down the street. If I had to take a taxi, [to go to a supermarket] I couldn’t do that because that’s too expensive, every day to pay for that? (Participant 05)

Finding 3: Respondents did not practice meal planning before purchasing a meal or food from a supermarket resulting in poorer diets.

 Out of 20 respondents, 17 reported they did not plan their meals or food purchases.

I also used SCT to understand food desert resident’s dietary behavior; SCT helps explain a resident’s self-efficacy and health beliefs (Bandura, 1998). This theme shows that since there was a lack of meal planning behavior, food desert residents had poorer diets. According to Hanson et al. (2019), individuals practicing meal planning have a greater consumption of fruits and vegetables in their diet. This is noteworthy because meal planning, as an indicator of home food preparation, also indicates healthy eating (de

Camargo, Botelho, Dean, & Fiates, 2020).

One commonality throughout this study was that meals were not planned, with 17 interviewees mentioning they did not plan their meals and ate what they felt like eating when they were hungry while at the market or food venue. These 17 respondents answered that their meals were “spontaneous.” One respondent stated, “Like I said, I eat based on whatever I have a taste for.” Another respondent explained how she selected the foods she had eaten that day, “I was craving it [for breakfast]. At the last minute, it was in

the morning. I asked my husband to pick up the bacon because that was a very, very vital part of the sandwich. My husband and I both craving Bonchon [Korean fried chicken for dinner], so we ordered it.”

However, three interviewees mentioned they planned their meals due to health- related issues (i.e., diabetes, heart disease, and high cholesterol). In these instances, the interviewees deliberately planned their meals to maintain a healthier lifestyle.

Finding 4: Respondents preferred to food shop at a supermarket versus online.

 Out of 20, 16 respondents reported making food purchases at brick and mortar stores versus online.

Motivation Theory was used to understand why food desert residents choose to make lengthy trip to supermarkets versus shopping online. Motivation Theory provided a way to determine the drivers of food desert residents’ food shopping behavior. This finding indicates that food desert residents prefer to shop at supermarkets. The residents who made purchases online did so to buy products and foods not offered within their communities and for convenience. Four interviewees referred to purchasing items online; a few key statements are noted below. This is significant, given the fact that those living in food deserts lack access to supermarkets that offer fresh foods and shopping online for food could help mitigate this problem. Food desert residents preferred shopping at supermarkets because of the social benefits that come with it.

My groceries two days ago purchased online, Fresh Direct, sent to my house…we bought regular groceries … I don’t know, the convenience is that I can do it ahead of time and just prepare…especially if I can do it online. (Participant 18)

They don’t have any retail stores [within their neighborhood] and I don’t think anyone else offers that service… things like, you know electronics. Yeah, that I’ll buy online. Or things like parts for a car or things that are mechanical. (Participant 11) 48

[In response to why they shop online versus their neighborhood] It’s still very industrial, very commercial…there is no supermarket or pharmacy actually… but I know it’s not always going to be like that. I’m hopeful. (Participant 13)

[Regarding shopping for food online and how it’s cheaper] Now that Amazon bought whole foods, they said that they’re going to reduce the price, that what Amazon does—the fixed prices. (Participant 04)

Discussion

These findings are noteworthy as they shed light on the fact that those who live in food deserts are willing to travel an average of up to a 40-minute each way to engage in decision making about their purchases, having more than one product to choose from, and benefiting from the opportunity to socialize with other people. The literature indicates that food shopping is also about social connectedness:

Human behavior is creative and highly unpredictable. People do not necessarily shop for food at the nearest food store. Some people travel farther distances for food because they receive better value, higher quality, and more selection. Moreover, shopping is a social experience. It involves human interaction… (Adams, Ulrich, & Coleman, 2010: 60)

By traveling to markets outside of their neighborhoods, residents of food deserts are setting out to improve their overall sense of well-being. A food desert resident improves their well-being because these trips can provide a resident with “basic material for a good life, health, security, good relations, and freedom of choice and action…”

(Hamann, Biggs, & Reyers, 2016: 3). While those of limited means may have fewer choices on employment opportunities or geographical locations where they can reside, by traveling to markets they can still have the freedom of choice of which products and foods they choose to purchase and at which venues they make their purchases. The more vulnerable a resident is within a food desert, the more likely they will have less freedom 49

of choice as they might make all of their purchases within their neighborhood. As

Hamann et al. (2016) state, “the poorer and most vulnerable sectors of society are dependent most on their immediate natural environment to meet their basic needs” (p. 7).

Food desert residents also travel in search of a variety of better quality products and stores that may offer a lower price point than the products in their immediate neighborhood. The findings also suggest that residents who reside in food deserts do not plan their meals when purchasing their foods, regardless if they are shopping within their neighborhood or if they have traveled to a market outside of their neighborhood. Lastly, the findings also suggest that online shopping might fill the gap for purchasing items not available within food deserts. Those who live in low-income, low-access areas still seek and require a level of quality in their products and could shop online to fill this gap if they are unable to travel to a retail venue or find a product within their neighborhood.

Food desert residents who lack the ability to choose their foods or are unable to purchase preferred foods due to lack of availability may have a lower sense of well-being

(Suter, 2008). Those who reside in food deserts and deliberately engage in decision- making about their foods and other products are actively improving their well-being by increasing their sense of freedom of choice and actions. Residents of food deserts may also increase their well-being by increasing the variety of foods they choose from when purchasing their groceries. The role food plays in one’s health is imperative; however, the thinking of food as more than health and as a greater role it plays in one’s well-being is significant to those residing in food deserts. The access to availability and variety of food at the other markets increases a food desert resident’s food knowledge and socialization

(Block et al., 2011). Therefore, food can serve as a catalyst for improving a food desert

resident’s sense of well-being via food well-being (FWB), defined as “positive, psychological, physical, emotional and social relationships at both the individual and societal levels...FWB is necessarily influenced by the cultural, environment, and legal factors that governs people…” (Block et al., 2011: 1).

This research data shows how residents of food deserts who are able to purchase outside of their neighborhoods better control their consumption and behaviors by deliberately choosing where to purchase their foods and other products. If these residents are forced to shop within their neighborhoods, food deserts offer little to no availability and direct the residents’ consumption behavior. Therefore, these residents could suffer from a diminished sense of well-being. According to Durayappah (2014):

The needing classification of SWB [Subjective Well-Being] purports that a set of elements that every human needs, regardless of his/her values, is essential to attaining subjective well-being. Maslow (1943) suggested that a hierarchy existed of five levels of basic needs—starting from physiological needs, safety, love/affection, self-esteem, to self- actualization—that must be satisfied in order, one after another. Wilson (1967) suggested basic universal needs exist; the prompt fulfillment of those needs causes happiness while the needs that are left unfulfilled result in unhappiness. (p. 6453)

If you put this reference into the context of a food desert, the fulfillment of basic needs is a major goal for residents. Ahmed, Bwisa, Otieno, and Karanja (2014) summarize this

“as a way of action that is necessary to achieve the main goal given scarcity of resources”

(p. 80).

This study shows that food residents will avoid shopping at their local markets if the produce and other foods are of poor quality. Contrary to research, food desert residents’ preferences for quality, variety, and pricing are on par with higher-earning consumers (Zenk et al., 2005). Food deserts are simply more complex and should be

viewed as a complex problem that needs to be studied from a variety of different lenses.

For example, many individuals from my sample shopped for their meals at Bodegas

(Appendix F). Bodegas are convenience stores throughout New York City where residents can buy basic staples but rarely fresh foods. In East and Central Harlem, they are a primary source of food for neighborhood residents (Shirazi, 2016). As such, “only

2% of Central Harlem Bodegas, and 4% of East Harlem Bodegas carry leafy green vegetables” (Shirazi, 2016: 1). New Yorkers who reside within food deserts and who are not able to take or afford public transportation rely on Bodegas and other fast-food stores for their food purchases. The well-being of these individuals could be improved if

Bodegas offered a variety of quality fresh, healthy foods at affordable price points

(Dannefer, Williams, Baronberg, & Silver, 2012; Hilmers, Hilmers, & Dave, 2012;

Karpyn, McCallops, Wolgast, & Glanz, 2020; Thompson & Porter, 2015).

By reviewing the research via Social Cognitive Theory (SCT), the findings are those residents who are able and willing to travel to a market place outside of their neighborhood may have a higher sense of well-being given they have the forethought and self-regulation to plan their trips (Stajkovic & Luthans, 2002). According to Stajkovic and Luthans’ (2002) studies on SCT, “self-regulation and reflection, self-efficacy is defined as an individual’s belief (or confidence) about his or her abilities to mobilize motivation, cognitive resources, and courses of action needed to successfully execute a specific task within and given context” (p. 126).

Those individuals residing within food deserts are motivated to travel and carry out a positive approach to counter living within a food desert. This improves well-being, which can improve these resident’s self-confidence. Bandura (1986) suggests people are

motivated by their own belief in their ability to control their actions. People who travel to make purchases for variety, quality, and lower price points act out of motivation

(Stajkovic & Luthans, 2002) to control their environment and gain freedom of choice.

These individuals exemplify the relationship between human action and environmental outcomes (Stajkovic & Luthans, 2002). Those who traveled to markets outside of their neighborhood also show a self-regulatory capability; they are going against the restrictions of what is available to them within their neighborhood and taking measures to buy what they want and need outside of their neighborhood (Sparks, Bania, & Leete,

2011).

Residents of food deserts who travel to make their purchases are also exhibiting intrinsic motivation toward achieving well-being. These individuals are performing “an activity in order to attain some separable outcome…which refers to doing an activity for the inherent satisfaction of the activity itself” (Ryan & Deci, 2000: 71). In the instance of residents of food deserts, the behavior of traveling to markets is prompted by the lack of products available to them within their neighborhoods. The act of traveling is part of the process of their preferred outcome via their motivated self-determination.

Implications

Academic Implications

 SCT can review the lived experience of those individuals in a food desert. SCT defines human action is caused by three factors: behavior, cognitive and other personal factors, and the person’s external environment (Miles, 2012). This research finds that those who live in food deserts make spontaneous food purchasing decisions while making purchases within their neighborhood and the markets they travel to. Those who live in food deserts are motivated to travel from their neighborhoods, an average of 20 minutes, to shop at markets that offer a variety of products and lower prices. My research also shows that individuals residing within a food desert are very much aware that there is a

lack of markets to complete their purchasing needs within their geographical location.

 This research will help define food deserts and further research to claim the existence of food deserts. More research on the topic of food deserts can provide an understanding of how they come about and the solutions needed to prevent them. Nonprofit organizations (NPOs) will benefit from more research as they can help tackle the issue of food deserts and assist individuals within these geographical areas and help bridge the subject of food insecurity.

Practitioner Implications

 Any non-profit that aims to improve the social inclusion aspects of low- income, low-access communities would benefit from reading research on food deserts. Therefore, health practitioners can review research on food deserts given the health implications associated with living in these types of neighborhoods. Obesity, the high rate of diabetes, and malnutrition are part of a poor dietary pattern followed by those individuals living in food deserts. Health practitioners can turn to food desert research in hopes of improving these types of patterns. All practitioners interested in food environments, whether be it from a food business, an agricultural business, or government policymaker involved with food systems, will also benefit from any various research conducted on food deserts.

 Research on food deserts focuses on geographical location and the proportion of low-income, low-access households in regard to racial demographics. The research concludes that many food deserts tend to be in low-income areas that are predominately inhabited by African-Americans. Much of the research finds low-income geographical locations to be food deserts, and they have fewer supermarkets per capita. (Block & Kouba, 2006)

 This research focuses on the geographical location to supermarkets and that those living in areas considered food deserts have limited access as they are further away from supermarkets (Zenk et al., 2005). This research study finds that there is diversity present in food deserts, and while many residents are minorities, not all are. Not all minority residents of food deserts are low- income. This study also finds that regardless of demographic background, most residents seek variety, quality and lower price points when making their purchases

Future Research

Regardless of the numerous articles and noteworthy media attention the subject of food deserts has gained within the last three decades, there is some that debate whether

food deserts exist given the lack of clarity of the terms that describe food deserts and food access (Bitler & Haider, 2011; Jiao, Moudon, Ulmer, Hurvitz, & Drewnowski, 2012;

Smoyer-Tomic, Spence, & Amrhein, 2006). Based on these gaps in existing research and on the findings in Study 1, further research is needed:

 Nonprofit Organizational Effectiveness: Future research is warranted on the effectiveness of nonprofits from the perspective of food desert residents. This can help understand gaps in service delivery of programs. Nutritional hunger causes psychological and emotional stress, thus having a negative impact on well-being. Knowledge of a food desert resident’s social aspects of well-being would position NPOs to have a greater social impact within food deserts.

 Innovation: Future research needs to be explored on what role technology can play in the solution to food deserts. Online shopping should be researched within food desert communities to understand how it is being utilized and how it might help deliver products usually unavailable within these neighborhoods. Research should also explore how social innovation can identify and remediate food deserts. Research should also explore how disruption innovation can tackle the phenomenon of food deserts by creating new markets to address the needs of those living in these types of neighborhoods.

CHAPTER 4: ARE NONPROFIT ORGANIZATIONS EFFECTIVE IN HELPING FOOD DESERT RESIDENTS ON THE SOCIAL ASPECTS OF WELL-BEING? (STUDY2)

Too often, nonprofits are viewed as rigid and bureaucratic—less nimble and capable of adapting in this fluid environment than our corporate counterparts. I don’t agree. — Anna Maria Chavez

Preface

In the first study, I found that the social lives of food desert residents played an important role in their well-being. For this study, I built on that by using a quantitative approach to understand if food desert residents found nonprofit organizations (NPOs) effective on the social aspects of their well-being by using NPO effectiveness as a moderating effect on malnutrition, access to healthy food, and social interactions. Food desert residents were also surveyed to determine if malnutrition, access to healthy food, and social interaction affected their well-being.

Introduction

In 1992, the United States Department of Agriculture (USDA) began measuring food insecurity in response to the National Nutrition Monitoring and Related Research

Act (NNMRR) (USDA, n.d.). However, prior to the USDA’s measurement of food insecurity, nonprofit organizations (NPOs), such as food banks and church soup kitchens, were already servicing residents within low-income, low-access areas. Despite this, food deserts are still a challenging problem in the U.S. (Ver Ploeg, 2010), and gaining insights into how NPOs can increase their effectiveness in the delivery of services to food desert residents is imperative to help those in need.

In general, measuring the effectiveness of NPOs is a complex topic, and the criteria used to assess effectiveness vary among organizations (Herman & Renz, 2008). 56

However, most NPOs use nonfinancial indicators to measure their effectiveness. These measures include board relations, goal attainment approach, system resource approach, reputational approach, customer orientation, and quality of programs (Forbes, 1998). This study focuses on the delivery of services and the social impact of programs because these two measures will provide knowledge on how NPOs can help food desert residents with the challenges of residing in a food desert and with the social aspects of their well-being.

There is limited research on NPO effectiveness that can contribute to theory building and improved practices in the area of the social aspects of well-being in food deserts.

Improving the well-being of food desert residents means not only helping residents with access to basic needs but also providing residents with the opportunity to flourish

(Wiseman & Brasher, 2008) and live their best life possible. As there is a broad range of measuring well-being (de Chavez et al., 2005), Study 1 clarified the social aspects of one’s life improves a resident’s well-being: feelings of social connectedness, social inclusion, and being satisfied with one’s social network (Berkman & Glass, 2000;

Kawachi & Berkman, 2000). Thus, findings from Study 1 provided strong evidence that the social aspects of a food resident’s life was important to their well-being. By examining this positive correlation through a complexity lens, I was able to examine and understand all parts of the resident’s life that are interconnected with their well-being

(Bertin & Jensen, 2019).

In addition, there is a gap in the research in the perception of NPOs within food deserts. To fill this gap, my research examines how NPOs are perceived by residents of food deserts on whether or not NPOs have any influence on their well-being. My study will provide insights and knowledge building for improved practices of NPOs to help

food desert residents. Therefore, my research question is: Are nonprofit organizations effective in helping food desert residents with the social aspects of well-being?

Knowledge gained from this study will provide a conceptual framework for NPOs to measure the delivery of services and social impact. This chapter is organized by providing a theoretical framework and hypotheses, defining the research design, discussing key measures, reporting main findings, with a conclusion of implications, limitations, and a suggestion for future research.

Theoretical Background and Hypotheses

In order to examine nonprofit organizational (NPO) effectiveness within low- income low-access areas on a resident’s well-being, I tested a theoretical framework of direct relationships: Access to Healthy Foods and Well-Being, Malnutrition and Well-

Being, and Social Interaction and Well-Being. These relationships can be seen in Figure

5. I also tested for NPO Effectiveness moderation on the relationships between Lack of

Access to Healthy Foods, Malnutrition, and Social Interaction.

Figure 5: Theoretical Model

Problem of Practice

Lack of Access to Healthy Food

Included in the 2009 report to Congress by the Economic Research Service (ERS) at the United States Department of Agriculture (USDA) was a Food Access Research

Atlas (formerly the Food Desert Locator) (Ver Ploeg et al., 2009). The Food Access

Research Atlas is a mapping tool that provides information on geographical areas with limited access to grocery stores. Essentially, the Food Access Research Atlas provides a view of food deserts where residents are in poorer health due to their diet (Morris, 2013).

This is important because, according to Lucan, Karpyn, and Sherman (2010), the leading cause of disability and premature death is diet-related. Also, research indicates that the

farther individuals must travel to buy fresh, healthy foods, the less likely they are to have healthy foods in their diet (Stack, 2015). Further findings support the conclusion that individuals who consume less healthy foods tend to be in poorer health (Stack, 2015).

Beaulac et al. (2009) reviewed 49 studies that showed disparities in food access are dictated by income. Research indicates that food desert residents are greatly affected by diet-related diseases simply because they do not have access to or cannot afford healthy foods (Buila, 2011; Robert, 1998). Other literature reviews communities or environmental factors concerning food deserts and well-being. Residents of food deserts must rely on gas stations, fast food vendors, and convenience stores for most of their food purchases. In Study 1, New York City residents mentioned their corner store or bodega as their primary food market. Relying on these types of markets where 80-90% of the foods available for purchase are unhealthy (Stark et al., 2013) has detrimental health outcomes for food desert residents. Most food desert residents are unable to improve their diet because they simply cannot afford to purchase healthy foods at their local or distant markets (Black, Moon, & Baird, 2014; Haynes-Maslow, Parsons, Wheeler, & Leone,

2013; Lucan et al., 2010).

Understanding the food habits of food desert residents provides insights into how food affects a resident’s well-being (Grunert et al., 2007). Ares et al. (2016) carried out a study in yielding 1,382 participants on food-related well-being in seven countries: Brazil,

China, France, Portugal, Spain, Uruguay, and the USA. Ares et al. (2016) found that a majority of respondents claimed that food “is good for well-being” and that food “makes me feel good” (p. 66). There was a strong correlation between food which “is good for well-being” and “physical aspects of health” (Ares et al., 2016: 67). All of this indicates

that food desert residents who eat healthy foods will have improved health and well- being.

Access to healthy foods is defined as affordable, fresh, and healthy foods available for purchase within one mile of an individual’s home (Wang, Touboulic, &

O'Neill, 2018). Research suggests that poorer (low-income) neighborhoods are often devoid of supermarkets (Chung & Myers Jr, 1999; Kaufman, 1998). As a result, food desert residents have less access to healthy fresh foods due to the lack of markets that offer these foods for sale. If they are for sale, they are at higher prices and tend to be of poorer quality (Chung & Myers Jr, 1999; Hendrickson, Lave, & Matthews, 2006; Zenk et al., 2005). A resident’s low-income status and lack of transportation pose two more barriers to accessing healthy foods (Garasky, Morton, & Greder, 2006; Pucher & Renne,

2003). Additionally, the foods available tend to be unhealthy (Alcaly & Klevorick, 1971;

Blanchard & Lyson, 2006; Block & Kouba, 2006). These foods generally tend to be processed foods for longer shelf life and fast-food options. Numerous studies find that continuous consumption of processed and fast foods that are higher in sugar, salt, and fat lead to poorer health (Block & Kouba, 2006; Block et al., 2011; Gallagher, 2006; Lewis et al., 2005).

In contrast, the ability to shop for fresh, healthy foods at supermarkets is associated with greater access to healthier food options (Cheadle et al., 1991; Glanz et al.,

2007; Larson et al., 2009) and the ability to obtain a healthier diet (Beaulac et al., 2009;

Cheadle et al., 1991) with increased fruit and vegetable intake (Rose & Richards, 2004).

Communities with greater access to supermarkets also tend to have a lower prevalence of obesity (Inagami, Cohen, Finch, & Asch, 2006; Morland, Roux, & Wing, 2006).

A significant amount of research indicates health and place-based areas such as food deserts are correlated (Airey, 2003). Low-income, low-access areas tend to be cut off by a lack of infrastructure, thereby restricting residents’ mobility. When food desert residents are restricted from purchasing foods that benefit their health and provide a social outlet, their well-being is diminished. On the other hand, when they have access to healthy foods, their well-being improves. This leads to postulate the following:

Hypothesis 1. Lack of access to healthy foods has a negative effect on well-being.

Malnutrition

Malnutrition is defined as inadequate nutritional status due to an unbalanced diet

(Castillo et al., 2012). Food desert residents often suffer from the undernutrition of healthy foods and overconsumption of energy-dense foods. A diet consisting mostly of energy-dense foods will lead to health disparities (Castillo et al., 2012). Wells (2012) argues that obesity is one form of malnutrition influenced by one’s food environment.

Food desert residents often suffer from “hidden hunger,” which implies a chronic lack of vitamins and minerals in one’s daily diet (Biesalski, 2013, Chapter 2: 25-50). Stein

(2010) states that “malnutrition has a considerable negative impact on an individual’s well-being” (p. 45).

The U.S. has a complex food system (Appendix E). Food deserts are part of this complex food system due to their food-built food environment. The many components that make up a food desert resident’s food environment put a resident at risk for malnutrition and diminished well-being. For instance, the lack of supermarkets and access to healthy foods is one major component that influences a resident’s malnutrition.

On the flip side of this is the overabundant fast-food chains, foods found at gas stations,

and convenience stores. These statements are consistent throughout this dissertation because of the severity and implication on a resident’s well-being. Food desert residents are healthy food insecure, and with their micronutrient deficiency, they have more health issues that stem from malnutrition, such as obesity. Also, residents of food deserts often experience stress concerning accessing food either because of their income and/or geographical constraints (Bublitz et al., 2019). This stress, state Chilton and Booth

(2007), of “hunger in the body,” is tailgated by “hunger of the mind” preventing a person from thriving (p.120). Thus, I hypothesize:

Hypothesis 2. Malnutrition has a negative effect on well-being.

Social Interaction

A food desert resident’s limited mobility impacts their social network resulting in isolation. Research demonstrates that the absence of positive relationships in one’s life can be a risk for obesity and mortality (Cacioppo & Cacioppo, 2014). Obesity affects functional mobility, which further exacerbates food desert residents’ ability to participate in daily life activities (Forhan & Gill, 2013). Lack of social connections makes an individual feel sad, which translates into loneliness (Ryff & Keyes, 1995). The effects of loneliness can heighten one’s hunger and need for sugar intake due to human defenses to social threats (Cacioppo & Cacioppo, 2014). Residents of food deserts, who experience loneliness and lack transportation, will purchase foods within their neighborhood, most of which are processed or fast foods (Bitler & Haider, 2011; Chung & Myers Jr, 1999;

Macht, 2008; Mead, 2008). Furthermore, social isolation has negative impacts causing individuals to become less engaged, have fewer meaningful relationships in their life, and cause negative emotions (Cacioppo & Cacioppo, 2014). Therefore, I hypothesize:

Hypothesis 3. Social interaction has a positive effect on well-being.

Nonprofit Organizational Effectiveness

Although nonprofit organizations (NPOs) vary, a good indication of effectiveness is the measurement of delivery of services, including customer orientation and quality of programming. Within the context of food deserts, NPO efficiency amounts to providing programs that promote well-being. Understanding an NPOs capacity to build new processes to fulfil missions and goals is one aspect of increasing the effectiveness of

NPOs (Bryan, 2019). NPOs that provide healthy food to food desert residents provide a way for residents to become healthier. As there is a link between good health and well- being, I hypothesize:

Hypothesis 4. Nonprofit organizational effectiveness weakens the negative impact of lack of access to healthy foods on well-being.

Hypothesis 5. Nonprofit organizational effectiveness weakens the negative impact of malnutrition on well-being.

There are a multitude of NPOs that foster social interaction and well-being, for example

NPOs focused on the arts have had a strong history of bringing people together (Stern &

Seifert, 2017). Other examples of successful NPOs that create spaces for social connectedness, social networking, and improving a food desert resident’s well-being are urban food gardens, such as Harlem Grown (harlemgrown.org) mentioned in Study 1.

Therefore, I hypothesize:

Hypothesis 6. Nonprofit organizational effectiveness enhances the positive relationship between social interaction and well-being.

Research Design and Methods

Methodology

I carried out a quantitative psychometric study. The study design included an online survey consisting of 52 questions. The sample size of 392 respondents included food deserts within the U.S. The questionnaire allowed participants to self-report their demographic information, attitudes, beliefs, and feelings (Teddlie & Tashakkori, 2009). I utilized the Statistical Package for Social Sciences (SPSS) and Analysis of Moment

Structures (AMOS) software to conduct the analysis. The following sections detail the methods, sample, and statistical analysis.

Construct Operationalization

All measures were ranked on a 5-point Likert scale ranging from 1 = Strongly

Disagree to 5 = Strongly Agree. All constructs were tested in a q-sort and are reflective.

Dependent Variable

Well-being 5 (WELL). For this perceptual measure, a six-item scale from

Seligman and Csikszentmihalyi’s (2000) PERMA model included five core elements of well-being used as follows: Positive Emotions, Engagement, Relationships, Meaning, and

Accomplishments.

Moderating Variable

Nonprofit Organizational Effectiveness (NPE). A six-item scale to measure the effectiveness of nonprofit organizations (NPOs) was adopted by Epstein and McFarlan

(2011), Herman and Renz (1999), and Quinn and Rohrbaugh (1981). NPO effectiveness is multidimensional and can include a great variety of measures as the study evolves. For this study, the meaning is as such: flexibility regarding the continuum of building

relationships with stakeholders. It also means a focus on the emphasis on people’s well- being development encompasses the process of programs and positive outcomes of such programs.

Independent Variables

Access (ACC). This measure describes the associations between individuals and demographics in terms of restriction to food due to lack of money, transportation, and the inability to carry groceries (Burns, Bentley, Thornton, & Kavanagh, 2011). The six items were adapted from Burns et al. (2011). All six items were used within the survey.

Malnutrition (MAL). A six-item scale was used to examine a person’s diet which suffers from protein-calorie malnutrition (Coleman-Jensen, Rabbitt, Gregory, &

Singh, 2015). It is a measurement of food insecurity and malnutrition from a diet based on calorie-dense foods. A sample question from this scale is, “Does your household rely on foods from fast-food restaurants, gas stations, convenience stores/corner stores for your meals?”

Social Interaction (SI). This is a perceptual measure of feelings of connectedness. It also measures an individual’s social contact with others and social activities. The six items measured the pervasive social contact or communication and the participation in social activities or lack of. The scale was adapted by de Jong Gierveld,

Van Tilburg, and Dykstra (2006).

Control Variables

Education (EDU) (Control Variable). This reflective item determines which educational level was completed by the respondent by asking which grade the respondent had completed. The grades were measured as follows: (1) Less than High School, (2)

High School, (3) Some College, (4) 2 years of College (Associates), and (5) 4 years

(Bachelors) or above.

Income (control). An item was adapted from the United States Department of

Health and Human Services’ Office of the Assistant Secretary for Planning and

Evaluation Poverty Guidelines. The household measurement used in the survey as follows: (1) Below $10,000, (2) $10,000–$25,000, (3) $25,000–$39,000, (4) $39,000–

$118,000, and (5) Above $118,000.

Survey and Scale Development

For this study, I created a 52-question survey. First, the survey was set up within

Qualtrics and was pre-tested in two Q-sort rounds to test the quality of the survey. The first round included 23 individuals from my professional network; the Q-sort did not receive a minimum 60% placement rate. Thereafter, items of the original survey were deleted or amended. Next, another q-was conducted on 13 individuals from my professional network; this round received a 90% or higher placement rate. Thereafter, I finalized the survey and engaged my professional network for responses. The construct table for my study (Appendix H) was used to guide my data examination.

Data Collection

I collected data for this study from my professional network and the general population. The construct table for my study (Appendix H) was used to guide my data examination; my data was collected using the online survey Qualtrics software.

Sample Population / Demographics of respondents. A total of 392 respondents were obtained for analysis. Among the respondents, 29% had an income above $118,000,

45% between $39,560 and $118,000 and the remaining 26% of was below $25,000. My

respondents had the following education: 73% had a 4-year degree, 22% of respondents self-identified as some college education, and 5% had a high school or less than high school education.

Data Screening

Case and variable screening.

Missing data. I performed a variable screen and observed the data. I found missing values within variables. I deleted 94 rows due to having fully incomplete responses, which accounted for more than 20% missing data per row.

Unengaged respondents. I then case screened the data for low standard deviation by transferring the data onto an excel spreadsheet via conditional formatting to highlight low unengaged responses; no low standard deviation was found within the data set. I removed two rows for not being engaged; these respondents answered Somewhat Agree to almost every Likert scaled item.

Outliers. I then checked for outliers on continuous variables. I proceeded with descriptives to explore statistic outliers within the variables. No erroneous outliers were found. I observed normal distribution for my indicators of latent factors and all of the other variables.

Normality. In terms of kurtosis and skewness, no unusual skewness was noted; however, I observed kurtosis for the moderating variable. Kurtosis ranged from benign to

5.2. I found this figure is within relaxed rules suggested by Kline (2011), who recommends ten as the upper threshold for normality.

Homoscedasticity. I tested results for homoscedasticity scatter plots. The plots showed consistent patterns indicating homoscedastic relationships between the IVs and

DVs.

Multicollinearity. I examined the variable factors for the Variable Inflation Factor

(VIF) by calculating a VIF for each independent variable after running a multivariate regression and observed no factors greater than 2; the greatest factor at 1.09 is far less than the threshold of 10 (O’brien, 2007).

I then proceeded with a two-step approach of analyzing all of the measures for validity and reliability before I continued on structure modeling (Anderson & Gerbing,

1988). An Exploratory Factor Analysis (EFA) was run to factor identity, validity, and reliability (Reio Jr & Shuck, 2015). Thereafter, a Confirmatory Factor Analysis (CFA) was run for the validity of the measurement model and to determine the factor structure of the dataset (Vandenberg & Lance, 2000).

Measurement Model

Exploratory Factor Analysis (EFA)

The initial Exploratory Factor Analysis (EFA) was done using SPSS software.

Data were examined for adequacy using the Kaiser-Meyer-Olkin (KMO) Measure of

Sampling Adequacy, and I determined the KMO to be acceptable, at 0.78. Bartlett’s Test of Sphericity was significant with the statistics 푋² = 2201.715, df = 136, p-value 0.00. All communalities were above the threshold of 0.30, except for Access 1 (0.34), Malnutrition

5 (0.37), and Social Interaction (0.28). I used Principle Axis Factoring and suppressed anything below the value of 0.20 (Hair, Black, Babin, & Anderson, 2010). I then selected the Promax Oblique Rotation Method (Matsunaga, 2010). The five factors extracted

explain 68.51 % of the variance after removing items from Access 3, 4, 5, 6, (ACC),

Malnutrition 4 (MAL), Nonprofit Organizational Effectiveness 1, 4, (NPE), and Well- being 1,2, 4 through 6, (Well). Iterations were removed one at a time, and all factors were removed for high cross loadings and low communalities.

The Cronbach’s alpha exceeded the 0.70 threshold showing good reliability, except for Well-Being (0.64) and Access (0.64); both were close to the threshold (Hair et al., 2010). The final pattern matrix shows convergent validity and reliability (Appendix

I). The factor correlation shown below in Table 3 was adequate with no values exceeding the threshold of 0.70 (Hair et al., 2010).

Table 3: Correlation Table

Construct Mean Std Income EDU WELL ACC NPE MAL SI Deviation Income 3.54 1.122 1 .128* 0.014 0.032 -0.048 0.044 -0.007 EDU 4.45 0.973 128* 1 0.065 0.032 -0.008 .182** 0.112 WELL 1.8055 0.41925 0.014 0.065 1 .194* 0.100 .210 .539** ACC 4.6979 0.63609 0.032 0.032 .194** 1 -0.102 351** .422** NPE 1.8452 1.08933 -0.048 -0.008 0.100 -0.102 1 -0.067 0.064 MAL 4.2974 0.49459 0.044 .182** .210** .351** -0.067 1 .546** SI 6.3310 1.32122 -0.007 0.112 .539** .422** 0.064 .546** 1 * p < 0.050, ** p < 0.010, *** p < 0.001

The data was then deemed adequate for further study (Hair et al., 2010). The factors are all reflective scales, and each factor indicator is expected to be highly correlated, indicating they are interchangeable.

Confirmatory Factor Analysis (CFA)

Model Fit

The Exploratory Factor Analysis (EFA) solution was defined as a Confirmatory

Factor Analysis (CFA) model. The mined factors were then subjected to a CFA using

AMOS software (Appendix J). My model was then checked for model fit and validity and reliability. Model fit was adequate with 푋² = 225.603 df 109 and p-value .00. The model fit statistics are CMIN/DF of 2.07, indicating excellent fit (Hu & Bentler, 1999).

The Root Mean Square Error of Approximation (RMSEA) is excellent at 0.06

(MacCallum, Browne, & Sugawara, 1996). The Goodness of Fit Index (GFI) is adequate at 0.92 (Tabachnick & Fidell, 2007), as well as the Adjusted Gross Fit Index (AGFI) at

0.88 (Hu & Bentler, 1999). The Comparative Fit Index (CFI) was acceptable indicating model fit at 0.94, and the SRMR was excellent at 0.05 (Hu & Bentler, 1999). My PClose was greater than the threshold of 0.05 at 0.60; taking all of the data into consideration, the model shows a parsimonious good fit. I then proceeded to analyze for construct validity and reliability.

Reliability and Validity

As shown in Table 4, the Composite Reliability scores were adequate, ranging from 0.70 to 0.90 (Hair et al., 2010). Convergent validity is achieved with AVE values greater than 0.50 (MacKenzie, Podsakoff, & Podsakoff, 2011), except for Access (0.44).

The figure was close enough to the threshold to continue with the analysis. The AVE is greater than the MSV, thus demonstrating the model has discriminant validity

(MacKenzie et al., 2011). The model was adequate and satisfactory for further testing.

Table 4: Construct CFA Convergent Validity and Reliability

Construct CR AVE MSV SI MAL NPE ACC WELL SI 0.856 0.503 0.243 0.709 MAL 0.860 0.610 0.243 0.493*** 0.781 NPE 0.903 0.823 0.009 0.600 -0.062 0.907 ACC 0.701 0.441 0.122 0.350*** 0.288*** -0.086 0.664 WELL 0.706 0.566 0.235 0.485*** 0.185* 0.092 0.156 0.752

Common Method Bias (CMB)

I then examined the model for Common Method Bias (CMB) by using a Common

Latent Factor (CLF) (Podsakoff, MacKenzie, Lee, & Podsakoff, 2003). I performed this function to assess for any systematic error and any method variance. I reasoned it was best to analyze the model for CMB (Appendix K) as the survey might have a weakness in it; that is to say, the survey items or scales used might have caused the weakness. Also, the data collection might have had an occurrence of respondent bias, having a “self- report” aspect of responses, meaning, either consciously or unconsciously, respondents may have answered the survey in a systematic fashion.

I created and compared three nested models: (1) where the CMB factor with indicator loadings is freely estimated or unrestricted, this will also allow us to determine which of the CMB factor account for the variance of each indicator; (2) The CMB factor indicator loadings are fixed to equal each other assuming that CMB does not vary across indicators; and (3) the CMB factor indicator loadings are fixed to 0, assuming the CMB factor does not account for any variance in the indicator variables. I compared the results of the nested models between both models to assess the statistical significance of CMB in the data.

I then analyzed for CMB as “evidence suggests that between 18 percent and 32 percent of the variance in items is attributable to method factors” (Podsakoff, MacKenzie,

& Podsakoff, 2012: 543). I also performed chi-square difference tests and examined the model fit indices and regression loadings. I first started with a good CFA model of factors. I then ran the model and examined model fit. Model fit was adequate with 푋² =

204.982 df 93 and p-value .000. The model fit statistics were CMIN/DF of 2.20,

indicating good fit (Hu & Bentler, 1999). The Root Mean Square Error of Approximation

(RMSEA) was good at 0.06 (MacCallum et al., 1996). The Goodness of Fit Index (GFI) was adequate at 0.93 (Tabachnick & Fidell, 2007), as well as the Adjusted Gross Fit

Index (AGFI) at 0.88 (Hu & Bentler, 1999). The Comparative Fit Index (CFI) was good indicating model fit at 0.95, and the SRMR was at 0.04 (Hu & Bentler, 1999). The

PClose was at 0.03 below the threshold of 0.05. Taking all of the data into consideration, the model shows a parsimonious good fit.

I added the CLF to the model and then created the nested models. I ran the model and compared the regression weights to notice a change between the nested models. I examined the model fit of the model with unconstrained and fully constrained models.

Shown below in Table 5 is a comparison of model fit between the Unconstrained model,

Constrained to Equal model, and Constrained to Zero model.

Table 5: Model Fit (CMB with CLF): Comparison of Nested Models

Model CMIN DF P CMIN/ GFI AGF CFI RMSE PCLOS DF I A E Model 1: 204.982 93 .000 2.204 0.927 0.880 0.947 0.064 0.028 Unconstrained Model 2: Equal 542.377 109 .000 4.974 0.761 0.664 0.795 0.116 .000 Model 3: Zero 542.934 110 .000 4.936 0.761 0.667 0.795 0.116 .000

The model fit statistics are CMIN/DF of 2.20 for Model 1, 4.98 for Model 2, and

4.94 for Model 3, indicating good fit (Hu & Bentler, 1999). The Root Mean Square Error of Approximation (RMSEA) was good at 0.06 for Model 1, adequate at 0.11 for Model 2, and 0.17 for Model 3 (MacCallum et al., 1996). The Comparative Fit Index (CFI) was acceptable at 0.95 for Model 1, 0.79 for Model 2, and 0.79 for Model 3, indicating model fit. The PClose was below the threshold of greater than 0.05 at 0.03 for Model 1, 0.000

for Model 2, and for Model 3. Regardless of Model 2’s and Model 3’s PClose, by taking all the data into consideration, the model showed a parsimonious good fit. I then conducted a chi-square difference test for CMB. The results are in Table 6.

Table 6: Chi-Square Difference Test: For Common Method Bias

Model DF CMIN P NFI Delta IFI Delta RFI TLI 1 2 rho-1 rho2 Equal 16 337.395 .000 0.150 0.156 0.167 0.178 Model 2 Zero 17 337.952 .000 0.150 0.157 0.165 0.176 Model 3

A comparison of the nested models shows that each model is different, and CMB could be a concern within the data. I then imputed the data to include the CLF. I used the imputed data for the structural model as this will ensure I have CLF factor-adjusted constructs.

Structural Model

To test the Structural Equation Model (SEM), I used the composite variable, which was created in AMOS using the sample of 296. I tested for direct effects, interaction effects, and included two controls: Income and Education.

I ran a Cook’s Distance analysis to determine if any multivariate influential outliers existed and found only two cases of observed Cook’s Distance slightly greater than 1; however, I felt that there was no cause to remove any outliers due to the few cases found. Model fit was adequate with 푋² = 258.460 df 84 and p-value .000. The CMIN/DF was at 3.09, indicating excellent fit (Hu & Bentler, 1999). The p-value shows the model is significant (Hair et al., 2010). The Root Mean Square Error of Approximation

(RMSEA) is good at 0.08 (MacCallum et al., 1996). The Goodness of Fit Index (GFI) is

adequate at 0.90 (Tabachnick & Fidell, 2007), as well as the Adjusted Gross Fit Index

(AGFI) at 0.85 (Hu & Bentler, 1999). The Comparative Fit Index (CFI) was good indicating model fit at 0.90 (Hu & Bentler, 1999), and the SRMR was excellent at 0.05

(Hu & Bentler, 1999). The PClose was excellent at 0.55, taking all of the data into consideration, the model shows a parsimonious good fit.

I then created a Causal Latent Model (CLM) within Amos to test for direct effects. I ran the model and reviewed the output viewing estimates and scalars. I tested for moderation, and I ran the model. I then viewed the p-values of each moderated effect.

Thereafter, I proceeded to review the results.

Results and Findings

Figure 6: Final Model

Table 7 shows the results of hypotheses tested for direct effects (H1, H2, H3). The following hypotheses were supported: Malnutrition has a negative effect on Well-Being

(β = -0.116, p = 0.050), and Social Interaction has a positive effect on Well-Being (β =

0.594, ***). The following direct effect hypothesis was not supported: Lack of Access to

Healthy Foods has a negative effect on Well-Being (β = -0.012, p = 0.831).

Table 7: Direct Relationship Hypotheses

Direct Relationship Hypotheses Standardized Regression Supported Weight

H1 Lack of Access to Healthy Foods has a β = -0.012, p = 0.831 No negative effect on Well-Being.

H2 Malnutrition has a negative effect on Well- β = -0.116, p < 0.050 Yes Being.

H3 Social Interaction has a positive effect on β = 0.594, p < 0.001 Yes Well-Being.

I then reviewed the results for moderation effectiveness, noted below in Table 8.

To do this, I edited the Trimmed Underscore C data set within Amos. Within the Analyze tab, I chose Descriptive Statistics and then Descriptives. I opted to save standardized value as variables for Nonprofit Effectiveness and what we were using in its interactions:

Access and Well-being, Malnutrition and Well-being, and Social Interaction and Well- being. I then multiplied the interaction by using the transform and computing variable function as such: Nonprofit Organizational Effectiveness x Access on Well-being,

Nonprofit Organizational Effectiveness x Malnutrition on Well-being, and Nonprofit

Organizational Effectiveness x Social Interaction on Well-being. I also include controls

Education on Well-being and Income on Well-being. Thereafter, I saved the data set

changes and relinked the data to the causal path model and ran it. I then proceeded to review the moderated effects.

The following hypothesis was supported: Nonprofit Organizational Effectiveness moderates the negative relationship between Malnutrition and Well-being (β = 0.017, p =

0.770). There was a change from negative direct effects: Malnutrition on Well-being (β =

-0.116, p = 0.055) to the positive moderated effects (β = 0.017, p = 0.770). This change provides evidence that Nonprofit Organizational Effectiveness weakens the negative relationship between Malnutrition and Well-being.

The following hypotheses were not supported: Nonprofit Organizational

Effectiveness moderates the negative effect of Lack of Access to Healthy Foods and

Well-being (β = -0.016, p = 0.766), and Nonprofit Organizational Effectiveness moderates the positive relationship between Social Interaction and Well-being (β = -

0.092, p = 0.101).

Table 8: Moderation Hypothesis

Moderation Hypotheses Standardized Supported Regression Weight

H4 Nonprofit organizational β = -0.016, p = 0.766 No effectiveness weakens the

negative impact of lack of access to healthy foods on well-being.

H5 Nonprofit organizational β = 0.017, p = 0.770 Yes effectiveness weakens the (Direct Effect of Malnutrition on negative impact of malnutrition Well-Being is negative, with the on well-being. Nonprofit Organizational Effectiveness moderation, it is no longer negative. Thus, H5 is supported)

H6 Nonprofit organizational β = -0.092, p = 0.101 No effectiveness enhances the positive relationship between social interaction and well-being.

When reviewing the relationship between food and health, many facets should be examined: socioeconomic, macroeconomic and community factors, and an individual’s health. Stack (2015) states that “socioeconomic factors, defined by social position based on income, education, and occupation, often play a large part in risk factors for an individual’s health” (p. 17). By using a complexity lens in this dissertation, I am better positioned to understand all of the diverse facets that encompass this relationship.

Complexity Science lends itself to a multiplicity of disciplines (Schneider & Somers,

2006). This aspect of complexity has helped me understand all of the various causalities of residing in a food desert. To understand the lives of food desert residents and how they achieve well-being, I needed to understand a food desert resident’s thoughts and reactions to their food environment. Complexity Theory also provided a way to connect the dots between a food desert resident’s food environment and their health (Sturmberg, Martin,

& Katerndahl, 2014). A complexity lens provided an approach to establish the connection between a food desert resident’s diet of foods found in their neighborhood and their health. It also helped access the impact of a resident’s health on their well-being.

One of the central claims of this study was to gain a better understanding of food deserts residents’ well-being and the factors that influence it. Therefore, my research included controls for both income and education. The results for the tested controls,

Education and Income, are as follows: Education has a positive relationship with Well-

Being (β = 0.017, p = 0.734), and Income has a positive relationship with Well-Being (β

= 0.020, p = 0.680). These results show that in this study, neither a resident’s education nor income level was associated with greater well-being. It is assumed that both

education and income would help well-being, as there is a common belief in the U.S. that money equals happiness (Smith, 2008) and that education influences happiness

(Michalos, 2008). Contrasting these findings to the direct effect social interaction has on well-being further support the implication of a food desert resident’s social life and the strong role it plays in their well-being.

Findings

My quantitative findings further indicate that food desert residents respond to their environmental constraints by traveling to supermarkets (Cannuscio et al., 2013;

Drewnowski, Aggarwal, Hurvitz, Monsivais, & Moudon, 2012; Ledoux & Vojnovic,

2013). This is important because access to a supermarket leads to the purchase of healthier foods, lowers a food desert resident’s risk of obesity and diet-related illnesses

(Morland et al., 2006; Rose & Richards, 2004; Zenk et al., 2005), and promotes well- being by engaging with other patrons and supermarket employees. Overall, the quantitative findings support my qualitative observations that food desert residents’ social interactions add to their well-being.

My study supports the validity of researching nonprofit organizational (NPO) effectiveness within food deserts and how they might provide access to food and help a resident with the social aspects of their well-being. Uhl-Bien, Marion, and McKelvey

(2007) state Complexity Theory can offer insights into how organizations become innovative and adaptable when addressing the challenges in food deserts. The authors also state that Complexity Theory allows for the understanding of the context or

“interactions and interdependencies” among organizations and people (Uhl-Bien et al.,

2007: 299).

NPOs can replace government market failure as social relationships are not considered a determinant of well-being by major U.S. government agencies (Holt-

Lunstad, Robles, & Sbarra, 2017). Therefore, NPOs should help food desert residents bridge social relationships (Glasgow, Green, Taylor, & Stange, 2012). Bridging relationships during the pandemic has been difficult. However, many food pantries and other community food initiatives use their social media sites to help build communities.

While much of the literature focuses on the consequences of social isolation while residing within low-income, low-access areas (Rankin & Quane, 2000), my research implies that addressing social isolation can improve a food desert resident’s well-being, thus increasing their emotional and social exchange support (Van Tilburg, Havens, & de

Jong Gierveld, 2004). NPOs are in a position to provide programs that strive to improve the social aspects of well-being; this would increase social interactions and the social networks of food desert residents.

Martha’s Table, located in Washington DC, is an example of an NPO helping food desert residents with the social aspects of their well-being. Martha’s Table’s mission is to help individuals thrive. Their programs focus on social inclusion by increasing a food desert resident’s access to healthy food, family leadership, and education

(marthastable.org). Martha’s Table’s mission is guided by the following principles:

1. Equity is Essential: We lead with an equity lens, making decisions rooted in access and opportunity for our neighbors (marthastable.org).

2. Community Knows Best: Our neighbors have a vision for their community and know what it will take to get there. We operate with a community voice at the head of the table (marthastable.org).

3. Neighborhood Matters: Neighborhoods influence access to resources that are critical for life success. We invest deeply in neighborhoods to

ensure a zip code does not determine someone’s future (marthastable.org).

During the COVID-19 pandemic, food desert residents turned to their online food pantry or other support groups like the Food is Free Project (FIF) when they needed food and social support. FIF has 350 worldwide movements aimed at growing food and creating stronger communities (foodisfreeproject.org). The mission of FIF is to promote the growing and sharing of food freely to connect neighbors within communities.

My Supported Hypotheses

This study implies that social interaction has a positive effect on well-being; this is shown through the data results of β = 0.594, p < 0.001. This finding indicates the significance socialization is for food desert residents. Respondents of the survey indicate social interaction has a greater effect on their well-being than food access. This finding is comparable to findings in Study 1 where residents of food deserts traveled great distances to supermarkets to socialize with others because of the limited options for social connectedness in their neighborhoods. Residents increased their social contacts by shopping at supermarkets outside of their neighborhoods; this improved their health outcomes (Uchino, 2006).

All of this implies that nonprofits organizations (NPO) should address the issue of social segregation and social isolation within food deserts by creating social inclusivity programs. This would translate into food desert residents having improved health outcomes because they have greater well-being. My findings also suggest more research is needed about individuals who rely on NPO food assistance (Paynter, Berner, &

Anderson, 2011), and greater insights into the effectiveness of NPOs that provide food assistance.

Another finding is the correlation between malnutrition and well-being.

Malnutrition had a negative effect on well-being demonstrates that food desert residents link their malnutrition to a poor sense of well-being. Research supports the claim that there is a strong association between food and well-being (Ares et al., 2014; Macht, 2008;

Rozin, 2015), NPOs could promote this aspect in their programs to help food desert residents improve their well-being.

Also, NPO Effectiveness weakened the Negative Relationship between

Malnutrition and Well-Being. The data presented provides evidence that food desert residents experience poor malnutrition and, as a consequence, lowered well-being. Their experience is that NPOs mitigate the consequences of malnutrition and help them with achieving a greater sense of well-being. This is because NPOs are providing emergency food relief directly influencing a food desert resident’s food consumption pattern. Food consumption can be a strong social vehicle that allows for social connectedness, which translates into greater well-being (Ares et al., 2014).

My Unsupported Hypotheses

Lack of Access to Healthy Food had a Negative Effect on Well-being and

Nonprofit Organizational Effectiveness Moderates the Negative relationship between

Lack of Access to Healthy Foods and Well-Being were not supported. The general picture emerging from these two findings is that people who reside in food deserts do not correlate healthy food consumption with improved well-being. A possible interpretation of this finding is that food desert residents do not link their eating habits with having

pleasant emotions; this would also include the physical place where they purchase their foods and where they consume their foods (Barrett, Mesquita, Ochsner, & Gross, 2007).

Food plays an indispensable role in every individual’s life for vital reasons.

However, not these reasons alone; food as a societal issue is multifarious because of the complexity involved in our food system (Appendix E). Food affects the short-term and long-term of an individual’s well-being (Scott & Vallen, 2019), such as one’s food availability and food access (Block et al., 2011; Bublitz et al., 2019), food consumption, and food socialization (Mugel, Gurviez, & Decrop, 2019; Parker, Umashankar, &

Schleicher, 2019).

Nonprofit organizations (NPOs) were not effective in moderating the negative relationship between lack of access to healthy foods and well-being; I attempted to establish how NPOs moderated the connection between healthy foods and well-being.

The aim was to evaluate NPOs’ effectiveness through their service delivery of food- related programs and how they responded to community issues that affect the social aspects of food desert residents’ well-being.

We should consider the challenges faced by hunger-relief nonprofits. Emergency food centers have difficulties stocking perishable fresh, healthy foods that need to be refrigerated or frozen (Handforth, Hennink, & Schwartz, 2013). Food banks are often the first to respond to a food desert resident’s call for emergency food (Tarasuk, St-Germain,

& Loopstra, 2019). However, many food banks simply do not have the physical space or the manpower to prepare meals made of fresh foods. This is unfortunate because most clients of food banks prefer to eat foods such as tomatoes, apples, chicken, and broccoli

(Campbell, Hudson, Webb, & Crawford, 2011: 185) to a meal consisting of processed or

snack foods (Campbell et al., 2011; Greer, Cross-Denny, McCabe, & Castrogivanni,

2016; Will & Milligan, 2015). This research implies that NPOs need more insights into what type of programs can deliver a social impact in food deserts.

Practical Implications

More than half of the adults within the U.S. are overweight (Flegal, Carroll,

Ogden, & Curtin, 2010), and over one-third of all deaths within the U.S. are due to heart disease, stroke, or type II diabetes—all of which are preventable diseases. Food desert residents reside in communities most affected by nutritional related illnesses (Leone et al., 2012). This research links food deserts with food access, food environment, and well- being outcomes. This research provides nonprofit organizations (NPOs) with results that show food desert residents are in need of organizations that can not only help them with access to healthy food, but also provide programs that help the social aspects of their well-being. The findings provide strong evidence that NPO social initiatives and programs are needed to provide food desert residents with greater well-being.

As NPOs play a critical role within food deserts because they provide emergency food relief (Meenar, 2016), they should consider that healthy food deprivation is a severe problem that can affect a resident’s well-being. Bublitz et al. (2019) state this dilemma succinctly, “Chronic hunger [for healthy foods], in turn, results in a multitude of adverse mental and physical out-comes, including drained and depleted well-being” (p. 136).

The research is aligned with existing literature that improving food access for residents of food deserts will promote better well-being outcomes (Cummins &

Macintyre, 2002). By understanding the needs of food desert communities, NPOs are better positioned to assist with food availability that meets their clients’ dietary and

nutritional needs. My study contributes to the understanding that NPOs that provide emergency foods should not only address the nutritional concerns of their clients, but also their well-being. The strategy of addressing these concerns would include altering operational strategies to incorporate well-being programs and form collaborative partnerships that would create the infrastructure to store and keep fresh foods onsite; this would ensure a variety of fresh foods for their clients.

Limitations

The data lacked diversity as a large proportion of the sample was in the high- income bracket earning $118,000 or more per year. A larger sample size of individuals making less than $25,000 would have made the data set more diverse. In addition, I had validity concerns within the data set; the AVE for Access at 0.441 was less than threshold

0.5. Also, the Cronbach’s alpha for Well-being at 0.642 and Access at 0.639 was less than the threshold of 0.70.

Future Research

Nonprofit Effectiveness Measured by Capacity-Building

There is a need to examine nonprofit organizational (NPO) capacity building in the delivery of services in food deserts. Capacity is defined as the methods NPOs achieve effectiveness (Bryan, 2019). The results yielded some interesting findings and oddly shows that food desert residents find their NPOs ineffective in accessing healthy foods and social interaction on their well-being because they do not know enough information about the NPOs that serve them, and/or they do not feel they can rely on their NPOs to mitigate any issues that they are experiencing. This was concluded from the NPO effectiveness survey questions (Appendix O).

Future research should include how NPOs build community-based programs aimed at responding to food insecurity and social exclusion problems. Examining the factors that limit and challenge NPO capacity building and effectiveness would increase the chances of program success within food deserts, simply because NPOs would understand what works and what does not work to build capacity.

Furthermore, the need for capacity building as understood through social capital should be analyzed (Putnam, 1995). This means taking into consideration the relationship aspects or social aspects of how to improve a community. Meenar (2016) states,

“community capacity is based on the relationship between human, organizational, and social capitals used to solve problems and improve community” (p. 78). Meenar (2016),

Coleman (1988), and Chaskin (2001) stress that social capital is a product of relationships between individuals within a community. Also, that community capital can improve the lives of individuals by building relationships between them and the organizations that serve their community.

Food Access, Food Environments

Future research should explore beyond the scope of the “supermarket proximity and health” framework (Cannuscio, Hillier, Karpyn, & Glanz, 2014) and review other aspects that make up food desert residents’ food choices and food shopping habits. This would also include the social aspects that make up their food environment; research should examine food desert residents’ social interactions and relationships that might influence their food purchases and consumption patterns (Zenk et al., 2005). By examining these relationships, nonprofit organizations (NPOs), non-governmental organizations (NGO), and policymakers are better positioned to understand how access to

healthy food plays a role in shaping an individual’s food environment, which impacts their well-being.

Nonprofit organizations’ Collaborative Partnerships with the Public and the Private Sector on the Social Aspects of Well-Being

Across a variety of research fields, there has been a strong interest in studying collaboration between nonprofit organizations (NPOs) and other organizations from different sectors (Shumate, Fu, & Cooper, 2018). The reason for this increased attention is cross-sector social partnerships between NPOs, the business sector, and the public sector have become increasingly common (Shumate et al., 2018). Social collaboration between NPOs and other organizations consists of shared “information, resources, and capabilities” (Bryson, Crosby, & Stone, 2006: 48). NPOs enter collaborative relationships for access and increased resources (Bryson et al., 2006), to improve management competence (Jamali & Neville, 2011), and to acquire new knowledge (Berger,

Cunningham, & Drumwright, 2004) The problems of food deserts, which are rooted in socioeconomic and policy issues, are complex. The social problems that exist within food deserts require organizational cross-sector cooperation to increase capacity. There is a gap in the literature that examines NPOs’ collaboration with other organizations on the issues of food deserts, especially about the residents’ well-being. By advancing research on the collaborative efforts on social issues of well-being within food deserts, organizations will be better positioned to implement social programs and increase their capacity within these areas. Collaborative efforts made between NPOs and other sectors, such as the government or private businesses can also promote new strategies to help residents of food deserts.

Conclusion

My study increases an understanding of food deserts. They are a complex topic that warrants future research. Improving food access conditions within food deserts may seem like an onerous task because in recent decades there has been an increase in people suffering from diet-related diseases (Bifulco & Caruso, 2007) and also due to the fact that food deserts encompass severe social stratification issues. However, by researching the experiences, feelings, and opinions of food desert residents, researchers are able to understand how to mitigate this complex problem from the perspective of those living there.

CHAPTER 5: THE PARADOX OF THE CORONAVIRUS WITHIN FOOD DESERTS: FACTORS THAT INFLUENCE THE SOCIAL ASPECTS OF A RESIDENT’S WELL-BEING DURING THE PANDEMIC (STUDY 3)

I'm not happy it happened, I'm horrified at how we handled it as a country. Overall, kind of a welcome break though. Yeah. Overall kind of a nice, slow down to be able to re-evaluate and really dig in. I know what's valuable and who is valuable in my life in my social circle personally. — Participant 30

Preface

In this study, the extrinsic component of the Coronavirus (COVID-19) became an included theme. The original study was to examine nonprofit organizational (NPO) effectiveness. However, with the emergence of COVID-19 in late 2019–2020, I wanted to gain an understanding of a food desert resident’s daily life during the pandemic, so I interviewed residents and asked them to compare and contrast their lives before and during COVID-19. This third study also examines food desert residents’ thoughts and opinions about NPOs that try to help with food access and the social aspects of their well- being during COVID-19. This final component of my research provides findings of how the pandemic had a silver lining affecting the lives of food desert residents. Also, during the pandemic, NPOs were effective in helping residents with the social aspects of their well-being and with access to healthy food.

Introduction

In December 2019, there were 27 cases of an “unknown pneumonia” outbreak in

Wuhan City, the capital of Hubei Province in China, a city with a population of over 11 million people (Lu, Stratton, & Tang, 2020). In January 2020, the Chinese Center for

Disease Control and Prevention (CCDC) identified the causative pneumonia and named it

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), and the World 89

Health Organization (2020) named it Coronavirus Disease 2019 (COVID-19). By March

2020, there was a total of 3,112 global deaths from COVID-19 and 90,870 confirmed

COVID-19 cases worldwide (Sohrabi et al., 2020). In one year, by March 2021, the number of global deaths from COVID-19 had reached over 2.7 million, with over 123 million COVID-19 confirmed cases worldwide (WHO, 2021). Like many other systems crises, COVID-19 shows our global interconnectedness and interdependence and their ensuing complexity (El-Taliawi & Hartley, 2021).

COVID-19 has caused a global health emergency, and the approaches to help stop the virus (e.g., social distancing, quarantine, shutdowns) have exacerbated food system failures and deficiencies (Bakalis et al., 2020; Garnett, Doherty, & Heron, 2020; van der

Ploeg, 2020). Prior to COVID-19, disparities found in food deserts such as built food environments, lack of access to healthy food, and health disparities such as malnutrition and obesity were already known. The pandemic has magnified these disparities

(Dubowitz et al., 2021; O'Hara & Toussaint, 2021; Singu, Acharya, Challagundla, &

Byrareddy, 2020) and has also added another layer of complexity to residing in food deserts (El-Taliawi & Hartley, 2021; Namazi & Kulish, 2020). Leddy, Weiser, Palar, and

Seligman (2020) state that due to these complex multidimensional relationships and problems comprising COVID-19 shown in Figure 7, COVID-19 has severe impacts on health and food insecurity outcomes, all of which affects an individual’s well-being.

Figure 7: Leddy et al. (2020) Social and Structural Impacts of COVID-19

Leddy et al. (2020) further state that health and food insecurity are influenced by structural, household, and individual factors (p. 2). Health and food insecurity are also affected by pre-existing structural contexts: economic disparities, health disparities, and a fragile food system. This is evident in food deserts where a majority of residents are considered low-income (Kelli et al., 2019) and have diet-related diseases due to consuming poor food found in their environment (Bustos, 2020; Stein & Ometa, 2020).

To further complicate matters, COVID-19 has disrupted the food system (Harris,

Depenbusch, Pal, Nair, & Ramasamy, 2020; Hendrickson, 2020; Orden, 2020; Savary et al., 2020; Worstell, 2020), causing an increased demand on Nonprofit Organizations

(NPOs) to provide food assistance to those in need (Kulish, 2020; Lakhani, 2020;

McGreevy, 2020). NPOs are now faced with the task of trying to remedy public health,

economic, social, and political system problems (Hartley & Jarvis, 2020). In this study, systems thinking or Complexity Science is used to interpret multifaceted and complicated problems when examining NPO effectiveness on the social aspects of well-being and the lives of food desert residents during the pandemic.

Leddy et al. (2020) explain that the structural context of COVID-19, the economic crisis, social distancing policies, the increased demand for food aid, and an overburdened health care system has stressed households and individuals (p. 2). For food desert residents, these stressors could affect the social aspects of their well-being, and a lack of healthy foods could lead to poor health outcomes and disease progression (Berkowitz,

Seligman, & Choudhry, 2014; Silverman et al., 2015).

In addition, during this pandemic, the already existing health disparities of food desert residents have put them at greater risk for contracting COVID-19. According to

Belanger et al. (2020), “Social determinants of health; access to healthy food, access to healthcare, location and physical environment […and…] obesity, chronic diseases, and severe negative outcomes from Covid-19 are all interrelated” (p. 2). Due to the pandemic, food desert residents are now in greater need of help from NPOs to remedy additional challenges brought on by the virus. The urgency of the pandemic on those in need is shown in Figure 8 below in a photo of food desert residents waiting in line for food in the

Bronx, a borough of New York City.

Figure 8: NPO City Harvest’s Food Distribution During the COVID-19 Pandemic

Photograph by Mike Segar, Source: Reuters, 2020

A healthy diet of fresh fruits and vegetables is essential to maintain good health and counter public health challenges such as pandemics (Conner, Brookie, Richardson, &

Polak, 2015). In contrast, a diet made up of processed foods that are high in sugar, salt, and fat can lead to diet-related illnesses, such as asthma, cardiovascular disease (Jhaveri,

Krishnan, Kir, Chen, & Angraal, 2020; Lichtenstein et al., 2006), severe obesity (Alston,

2020; Disterhaft & Van Aartsen, n.d.; Fossi, McCaffery, Riseborough, & Vedherey), diabetes (Berkowitz et al., 2018; Flint, Davis, & Umpierrez, 2020) and cancer (Must et al., 1999; Zimmet, Alberti, & Shaw, 2001).

Due to their poor diet of fast foods and processed food, residents of food deserts are at higher risk for diet-related and chronic diseases (Belanger et al., 2020; Singu et al.,

2020). Alarmingly, these are some of the factors that increase a person’s risk of catching

COVID-19. In addition, these health conditions heighten a person’s risk for a severe outcome of the COVID-19 virus. That is, if one catches the COVID-19 virus and has one of these health conditions, there is a greater chance of dying (Belanger et al., 2020; Tai et al., 2020). Many of these conditions exist within food deserts because many residents lack access to healthy foods (Huizar, Arena, & Laddu, 2020; Singu et al., 2020).

The multiple stressors of COVID-19 have weighed heavily on most individuals whose well-being has been disrupted by the pandemic (Giuntella, Hyde, Saccardo, &

Sadoff, 2021). This is noteworthy because well-being includes an individual’s stance on life satisfaction (Sirgy, 2012) and social isolation (Issa & Jaleel, 2021).

The Harvard Study of Adult Development found that an individual’s social life plays a large role in the satisfaction of one’s life (adultdevelopmentstudy.org). For the past 75 years, the study has been conducted with the same participants of men divided into two groups. The participants are asked questions about their daily lives (Waldinger,

2016). One group of men were recruited students from Harvard University, and the other were recruited from Boston’s most disenfranchised neighborhoods. The findings of this longitude study show relationships make people happier and healthier (Waldinger, 2016).

The Director of the Harvard Study of Adult Development states the following about an individual’s social life:

…social connections are really good for us and that loneliness kills. It turns out that people who are more socially connected to family, to friends, to community, are happier, they’re physically healthier, and they live longer

than people who are less connected. The experience of loneliness turns out to be toxic. People who are more isolated than they want to be from others find that they are less happy, their health declines earlier in mid-life, their brain functioning declines sooner, and they live shorter lives than people who are not lonely. (Waldinger, 2016)

Research indicates that the pandemic has impacted well-being (Duan & Zhu,

2020; Satici, Saricali, Satici, & Griffiths, 2020; Yang & Ma, 2020), causing feelings of isolation (Giallonardo et al., 2020) depression (Pérez-Fuentes, Molero Jurado, Martos

Martínez, & Gázquez Linares, 2020; Roy et al., 2020), anxiety (McElroy et al., 2020;

Roberts et al., 2021; Shanafelt, Ripp, & Trockel, 2020; Shevlin et al., 2020), suicide

(Fitzpatrick, Harris, Drawve, & Willis, 2021; Garfin, Silver, & Holman, 2020; Killgore,

Taylor, Cloonan, & Dailey, 2020; Lima et al., 2020), and poor sleeping patterns

(Salehinejad et al., 2020).

For food desert residents, this disruption may have posed additional challenges to their well-being, including further limited mobility issues due to changes or cancellations of public transportation due to COVID-19 restrictions (Liu, Miller, & Scheff, 2020;

Tirachini & Cats, 2020), food bank closures due to staff and volunteer following stay-at- home protocols (cnbc.com), and being socially isolated from family, friends, and co- workers (Hwang, Rabheru, Peisah, Reichman, & Ikeda, 2020). With this increased vulnerability, residents are faced with the quandary of challenges that come with living in a food desert and during the COVID-19 pandemic. Studies 1 and 2 affirmed the importance of the social aspects of well-being for food desert residents and the factors that challenge a food desert resident’s daily life. Therefore, Study 3 was conducted to understand how social distancing protocols and the challenges of residing in a food desert during a pandemic affect a food desert resident’s well-being and if NPOs help with these 95

matters. Given these challenges faced by food desert residents during the current pandemic, I adopted Grounded Theory (Charmaz, 2014) to address the questions: During the COVID-19 pandemic: What factors influence well-being in residents of food deserts?

Are nonprofit organizations effective in helping food desert residents on the social aspects of well-being?

Literature Review

To identify these factors, I reviewed the literature on Self-Determination Theory

(SDT) and Sensemaking Theory. This literature review aimed to examine the social aspects of a food desert resident’s well-being during the COVID-19 pandemic.

Reviewing this literature provided a foundation, background, and theoretical perspective to conduct and complete the study. SDT was used to understand a food desert resident’s mindfulness (Deci & Ryan, 2008) during the COVID-19 pandemic. SDT provides a lens to understand a food desert resident’s thoughts and feelings on what is happening within oneself and the externalities of one’s environment (Brown & Ryan, 2003). I used

Sensemaking Theory to understand how food desert residents made sense of the COVID-

19 pandemic. Sensemaking Theory provided a way to interpret a resident’s thoughts about their life before and during the pandemic.

Self-Determination Theory

Self-determination Theory (SDT) (Ryan, 2009) is a theory of personal development, human motivation, and well-being. SDT examines human behavior in a social context and the conditions that promote it. SDT is important in my study because it also suggests that in order for any human to have well-being, a set of universal basic psychological needs (i.e., autonomy, competence, and relatedness) must be met (Deci &

Ryan, 2000; Ryan & Deci, 2000; Ryan & Frederick, 1997). SDT provides a lens to understand human dispositions toward development and engagement (Deci & Ryan,

2002). It helps to understand how individuals develop a sense of self by engaging in active curiosity and new experiences centered on self (Deci & Ryan, 2002). SDT is relevant to my study because it contextualizes food desert residents’ developmental outcomes from their social-environmental conditions (Deci & Ryan, 2002). To understand the lives of food desert residents, it is important to examine the social relationships and to contextualize the fact that they reside in food deserts in terms of their well-being. In the sections that follow, I will take a deeper dive into three factors of SDT:

Competence, autonomy, and relatedness.

Competence

Within a social-environmental context, competence refers to individuals’ everyday interactions and their overall capabilities in regard to their life. Competence is a general feeling of confidence when dealing with challenges. In the present study, SDT provides a way to examine how food desert residents deal with the challenges of residing in a food desert during the COVID-19 pandemic. For this reason, the component of competence is important in this study because it helps understand a food desert resident’s need for social growth and well-being (Deci & Ryan, 2000).

Another important component of Competence is that it arises from developing one’s self and augmenting skills through activity. Competence in the context of this study examines a food desert resident’s capability of dealing with new challenges, specifically dealing with an unprecedented pandemic. This point of reference helps examine how

food desert residents understand, cope, and adapt to the changing environment around them (Deci & Ryan, 2000).

Autonomy

Autonomy is another aspect of SDT, and within the context of this study, it denotes the need for food desert residents to believe they are in control of their own behavior (Deci & Ryan, 2000). Autonomy is understood within my research as individuals’ behavioral motivations influenced by their own volition to have a desired outcome of achieving well-being. When individuals control their own actions, they feel a sense of freedom and the capability to express themselves. Before the COVID-19 pandemic, the commonality of life within food deserts was life faced with extreme challenges, such as a lack of access to healthy foods, limited mobility, and social segregation. Once the pandemic hit food deserts, these challenges were exacerbated by national food shortages, stay-in-place orders, and social distancing, along with the economic ramifications the pandemic had. This aspect of SDT theory helps understand what factors motivate a food desert resident to achieve well-being during the pandemic.

Relatedness

Included in SDT theory is the premise that in order to achieve a sense of self- determination, one must also have the feeling of connectedness to others or relatedness.

Relatedness within the context of SDT and my study is having the feeling of connectedness with individuals and with one’s community (Deci & Ryan, 2002). This facet helped examine and understand the social aspects of food desert resident’s life and how their social relationships shape their well-being during the pandemic. For this study,

I examined how food desert residents connected with others and if their relationships

changed from the time before and during the pandemic. This aspect of SDT helped better understand how relationships during COVID-19 play a role or not in a resident’s well- being. It also helped examine if food desert residents felt cared for, connected or cohered to groups, and participated in the sharing of resources (Deci & Ryan, 2000). The relatedness component of SDT provided a way to examine how food desert residents fit into a large social structure within their environment (Deci & Ryan, 2000).

Sensemaking Theory

Maitlis and Christianson (2014) state sensemaking is the process in which people seek to understand events and issues that go against their expectations because they are new, confusing, or ambiguous. Sensemaking Theory provides a lens to understand

(Weick, 1995; Weick, Sutcliffe, & Obstfeld, 2005) a persistent event and how that event influences behavior (Webb & Weick, 1979). While many academics are in agreement on what prompts sensemaking, they diverge on what Sensemaking Theory encompasses. For example, academics diverge on how it is accomplished, its orientation, and the degree to how it is shared (Maitlis & Christianson, 2014: 58). Some scholars state sensemaking is an individual’s cognitive process (Klein, Moon, & Hoffman, 2006), and others state it predominately applies to social situations (Maitlis, 2005) or it is a social construction

(Berger & Luckmann, 1966; Dreher, 2016).

In this study, Sensemaking Theory also works as a tool for the analysis of the qualitative data (Paull, Boudville, & Sitlington, 2013). This allowed for an examination of how food desert residents interpret and respond to their environment during the pandemic (Webb & Weick, 1979). Lüscher and Lewis (2008) state that Sensemaking

Theory provides a way to make sense of nebulous situations, reduces anxiety, and enables action to a challenging situation.

Sensemaking Theory helped recognize if food desert residents evince well-being through their actions. According to Weick et al. (2005), Sensemaking Theory takes into account a situation, such as the occurrence of the COVID-19 pandemic, provides a verbal and ideological context of the situation that can then serve as a motivation for action. The rationale within the social context of a situation serves as a type of guide to provide order to an individual experiencing the event. Sensemaking Theory provided the study with a deeper context to reviewing a food desert resident’s opinion, feelings, and experiences about the social aspects of their life during the COVID-19 pandemic.

My study also used Sensemaking Theory to understand how NPOs were effective or not in helping residents with the social aspects of their well-being and providing food and provisions. Weick (1995) states sensemaking is essential for organizations to handle astounding and perplexing events. Sensemaking Theory is used in this study to understand how NPO’s delivery of service succored a food desert resident during the pandemic. Other scholars state that sensemaking is an important activity for managers that allow the interpretation and understanding of key tasks and goals (Gioia & Thomas,

1996; Smircich & Stubbart, 1985; Thomas, Clark, & Gioia, 1993). This study implies how effectively NPOs reacted to the COVID-19 pandemic. Weick (1993) states that sensemaking is pivotal for organizations within turbulent contexts; it allows for comprehension and social cohesion. In my research, Sensemaking Theory guides my understanding if NPOs have helped food desert residents or not during the pandemic. It also allowed for the understanding of any social processes that occur during the COVID-

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19 crisis (Brown, 2000; Weick, 1993; Weick & Roberts, 1993) to better determine if

NPOs were effective with helping food desert residents with the social aspects of their well-being.

Methods

Methodological Approach

To examine and learn about the social aspects of food desert resident’s well-being during the COVID-19 pandemic, I conducted semi-structured interviews, using Grounded

Theory principles of Corbin and Strauss (1990). By using a qualitative approach of inquiry, I was able to hear detailed and thought-provoking answers to my interview questions (Appendix O) (Corbin & Strauss, 1990). This theoretical approach allowed for the interpretation of the research; it also guided my procedures and the analysis of my data (Corbin & Strauss, 1990: 418). The use of semi-structured interviews with food desert residents provided a framework to collect the data while also allowing for the emergence of findings. The premise of Grounded Theory includes a method of comparison and theoretical sampling (Corbin & Strauss, 1990). This approach is done simultaneously along with coding. This technique allowed for emergent themes leading to the consequential data collection. The data collection concludes at the point of saturation (Corbin & Strauss, 1990) or when no new ideas emerge from the data.

Sample

My sample consisted of 40 food desert residents who reside within the U.S., as shown in Table 9. Thirty-one of the 40 respondents were female. The lack of gender diversity is not a concern because research suggests that women tend to be head of households, especially in poorer families, and thus in charge of food purchases (Mencher

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& Okongwu, 2019; Mullings, 1995). My sample differed in geographical location, household makeup, and other aspects of their lives. Participants were either living with a partner with or without children, living with housemates with or without children, or living alone with or without children. Participants were solicited and contacted through the social media platform Facebook.

Table 9: Sample – Food Desert Residents

No. Female/Male Food Desert Location No. Female/Male Food Desert Location 01 Female Dayton, OH 21 Female New Orleans, LA 02 Female Laredo, TX 22 Female New Orleans, LA 03 Female New Orleans, LA 23 Female Northern, NH 04 Female Washington, DC 24 Male Hudson Valley, NY 05 Female Los Angeles, CA 25 Female Lubbock, Texas 06 Female Cleveland, OH 26 Male Rocky Mountains, CO 07 Male Newark, NJ 27 Female Boston, MA 08 Female San Juan, PR 28 Female Memphis, TN 09 Female Miami, FL 29 Female Rocky Mountains, CO 10 Male Washington, DC 30 Female Memphis, TN 11 Female Newark, NJ 31 Female Minneapolis, MN 12 Female Boston, MA 32 Female New Orleans, LA 13 Male Hudson Valley, NY 33 Female Albuquerque, NM 14 Male Hudson Valley, NY 34 Female New York, NY 15 Female Newark, NJ 35 Female Federal Way, Washington 16 Female Newark, NJ 36 Female Greater Philadelphia Area, PA 17 Female Roanoke, VA 37 Female Cleveland, OH 18 Female Savannah, GA 38 Male Cleveland, OH 19 Female Washington, DC 39 Male Miami, FL 20 Female New Orleans, LA 40 Male Hudson Valley, NY

Data Collection

Between June and September 2020, I conducted 40 semi-structured interviews averaging between 60–70 minutes each. All interviews were conducted by phone due to the contagious nature of the COVID-19 virus and social distancing protocols. Participants were recruited on Facebook. By joining groups that focused on food, food access, and the

COVID-19 virus, I was able to recruit participants from different parts of the U.S. With

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the permission of the participants, the calls were recorded on my mobile phone through the software application Rev. Thereafter, the recordings were first uploaded to my computer, and then files were uploaded on to the Rev website for transcription. I used

Rev’s software transcription services to ensure the anonymity of my participants.

The interview questions segued from asking the participants about their background to asking the participants questions about their lives and experiences before and during the COVID-19 pandemic regarding their relationships, health, mobility, food access, opinions about NPOs, and overall well-being.

Data Analysis

The data analysis began immediately following the third interview. The data analysis included three phases of coding: open, axial, and selective (Strauss & Corbin,

1990). During the first phase, I read the transcripts several times and then listened to the recorded interviews. Thereafter, I open-coded the transcripts line by line. As I read, I noted parts of the transcripts that I deemed “codable moments” or fragments (Boyatzis,

1998). During the axial coding (Strauss & Corbin, 1990), I examined key emergent themes and continued to review literature for greater insight into the themes. A final phase of the data analysis was selective coding which reduces the data to the categories that support key findings. The following section discusses my findings.

Findings

The five findings below discuss how exercise, healthier eating patterns, improved relationships, and Nonprofit Organizational (NPO) efficacious on a resident’s social aspects of well-being and food access programs have positively affected food desert residents’ social aspects of well-being. My data revealed paradoxical findings that

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residents of food deserts had increased well-being during the COVID-19 virus. Along these lines, the following key findings emerged:

1. Nonprofits are effective in helping food desert residents with the social aspects of their well-being and providing access to healthy foods

2. Food desert residents experienced improved relationships with family, friends, and with others in their community, increasing the social aspects of their well- being.

3. While food desert residents had anxiety about COVID-19, there was a silver lining in the COVID-19 crisis: residents experienced more quality time with family, time to slow down, and reflected on themselves and the world around them, increasing the social aspects of their well-being.

4. Food desert residents started or increased their exercise activity: walking, biking, and other activities improved their well-being.

5. Food desert residents had healthier dietary practices: they made healthier food choices, meal planning, eating at home, and eating with family or household members.

Finding 1: Nonprofits are effective in helping food desert residents with the social aspects of their well-being and providing access to healthy foods.

I used Complexity Theory to understand all of the factors of the effectiveness of

NPOs during the pandemic. Using Complexity Theory was imperative to understanding complex environments, such as food deserts; during chaotic disruptions, such as pandemics; and those interconnections to complex organizations that operate with and deal with complexity, such as with NPOs. The findings suggest respondents found NPOs effective in helping them with the social aspect of their well-being and with providing access to healthy food. The comments below provide insight into how NPOs were able to help residents access food. This is in contrast to Study 2’s findings that indicated that food desert residents did not find NPOs effective with the social aspects of their well-

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being. This study found a shift in food desert residents’ perception of NPOs, as residents found NPOs effective in helping with their social aspects of well-being.

NPOs have been working on the frontline of the COVID-19 crisis, sometimes referred to as “second responders” (Deitrick et al., 2020), helping food desert residents with their increased demand for food and other basic needs (Deitrick et al., 2020). NPOs proved they have adaptive capabilities (Prentice, Brudney, Clerkin, & Brien, 2020) during disruptive times (Shi et al., 2020; Young et al., 2020) that increased their effectiveness in food deserts.

Figure 9: Food Desert Resident’s Quotes on Finding Nonprofit Organizations Effective with the Social Aspects of the Well-Being and by Providing Access to Healthy Foods

I held them in high regard…you have to have that compassion and respect for those kind of agencies. (Participant 40)

So, nonprofit work now is important more than ever. (Participant 37)

And those that were helping before you've seen them pivot very quickly, like whatever they, you know whatever areas they were I guess dedicated to before it was like, okay, well, how can we help, like now in this COVID world. And so that was really amazing thing to see those organizations do that. Wow. (Participant 33)

We have a pretty strong food bank here. And they've been doing a lot of work. What are they doing? Like they have boxes, like pre-made boxes of food. You can come in and pick up…. They have a kind that a group of drivers will go and pick up a number of boxes and home deliver for people who like maybe don't have transportation. (Participant 32)

Yeah, I feel like the nonprofits have been very helpful. So we have on called [name omitted] and they have been instrumental in helping our school kids getting lunches. They have been donating food. They've been doing a lot of work. (Participant 30)

The nonprofits, I don't know what some people would do without the nonprofits right now. (Participant 25)

I would go to this other one [food bank] down the street from my house [name omitted] and they have a lot of fresh vegetables, potatoes, and fish, really good quality items. (Participant 19)

I think the nonprofit units have been so good at this time…what they've been doing is they have been making meals for people that have been affected by COVID and they've been delivering food to their houses…it just changes my thoughts around the nonprofit groups. (Participant 13)

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The response to statements extracted from Study 2 examines the opinions of food desert residents on NPO effectiveness. Findings corroborate that residents found NPOs to be effective in helping them with the social aspects of their well-being and were a reliable source that residents could rely upon during the pandemic. For the statements: “When I am faced with a problem, there are plenty of people I can rely on at food banks or nonprofits,” only 5% of respondents disagreed with the statement; “Within the last 12 months a nonprofit organization(s) has helped me improve my life,” only 5% of respondents disagreed with the statement; “Within the last 12 months a nonprofit organization (s) has helped me improve how I feel,” only 7.5 % of respondents disagreed with the statement; and “Nonprofit organizations make a positive impact on my neighborhood,” only 2.5% of respondents disagreed with the statement

Finding 2: Food desert residents experienced improved relationships with family, friends, and with others in the community. I used Self-Determination Theory (SDT) to understand a food desert resident’s feelings of attachment, social connectedness, and the social mechanism linked to the social aspects of well-being. I also used Complexity Theory, as it provided tools to interconnect these relationships for deeper insights. The importance of a food desert resident’s relationships was another finding, specifically in terms of improved relationships with family, friends, and community. During the pandemic, food desert residents improved their relationships by spending more time with loved ones and created new friendships with neighbors. Residents also mentioned the importance of their relationships in their lives and the important role these relationships played in their well- being. Findings are aligned with current research that online social connections helped

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reprieve any feelings of social isolation and provided a way for food desert residents to improve their relationships during the COVID-19 pandemic.

Figure 10: Food Desert Resident’s Quotes on Improved Relationships

I feel like we've all relied on each other more just for emotional support, living 17 miles out of town by choice, you know, like you have to make special trips to do anything or have a log of coordination and planning to do anything, to maintain a friendship where I live. (Participant 30)

We all go for walks every day in the morning with the dog. We play games, we play board games, card games, clean the house…make banana bread…And we spend so much time inside the house so we've gotten a bit closer…. (Participant 17)

Also our relationship before we would get into small little arguments and we stopped talking or something. And then you know we went to work and forgot about it. And it took up a lot of our energy, But now since COVID we're face to face every day, it forces us to talk about our situation and fix it faster than before. (Participant 13)

We do favors [neighbor] and vice versa. So the husband of that couple became ill…she called and asked us to give her ride home cause he was at the hospital…I think the next day I was taking her and her daughter to the store to the supermarket... I think it's probably 10 miles or so to go to the store. (Participant 38)

Surprisingly, I feel like they've [relationships] improved. (Participant 37)

Neighbors have been wonderful because she [an elderly friend] has shared the photographs on Facebook of them leaving food packages on her front step. (Participant 36)

I think if anything, we've become more open with one another [co-workers]. I know a lot more about everybody's personal lives. You know, I think there's definitely been a stronger sense of comradery…yeah, I would say we've become closer. In the beginning of COVID, my dad siblings started doing weekly zoom calls, so we did spend more time talking to them than we normal do my aunts and uncles and cousins. It was nice…. So I mean the unintended consequences that everybody was more connected.... (Participant 35)

Since COVID in general, I think we're checking up on each other a bit more … now we've kind of taken that step to be like, Hey how are you doing? (Participant 33)

But yeah, it's turned me inside, but I also feel like I maybe know my community a bit more. I live in a row of houses that we have like entrances on the ground, but there's a big balcony and we can sit and chat. And once the pandemic started we were the only people each other was seeing, cause you couldn't have friends over...so it has strengthened those friendships which I am really grateful for. (Participant 32)

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Finding 3: While food desert residents had anxiety about COVID-19, there was a silver lining in the COVID-19 crisis: resident’s experienced more quality time with family, time to slow down, and reflected on self and the world around them increasing the social aspects of their well-being.

I used Sensemaking Theory as a lens when analyzing of a food desert resident’s statements on life uncertainties brought on by COVID-19. Complexity Theory provided a lens to understand the complexity of the COVID-19 and all of the ramifications of the crisis. My analysis revealed that while the respondents experienced anxiety and fear about the COVID-19 pandemic, there was a silver lining to the virus. Residents experienced increased well-being while spending more time with family and friends.

During the pandemic, residents experienced a slowing down in their lives where they have taken the opportunity to appreciate nature, their relationships, and have taken the time to reflect on their own lives. This finding corresponds to research that unfathomable experiences that cause negative consequences and occurrences can provide opportunities for growth. In this study, food desert residents improved their well-being by socially connecting with others and improving relationships. Residents also experienced a deeper sense of gratitude for their family and friends.

Figure 11: Food Desert Resident’s Quotes on COVID-19 and Their Well-Being

You know, there's a silver lining and all of it, and that is you know we're probably rethinking a lot of things, life, et cetera, families, you know, and how people are feed, food systems…. (Participant 25)

So my book, the book I'm writing about is about appreciating what you have while you have it. So before I stared the book in 2018, and when the virus struck to me, it brought so much value to what I was writing that it was like an injection of steroids, it was something like, wow, this really is making the point of my book, really stand out that we shouldn’t take things for granted. Naturally, the virus brought my book, but the epitome of my book into focus that you shouldn't take things for granted, you should appreciate what you have while you have it. COVID-19 has exposed so many things and our infrastructure is it's the most, it's such a beautiful it is. COVID is such a paradox. It is a blessing and a burden and it has 108

exposed. Like I said, so many things in our infrastructure, it shows that people should be paid more like the grocery workers, like the teachers, like the day-care provides, like the social workers, it shows that that these things matter so much more, the grocery clerk that's 65, you know taking your money and, you know taking your cash and helping you in the store. Those things matter. And they're getting so underpaid, it's atrocious. So I think that the pandemic has exposed things that must be changed and nonprofit and no exemption, they deserve more respect for sure. Now when the virus struck [name omitted] it really assessed, it just, it just made it really validated….it really has been a such a paradox, it’s been a beautiful, a beautiful burden, that's the best way to put it a beautiful burden. It's been a revelation to people. I think, I think it's helped people understand and appreciate what they have, what they don't have, that people in their community that do the things that they take for granted, the bus driver, the subway worker, the clerk at the grocery store, those things, have been illuminated by this virus. And I hope I pray that people, these people are paid better and respected more it a beautiful burden has been the Coronavirus. I mean I had more free time. I was able to, to go out and do some extracurricular activities I like to do more. It did give me time to plan how to restructure my life in ways that, so yeah, I would say there were some positives. (Participant 40)

After COVID the benefits are more family time. During my time off, it was really nice to be around them, going home to be around them. I really appreciated, I love knowing that with the time that was open, people got the time opportunity to relax or take care of their well-being. (Participant 37)

I hope to continue after the new normal to continue my new habits, that's what I want to continue." "So I will say that I almost felt guilty for even thinking my well-being has improved knowing how bad others have it now… And so suddenly having this dramatic change was something that I needed... Yeah, so you feel a little guilty for that inequity, like enjoying your life now because of what's going on..." " It was an opportunity to be able to be able to refocus and figure things out...to take that breath and say okay, now let me figure everything else out. (Participant 33)

You know; I'd like to look at some positive things. I think, you know, long term there'll be some outcomes that might help family life. (Participant 29)

Before it was every man for himself, you know, but during this crisis now it's like people have more generosity, I have seen a lot of generous people helping other people out. (Participant 27)

But no it like if I compared before and after my life is a million times better now. Yes, I would actually, I mean, I grew so much during this, this the virus…I have inner strength … I got more active. It's a million percent better. (Participant 24)

So it's kinda like teaching people to help out, not be so selfish…be like more open your eyes to the world around you because you're not, you all share the same home, same earth, the same community so we need to protect it. … It just made me realize the social aspects of things we take for granted, you know we shouldn't take them for granted like our friends and family and relationships and the social life thing. (Participant 17)

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Finding 4: Food desert residents started or increased their exercise activity: walking, biking, and other activities which improved their well-being.

I used Self Determination Theory (SDT) to interpret a food desert resident’s behavior during COVID-19. SDT was also used to understand if COVID-19 had any type of impact on a resident’s behavior. I used Complexity Theory to better understand the impact of the system failures (e.g., health, economic, and government) on a resident’s life. My data suggest that food desert residents participated in increased physical activity to attenuate stress and socially engage with others during the COVID-19 pandemic. The findings shown below in the residents’ statements elucidate how exercise is either used as a coping mechanism or a means to socially engage with others.

Figure 12: Food Desert Resident’s Quotes on Increased Physical Activity

It's [biking] a great stress relief and that's always needed for anybody. Everybody needs an outlet, whether it's creative or spiritual, whether it's emotional, everybody needs and outlet. And so biking is one of mine. It releases any stress. It's a good way to decompress after a long day, long week, it's physical, it benefits you physically, mentally, emotionally, spiritually. It's one little thing that that fits almost all of those parameters of, of good well-being and social well-being. So man. Yeah, it’s been wonderful.... (Participant 40)

But now with COVID I am walking everywhere I go. So I'll walk upwards of like five to 17 miles, depending on where I need to go and I need to get done…I think before COVID I would be taking public transportation, but I noticed that my health overall has completely improved with the walking. (Participant 37)

I think I've done more the outdoors. Yeah, I bought a kayak, so I've been doing that and fishing, camping. So I've done more activity as I have more spare time. (Participant 38)

I get out and I take walks not only to get my groceries or, my medication or whatever, but if I order food, instead of having it delivered, I'll go and pick it up…I mean maybe if I hadn't been walking, I would have gotten a diagnosis of severe depression, not moderate. (Participant 36)

I do feel isolated, I get out and I go for a walk by the water or I go to Central Park. (Participant 34)

And then once it happened and people were furloughed or unfortunately losing their jobs fully and the thing like that there was a difference, there was a change there. You saw people able to you know, go out and take a walk. I saw a lot more people started taking the same path that I was taking, either riding their bikes, or running. It's a lot of people I didn't see before. (Participant 33) 110

We'll do outdoor play dates, you know physical distancing…yeah, and going camping and stuff like that. We've tried to, you know, maybe appreciate the outdoors a little bit more and cherish the few interactions that we get with my friends, kids, things like that. (Participant 30)

I have been forcing myself to move as much as possible when I can like physical movement, which is why I prefer meeting friends for a bicycle ride or a walk. I feel healthier. (Participant 27)

My thinking is more clear, … I walk between 2 and 4 miles a day. (Participant 24)

So I think there's a lot of things ... it was a lifestyle change, um and the funny thing is my daughter has recently lost a bunch of weight, she's not working so she's been riding her bike and going for walks. (Participant 18)

Literally I went off the trail. I walked 34,000 something steps. Yes, I did that. Holy crap, you realize that was 14 and half miles. (Participant 23)

Finding 5: Food desert residents had healthier dietary practices: resident’s made healthier food choices, meal planning, eating at home, and eating with family or household members. I used SDT to understand changes in behavior of food desert residents during the pandemic. Food desert residents also stated that they were eating healthier foods, eating more meals at home, and eating meals with others. Due to stay-at-home orders and the closing of local food venues with their neighborhood, many food desert residents ate more home-cooked meals. They also planned more meals and food shopping and made a conscious effort to eat healthier foods. Residents expressed feeling healthier.

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Figure 13: Food Desert Resident’s Quotes on Healthier Eating Patterns

Now that I am walking that amount, I just don't think about the fast food as often. (37)

And you know there are obviously benefits to being able to take the time to exercise and do everything. So a big part for me has been actually cooking at home more. Before COVID I was not very healthy, now with COVID you don't have an excuse to get other there and go running and move around a bit. My health has dramatically improved everything from mental health and we hear constantly how mental health is tied to physical, so many people that I know are trying to take this opportunity to be active. So it was like getting from eating out every day to cooking. And then now it’s being more conscientious of what I'm cooking. (Participant 33)

It made me shop a lot healthier, completely healthier. (Participant 24)

I keep fruit in a bowl so I can see it. Cause it makes me feel, it gives me this feeling of abundance when I can see it really. Okay, you're like oh god I hit the jackpot…it makes me feel like gratitude, it makes me feel grateful that I have all this wonderful food. (Participant 19)

My goals were to lose two to three pounds a month. Nothing too drastic…so I was down by March, was down like 11 pounds, Wow. (Participant 16)

So that's one positive thing is that we've been eating more vegetables, you know and trying out new things. Participant (13)

Discussion

Many researchers are calling the COVID-19 pandemic a Black Swan (Taleb,

2007) event. This is due to the surprising and disruptive nature COVID-19 has had around the world. Using Complexity Theory provided me with tools to understand all of the challenges and implications the pandemic had on food desert residents.

Understanding all of the moving parts or agents involved in a food desert resident’s life during the pandemic allowed for a greater discovery and identification of paradoxical findings.

Relatively little is understood about how the COVID-19 pandemic affects those residing in food deserts. This is understandable because, as of the time of this writing, we are in the midst of the pandemic. The limitations of what we know about the COVID-19

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virus are increasingly apparent; hence, the justification for conducting this research.

Thus, this study was designed to examine food deserts in this context and the challenges of residing within a food desert during the pandemic. This study is concerned with how the virus affects the social aspects of food desert residents’ social aspects of well-being. I examined food desert residents’ daily life including their physical activity, food habits, their relationships, and whether NPOs are effective during the pandemic from the perspective of a resident.

The Role of NPOs during the COVID-19 Virus

The data provides evidence for the claim that nonprofit organizations (NPOs) are effective in helping residents with their social aspects of well-being and with access to healthy foods during the pandemic. This is noteworthy because during the pandemic, more than 1 in 10 American families did not have enough to eat (DeParle, 2021).

Respondents answered questions extracted from my second study to evaluate

NPOs on the social aspects of well-being; the majority of respondents answered strongly agree on NPO effectiveness. When asked their opinion on NPO effectiveness during the pandemic, respondents expressed their gratitude and appreciation for the hard work NPOs are doing during the pandemic.

COVID-19 as a Paradox

Contrary to my expectation, the general picture emerging from the analysis is that the COVID-19 pandemic has provided the opportunity for residents to improve their well-being. Respondents mentioned they had more time to spend with family. They also mentioned the ability to connect and reconnect with friends. During the pandemic, residents have improved their relationships with their neighbors and created new

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relationships within their community due to the pandemic. Respondents reported increased or new activity of physical exercise and healthier eating habits. All of these findings go against the hypothesis that COVID-19 may only have negative effects on a person’s well-being (Blasco-Belled, Tejada-Gallardo, Torrelles-Nadal, & Alsinet, 2020;

Zacher & Rudolph, 2020).

Increased Physical Activity

The benefits of exercise have been acknowledged since the 1800s (Hickman,

2013). Since then, many organizations have promoted and established the idea of the use of exercise and green spaces to improve well-being (Masterton, Carver, Parkes, & Park,

2020). Research implies the benefit of exercise can reduce chronic diseases (Warburton

& Bredin, 2017), lowers the risk of premature mortality (Rhodes, Janssen, Bredin,

Warburton, & Bauman, 2017), and improves the self-perceived quality of life (Laforge et al., 1999). Studies also show that physical activity helps with bouts of depression, anxiety, anger (Hassmen, Koivula, & Uutela, 2000), and helps improve well-being (Abd

El-Kader & Al-Jiffri, 2016; Tulloch, Bombell, Dean, & Tiedemann, 2018). These studies reveal the importance of exercise is in order to have a healthy body and good well-being.

My study is significant because there is little research that focuses on the physical exercise within food deserts. Scant attention has been paid to how exercise improves food desert residents’ well-being.

My first finding established a connection between food desert residents’ exercise during the pandemic and their improved well-being. The time gained during the lockdowns allowed residents to engage in more physical activity. Many connections are explored for the first time in this study that were not raised in Study 1 or Study 2. Study 3

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explored the connection between how many of the residents mentioned walking, biking, and other forms of physical activity during their COVID-19 lockdown. They also mentioned COVID-19 was a sort of boon, albeit the virus was viewed as a negative.

Some of the respondents mentioned exercising in a natural setting or an urban green space, promoting social interaction and increasing social aspects of well-being. Thus, exercise was also a social activity as being outside with a mask allowed residents to remain socially distant from friends but still connect as they exercised together; the positive health effects residents felt helped them improve their well-being.

Healthier Diets and Eating Practices

The picture emerging from my analysis is that food desert residents are eating healthier foods during the pandemic than prior to when the pandemic started. Residents reported planning out their meals to ensure they were eating healthier and to make sure they were not spending above their budget. As food desert residents found themselves unable to go out to restaurants, they are eating more home-cooked meals at home with their family or with whomever they live with. Residents reported enjoying the opportunity to eat meals with others compared to before the pandemic when life had been

“crazy” or “always on the go.” Residents also reported that the lack of foods available in supermarkets caused concern. However, during the pandemic, food banks had improved their food availability to include fresh fruits and vegetables, dairy products, and fresh proteins, such as ground turkey and fresh fish.

My study provides the validity that food desert residents find healthy foods an important constituent of their diet. Contrary to much of the research that emphasizes that food desert residents won’t change their eating habits if they had access to a

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neighborhood supermarket (Dubowitz et al., 2015; Ghosh-Dastidar et al., 2017; Roussy,

2014), this study suggests otherwise. Eating healthier foods leads to good health; good health leads to feeling good or having good well-being.

All of the challenges brought on by the pandemic have caused many individuals to feel physically and emotionally enervated. My findings find preliminary evidence that food desert residents have created stronger social relationships during the pandemic.

These stronger relationships have helped them deal with the asperities of the pandemic.

Rather than be weighed down by COVID-19, residents are experiencing closer relationships with their families, friends, and within their community. Thus they have experienced improved social aspects of their well-being.

Limitations

While the data is reliable, it was not diverse, which might not allow for the generalization of the food desert resident population. While this does cause some non- conclusive assumptions about the study, overall, this study provides strong findings.

However, a more diverse sample would have allowed for a more robust data collection.

The sample size was small, comprised of 40 food desert resident respondents. I made efforts to collect both a diverse and large as possible sample; however, most of the respondents who agreed to be interviewed were women, and the saturation occurred around the fortieth interview.

Another limitation was that food desert residents were asked to speak about past experiences and opinions before the COVID-19 virus. The accuracy of a respondent’s memory varies, and it is possible that the respondent’s statements were incomplete or biased given the context of the interview. However, I did ask questions about recent

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experiences and opinions right before the pandemic hit, which is a time frame within the year allowing for better precision in the respondents recalling their past.

Implications and Future Research

Implications for Academia

The aim of this study was to understand what influences the social aspects of a resident’s well-being. One of the central claims of the study was the underlying importance of a resident’s social life during the pandemic. This study provides academics with findings that clarify the role of social ties and the important role it plays in affecting a person’s well-being. Furthermore, it provides preliminary research on the importance of relationships in one’s life during a time of crisis.

Implications for Practitioners

This research helps practitioners of nonprofits organizations (NPO) understand the underlying factors that make up the social aspects of well-being for food desert residents. By understanding these factors and what influences food desert residents’ well- being, NPOs are better positioned to meet their goals of helping food desert residents achieve well-being. This study provides a framework for NPOs to understand how relationships play a role in helping food desert residents achieve well-being.

Future Research

This study allowed for a greater understanding and a vicarious examination of food desert residents’ lives as they are dealing with the pandemic. Findings from this study revealed that the compositional factors that influence a food desert resident’s well- being have been essential for helping them overcome any type of lassitude of anxiety and fear brought on by the COVID-19 virus.

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It can be concluded that to have a greater understanding of the social aspects of a food desert resident’s well-being, future studies should be conducted. Future research should include longitudinal studies on residents’ well-being to gain a deeper understanding of how the pandemic is affecting a resident’s life. A longitudinal study would allow for the collection of multivariate data and allows the researchers to clearly define variables (Carlson, 1998) and identify links between extrinsic influences and intrinsic outcomes due to the pandemic (Russo, Hanel, Altnickel, & van Berkel, 2020;

Zacher & Rudolph, 2020).

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CHAPTER 6: CORE AND INTEGRATED FINDINGS

…the other America… – Dr. Martin Luther King Jr. (1967)

Core Findings

It has been over 50 years since Dr. Martin Luther King Jr. designed the Poor

People’s Campaign, an effort to improve the socio-economic conditions of “the other”

Americans left behind by the American Dream (Laurent, 2019). In the spirit of the same vein, I began this research to understand the pockets of communities in the U.S. that experience this “otherness” Dr. King references. I started this exploration by understanding how food desert residents face their daily life challenges and the factors that counter these challenges and improve a resident’s well-being. This dissertation incorporated three studies to examine the social aspects of well-being in food deserts and how effective nonprofit organizations (NPOs) are in helping food residents achieve it.

Taken as a whole, the three studies yielded corresponding knowledge and insights to help

NPOs implement socially innovative approaches to their delivery of services. NPOs can be in a better position to help those who lack access to basic needs and improve their human development by helping with their feelings of social connectedness and social inclusivity. NPO managers that understand the teeming systems that make up a food desert and the context of how those systems affect a food desert resident’s well-being can improve their delivery of services to help their clients thrive and flourish.

Each study presents insights into the thoughts and experiences of food desert residents, and all three together provide a perspective on how food desert residents achieve well-being and the components of their social lives that add to their well-being in the face of the challenges posed by living in a food desert. These perspectives are 119

important as they can offer NPOs guidance on how to have a greater social impact on the social aspects of well-being within food deserts. This research suggests NPOs need to understand their clients’ needs and gain knowledge of how problems in complex environments impact their clients’ lives. This is shown below in Table 10. Table 10 is updated from Chapter 1, and it now includes the results of each study.

Table 10: Research Study Summary with Results

Study Phase Research Sample Motivation Results and Method Question

Phase 1 – What 20 Food The aim of this Emerging Factors: The importance of Social Qualitative factors Desert initial study Interaction, Access to Healthy Foods, and the influence Residents sought to occurrence of Malnutrition on a food desert resident’s Grounded well-being within New understand how Well-Being. These factors help generate knowledge on Theory, Semi- in residents York City food desert how residents achieve well-being and nonprofit Structured of food and Orange residents achieved organizations moderating factors. The main findings Interviews well-being by are below: deserts? County, NY using identified patterns of access. Food desert environments influence food choices. Social Interaction improves a resident’s well-being. Residents do not practice healthy dietary practices. Residents prefer to shop at supermarkets vs. online to socially engage with others.

Phase 2 – Are Food Desert The purpose of Nonprofit organizations (NPOs) moderate the effect of Quantitative nonprofit Residents this study was to malnutrition for food desert residents. Social organizatio within the understand the Interaction has a strong positive effect on a resident’s Anonymous ns effective United States factors that make well-being. The findings in this study affirm the Surveys in helping NPOs effective in importance of the social aspects of well-being for food food desert 392 helping food desert residents. It also sheds light that NPOs are not desert residents addressing this aspect for food desert residents. The residents with the social main findings are below: with the Respondents aspects of well- social being. Food desert residents found NPOs effective in aspects of helping them with their malnutrition, but not with well-being? access to healthy food, or with the social aspects of well-being (contrasts Study 3). Social Interaction has a strong positive influence on a resident’s well-being (similarly to Study 1). Residents did not associate healthy food to well-being (similarly to Study 1). A resident’s malnutrition diminished their well-being.

Triangulation No research This is a Bridging of The meta-inference analysis suggests that the social Phase question. combination themes for the aspects of a food desert resident’s life is important to of Phase 1 interpretation and their well-being and nonprofit organizations (NPOs) Integration 1 of and Phase 2. explanation of need to improve their effectiveness of delivery of data through qualitative and services in the area. NPOs do play an important role in triangulation quantitative data. helping food desert residents with access to food.

Meta-inference results of Phase 1 and 2

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Study Phase Research Sample Motivation Results and Method Question

Phase 3 – During the 40 Food This study was During the COVID-19 pandemic, food desert residents Qualitative COVID-19 Desert conducted to found nonprofit organizations (NPOs) effective in pandemic: Residents examine food helping them with the social aspects of their well-being What within the desert residents’ and with access to healthy foods. Paradoxical findings factors United States social aspects of are that food desert residents improved the social influence well-being during aspects of their well-being during the pandemic. the COVID -19 Residents also improved their health. Findings in this well-being pandemic. It study are contradictory to Study 1 and Study 2, in residents examines the implying NPOs improved effectiveness of delivery of of food relationship services during the COVID-19 pandemic. The main deserts? between the findings are below: Are COVID-19 nonprofit pandemic and a NPOs are effective in helping food desert organizatio resident’s well- residents with social aspects of their well-being ns effective being. It also (contrasts Study 2). in helping examines the role food desert of NPO A resident’s social life/relationship has a positive residents on effectiveness on influence on their well-being (similarly to Study 1 the social the social aspects and 2). aspects of of well-being within a food Food desert residents improved their relationships well-being? desert. during the pandemic; they also improved their overall well-being.

Residents mentioned the importance of exercise on their well-being (contrasts Study 1).

Residents had healthy dietary practices (contrasts Study 1) and mentioned healthy food in regard to their well-being (contrasts Study 1).

Triangulation No This is a A review of The significance of the social aspect of a resident’s Phase research combination findings from all well-being is a common thread in the narrative of this Integration 2 question. of all three phases. dissertation. Integrated findings imply NPOs can play Phases:1 - 3. an important role in helping food desert residents with the social aspects of their well-being and with facing the challenges of residing in a food desert environment.

In Study 1, the findings showed that the social aspects of well-being are important for food desert’s residents and that food desert residents face challenges due to where they live. This study discovered that food desert residents achieved well-being by socially engaging with others, giving them a feeling of freedom and an enhanced quality of life.

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This study confirmed that food desert residents are faced with challenges such as a lack of access to healthy foods, limited mobility or transportation options, and resultant poor dietary habits. The results demonstrated two things. First, to be able to help food desert residents, NPOs should know that the social life of a food desert resident is central to their well-being. Second, the persistent challenges of residing in a food desert have not been mitigated; social innovative approaches could attenuate these challenges. In Study

2, I ask food desert residents their perspective on how effective nonprofits have been in helping them with the social aspects of the well-being.

In Study 2, the independent factors were derived from Study 1 to include the challenges, such as access to healthy foods, malnutrition, and social interaction. This study investigated the effectiveness of NPOs moderating these independent factors on well-being and affirmed that NPOs effectively helped food desert residents reduce the occurrence of malnutrition. This is important, given the negative health effects correlated with malnutrition, such as cancer, infections, obesity, and diabetes. This study also corroborated findings from Study 1 that social interaction has a strong positive effect on well-being. This study further supported the factor of the social context of well-being and its significance in a food desert resident’s life. However, while NPOs helped residents with access to food and mitigated a resident’s malnutrition, they were not effective in helping residents with the social aspects of their well-being. This suggests that complex interconnections of a resident’s life influence a resident’s social aspects of well-being.

NPOs could be better positioned to help residents if they are cognizant of the social conditions of a resident’s environment, living conditions, and their everyday life. In

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Study 3, these aspects are examined by comparing a resident’s life before and during

COVID-19.

Study 3 found that during COVID-19, food desert residents improved the social aspect of their well-being due to increased social connectedness, which strengthened their relationships. Residents also achieved well-being with increased physical activity and by eating healthier. This helped improve their well-being and deal with the stressors of residing in food deserts during the pandemic. This study found NPOs were also effective in helping residents with the social aspects of well-being. Food desert residents found the service delivery of NPOs effective in helping them access healthy foods. During the pandemic, residents improved their well-being by practicing healthier eating habits, including planning meals, eating healthier foods, and eating meals with others. This is a stark contrast to Study 1, where meals were not planned and healthy foods were not consumed. This finding demonstrates that food desert residents want to eat healthy foods and socially engage with others. During COVID-19, food desert residents also improved their well-being by strengthening relationships with family, friends, and neighbors. This was another contrast to Study 1, as food desert residents in Study 3 improved their well- being through physical exercise, either by walking, biking, gardening, or activities set in nature.

Integrated Findings

The integration of my three studies through meta-inference and triangulation

(Tashakkori & Teddlie, 2008) provides the framework for this dissertation. Conjointly, the three studies, via a mixed-methods approach, allow for the triangulation of understanding real-life storylines and the perspective of the person providing their life

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story (qualitative). This allowed me to triangulate with quantitative findings and enabled me to interpret quality of life (positive emotions, engagement, relationships, meaning, and accomplishments) (Seligman, 2011) or well-being in the research (Klassen &

Murphy, 2020). The first integration point occurred after Study 2 when I reviewed the findings from both Study 1 and Study 2. The second integration point occurred after

Study 3 when I reviewed all three studies to form my overarching findings and implications.

Integration 1

In Study 1, I found that food desert residents achieved well-being by social engaging with others at supermarkets. This led to the inclusion of the social aspects of a food desert resident’s life as a determinant of having well-being. In addition to the challenges of a resident’s well-being, such as lack of access to healthy food, malnutrition, lack of mobility, and social segregation, the social aspects of a resident’s well-being were examined. Study 2 was conducted in order to investigate the effectiveness of nonprofit organizations (NPOs) in helping residents with the factors that challenge them in their daily lives and with the social aspects of their well-being. Incorporating the findings of these two studies serves as a coda for integration 1. The takeaway is that social support networks, social relationships, and aspects of a resident’s social life have a highly positive effect on a resident’s well-being. The fact that residents in both studies did not find NPOs effective in helping them with the social aspects of their well-being pointed out that NPOs should improve their delivery of service to improve in this regard.

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Integration 2

Study 3 examined a food desert resident’s life before and during the COVID-19 pandemic. This study brought in COVID-19 as a new element because the research was conducted during the pandemic and the implications of the serious life risks of residing in a food desert. The second integration points to contradictory findings of earlier studies, as well as paradoxical new findings. During COVID-19, food desert residents improved their dietary and exercise habits and found NPOs effective in helping them with their well-being. This finding points to the fact that food desert residents exhibit self-efficacy in their well-being and that NPOs can play a positive role in helping food desert residents with the social aspects of their well-being. As in my previous studies, the results of Study

3 confirm the substantial role social relationships play in a food desert resident’s well- being. Taken altogether, the two integration points present evidence to increase their effectiveness within food deserts NPOs should consider the social aspects of a resident’s well-being when designing their programs.

This dissertation aims to understand the perspectives of a population in the U.S. in order to provide a basis for NPOs to become more effective on the factors examined in my research. The 23.5 million Americans that reside in food deserts face challenging problems due to lack of access to basic needs and social segregation. This dissertation identified environmental, living conditions, and everyday life factors (Figure 14) that play key roles in affecting a food desert resident’s well-being. Understanding these factors plays a key role in NPO effectiveness in helping residents with the social aspects of their well-being.

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Figure 14: Environment, Living Conditions, and Everyday Life in Food Deserts

Adapted from Curtis, Kvernmo, and Bjerregaard (2005); Photo: Warren Kalaski for the Washington Post/Getty Images

Implications for Practice

Reviewing the studies, the following recommendations provide guidance on how

NPOs can be effective within food deserts. These recommendations are applicable to other populations that face a lack of access to basic needs and adversity due to their environment.

The first phase of the research revealed the importance of social aspects of well- being. By providing a social aspect context within their service delivery of programs,

NPOs will help their clients’ well-being. This translates to residents having greater health and socio-economic opportunities due to their enhanced well-being.

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The second phase of the research confirmed the importance of a resident’s social aspects of well-being. In addition, it confirmed (in accordance with the literature) that

NPOs do play a role in helping food desert residents curb malnutrition. However, their lack of effect on the well-being of residents suggests that existing programs need to be modified or expanded to address the social aspects of well-being.

The third phase of the study showed that food desert residents want healthier diets, their social relationships are significant to their well-being, and that they practice self-efficacy by exercising. These findings show that even in crisis mode, NPOs can improve their efficiencies to increase their social impact. For example, in this phase, food deserts found NPOs to be effective on the social aspects of well-being and with helping them access healthy foods. Food desert residents mentioned that NPOs started using different delivery of services methods and that NPOs helped them with the social aspects of well-being. This suggests that NPOs could have improved practices and social impact through social innovation. These findings differ from Study 2 where residents did not find NPOs helpful with mitigating their feelings of perceived social isolation, thus not helping residents with feelings of loneliness, feeling isolated, or feelings of sadness.

Feelings of disconnectedness and perceived social isolation diminish well-being and health and increase mortality rates in adults.

Adapted by McGrath and Bates (2017), the main achievements, including contributions to help NPO practitioners, can be visualized in the Know Your Client Model

(Figure 15) that can help with the effectiveness of NPOs on the Social Aspects of Well-

Being in Food deserts.

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Figure 15: Know Your Client Model NPO Effectiveness on the Social Aspects of Well-Being in Food Deserts

Use this Know Your Client Model and identify the factors that influence the social aspects of your client’s well-being. Also use this model to explain the factors that may pose challenges to a food desert resident’s daily life and their well-being. The model itself is formed in multiple circles representing both an attractive aesthetic and areas that can be associated with well-being.

The Know Your Client Model contains foundations in Nonprofit Organizational Effectiveness Theory, Complexity Theory, and Social Innovation Theory. It calls upon these theories to inform managers of their industry, for preparedness of the complexities of their project work, and it offers managers new innovative practices for social-impact-delivery of services. The model also includes Dawson and Daniel’s (2010) four elements as a guideline for creating sustainable change.

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HOW TO USE THIS MODEL Managers should strive to understand the four elements when trying to have a social impact within food deserts. The proposed four elements are: a. people b. the challenge (which may be a problem or an opportunity) c. the process (by which the challenge is negotiated and understood) d. the goal (resolution of challenge toward to the objection of increased well-being) (Dawson & Daniel, 2010: 16).

Managers should have boots on the ground to identify and research to build knowledge on the externalities and systems that impact and make-up the area that they serve and how they impact a food desert resident’s social aspects of well-being.

Form Primary Teams to segment knowledge building on their area and to build relationships within the community. Managers should not only gather data and other facts, but gain a perspective of a food desert resident’s opinions and feelings on how the social aspects of their well- being can be improved. Focused teams would include: Red Team - Food Environments, Blue Team– Living Conditions, and Yellow Team Everyday Life.

Once Primary Teams have successfully gathered their preliminary information. Teams are dissolved and reorganized to create Secondary Teams. Secondary Teams take a deeper dive into their area: Purple Team - Food Environments on Living Conditions, Orange Team - Food Environment on Everyday Life, and Green Team - Living Conditions on Everyday Life.

Understanding the well-being of your client is difficult. Managers should expect building their knowledge on how to help food desert residents will be complex and nonlinear. This is shown above in the overlapping areas that influence a food desert resident’s well-being.

Applying social innovative approaches when creating programs will help managers with changing the inputs and outcomes of their delivery of services.

Managers should revisit the Know Your Client Model during project work to understand emerging changes in the area that they serve.

QUESTIONS TO ASK What does the client need and want to improve the social aspects of their well-being?

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What social innovative approaches are needed to create impactful delivery of services on the social aspects of well-being in food deserts?

All three studies were conducted with the premise that findings could help NPOs be more effective in their missions of helping their clients lead better lives. At the same time, this dissertation seeks to improve the effectiveness of NPOs within food deserts in the U.S. with empirical evidence that delivery of service programs should encompass the social aspects of their client’s well-being. The implications of the studies and the integrated findings of this dissertation apply to NPOs who serve communities at a local, national, and global level. This dissertation provides knowledge to NPOs to meet complex challenges and aid with the achievement of the United Nations Sustainable

Development Goals (SDGs). The SDGs are 17 interconnected global goals designed to be a blueprint for a more sustainable future for all by 2030 (United Nations, n.d.).

Complexity Theory provides an understanding of how complicated and chaotic achieving SDGs can be for NPOs. It also provides an insight into how the various SDGs within my study are interconnected and how they cause a network effect within food deserts (Mazzocchi, 2016). Each SDG goal within my study can be viewed individually or as a node or link (Barabási, 2012) that are connected and interacting together as a system (Mazzocchi, 2016). The following SDGs are addressed in this dissertation (Figure

16): Goal 2 – Zero Hunger, Goal 3 – Good Health and Well-Being, Goal 9 – Industry,

Innovation, and Infrastructure, Goal 10 – Reduced Inequalities, and Goal –11 Sustainable

Cities and Communities.

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Figure 16: United Nations Sustainable Development Goals (SDG)

Adapted from Harrison (2018), Illustration Remie Geoffroi (2018); unsdg.com

Implications for Theory

NPO effectiveness has held the interest of researchers for decades. Despite this constant attention, NPO effectiveness still needs a framework on how to define and measure it. The studies point to the fact that NPO effectiveness measurement should include a social context. These components help clarify NPO effectiveness and pave a new avenue to consider further research. There is also limited research providing clarity of NPO effectiveness measures. Researchers have had difficulties defining NPO effectiveness due to the various measurements across social sciences (Lecy et al., 2012).

The research on NPO effectiveness is considered inconsequential by critiques for this 131

reason (Herman & Renz, 1997). This limitation occurs when trying to define NPO effectiveness in generalizable terms. The three phases also imply that research conducted on disadvantaged communities should include individuals’ perspectives being considered within the research. Within each phase, the social aspects of well-being were significant, and overall, the studies add to the dialogue of well-being.

Limitations

The overall goal of this thesis was to expound on NPO effectiveness on the social aspects of well-being. It does so without any previous model to draw upon. Qualitative

Studies 1 and 3 have limitations. For Study 1, the sample size of 20 was small. This may cause a validity issue given the small sample size may not be generalizable and representative of the food desert resident population. Both studies lacked a diverse sample. For Study 1, the small sample size places a limit on the diversity of the sample, while in Study 3, the sample lacks gender diversity having fewer male respondents.

Study 2 had limitations given the sensitive topics included in the survey. These topics included access to food and the reliance on food banks, questions about food insecurity, and the inability to provide food for oneself and family. Due to these topics, survey respondents may not have answered some of the questions honestly, which is a concern with self-reported data.

Race and income are strong factors when examining food deserts. In Study 1 and

Study 3, race and income data were not collected. Another limitation is the varying geographical location of food deserts found in the studies. My sample consists of food desert residents from across the U.S. Comparing an urban food desert experience to a remote rural food desert experience presents different challenges to its residents. Thus,

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the diversity in my sample may cause a limitation and threat to the generalizability of my data.

Future Research

Further research is needed on organizational collaboration to improve the chances of addressing one of society’s nocuous issues: residing within a food desert and how that affects the social aspects of well-being. Well-being issues within food deserts in this context are viewed as “metaproblems” that can exceed the capacity of a single organization. Metaproblems are essentially manifested social issues that are often exacerbated within certain environments (Westley & Vredenburg, 1991).

The COVID-19 pandemic exposed all of the U.S.’ system failures, such as our food system, health care system, education system, emergency response system, and also our justice system. However, it also showed various nonprofit organizations (NPOs) and the business sector forming partnerships in response to the COVID-19 pan The CEO of

JPMorgan states, “The fault line is inequality. And its cause is staring us in the face: our own failure to move beyond our differences and self-interest and act for the greater good” (Egan, 2021). This research would provide a way of measuring effectiveness through a collaborative process using social innovation. A mixed-method approach would allow for a rich collection of data, beginning with a qualitative study, a researcher could identify constructs that can be later used in a follow-up survey to NPO practitioners. This qualitative research would examine NPOs’ consideration of the social aspects of well-being programs and how they might work with the business sector to improve their programs. Cleveland Roots is an example of an NPO that has formed partnerships (clevelandroots.org) to increase its effectiveness in helping food desert

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residents in Cleveland, Ohio. Cleveland Roots addresses United Nations Sustainable

Development Goals (SDG), shown in Figure 17: Goal 2 – Zero Hunger, Goal 10 –

Reduced Inequalities, and Goal –11 Sustainable Cities and Communities.

Figure 17: Cleveland Roots Partnerships Help Food Desert Residents in Cleveland, Ohio

Adapted: clevelandroots.org; unsdg.com

Cleveland Roots’ mission is “helping communities thrive” with goals to help food desert residents access healthy foods and create a sense of community within food deserts

(clevelandroots.org). One of Cleveland Roots’ NPO partners, Stone Soup CLE, connects individuals with healthy rescued food that would have otherwise wind up in landfills

(stonesoupcle.org). Besides Cleveland Root, Stone Soup CLE also has formed partnerships with Case Western Reserve University, Hunger Network of Greater 134

Cleveland, caterers, restaurants, and grocery stores to fulfill its mission of helping those in need of accessing` healthy food (stonesoupcle.org).

Conclusion

The three studies in this dissertation relied on a measurement of NPO effectiveness based on food desert residents' opinions, thoughts, and feelings on the social aspects of their well-being. NPOs that develop an awareness of disadvantaged environments, the living conditions of those environments, and their clients' daily lives will have greater clear-sightedness on how to improve their clients' social aspects of well- being. Thus, the perceptiveness gained into their clients' lives should derive from an

NPO's efforts to know their client and have a “boots on the ground” approach in their delivery of service programs. All of this could be complemented with research or data used to improve NPO effectiveness in having a significant social impact in food deserts or other areas that lack access to basic needs.

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Appendix A: Study 1 Summary of Research Questions*

1. Tell me about yourself? Probes How do you see yourself? Tell me about your neighborhood? How long have you lived here? What is something you would change if you could?

2. Think about a typical breakfast you’ve eaten over the last three days. Pick one of those meals and tell me about it. What did you have to eat, and where did you eat it? Where did you purchase your food? How did you get there? What form (s) of transportation did you take? Was the meal satisfying? Did you eat by yourself or with others? How did you decide to eat that? Did you plan this, or did it just happen?

3. Think about a typical lunch you have eaten over the last three days. Pick one of those meals and tell me about it. What did you have to eat, and where did you eat it? Where did you purchase your food? How did you get there? What form of transportation did you take? Was the meal satisfying for you and your family? How did you decide to eat that? Did you plan out your menu?

4. Think about a typical dinner you’ve eaten over the last three days. Pick one of those meals and tell me about it. What did you have to eat, and where did you eat it? Where did you purchase your food? How did you get there? What form of transportation did you take? Was the meal satisfying? Did you decide to eat that? Did you plan this, or did it just happen? 5. Is there anything you would like to tell me about your neighborhood?

* See Appendix G: Qualitative Interview Protocol

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Appendix B: Map of New York City Food Desert

https://www.cdc.gov/pcd/issues/2014/images/14_0086_01.gif

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Appendix C: Map of Orange County, NY Food Desert

Food Desert in Middletown, NY: https://www.ers.usda.gov/data-products/food-access- research-atlas/go-to-the-atlas/

https://www.google.com/search?tbm=isch&q=map+of+food+deserts+orange+county+new+York&spell=1 &sa=X&ved=0ahUKEwiIzM687IrYAhViT98KHU8zB_MQvwUIOygA&biw=1536&bih=723&dpr=1.25# imgrc=WKizu10osXEGSM

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Appendix D: Study 1 Coding

Initial/Open Coding Second/Axial Third/Selective Codes (sample) Coding (Sample) Coding Themes: Family Household Security God Religion Traditional Quality Optimistic Vibrant Positive Variety Travel/Transportation Mobility Freedom Pricing Quantity Selection Variety Affordable & Cheaper Lower Pricing Affordability Desirable Pricing

Good Produce, Meats Better Better Quality Happy Living Well Well-being Satisfied Contentment Gratification Foods Nutrition Health / Wellness Shopping Purchasing Decisions

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Appendix E: Photo of a Typical Convenience Store (Bodega) in New York City

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Appendix F: Food System Complexity Map

https://www.futurelearn.com/courses/food-systems-southeast-asia/1/steps/107818

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Appendix G: Study 1 Interview Protocol and Questions

Introduction Prior to obtaining signatures on documents, I thanked the participants for their time and provided information on the structure of the interview. By providing some background information, and welcoming the participant in a warm and friendly fashion I put the participants at ease, allowing for a better interview.

Primary Interview Questions 1. Tell me about yourself? Probes – How do you see yourself? – Tell me about your neighborhood? – How long have you lived here? – What are some thing you would change if you could?

2. Think about a typical breakfast you’ve eaten over the last three days. Pick one of those meals and tell me about it. – What did you have to eat and where did you eat it? – Where did you purchase your food? – How did you get there? What form(s) of transportation did you take? – Was the meal satisfying? – Did you eat by yourself or with others? – How did you decide to eat that? Did you plan this or did it just happen?

3. Think about a typical lunch you have eaten over the last three days. Pick one of those meals and tell me about it. – What did you have to eat and where did eat it? – Where did you purchase your food? – How did you get there? What form of transportation did you take? – Was the meal satisfying for you and your family? – How did you decide to eat that? Did plan out your menu?

4. Think about a typical dinner you’ve eaten over the last three days. Pick one of those meals and tell me about it. – What did you have to eat and where did you eat it? – Where did you purchase your food? – How did you get there? What form of transportation did you take? – Was the meal satisfying? – Did you decide to eat that? Did you plan this or did it just happen? 5. Is there anything you would like to tell me about your neighborhood? 142

Conclusion I want to thank you for taking the time today to speak with me. You shared so much wonderful information. Is it okay if I just clarify a few points before we leave?

Also, do you mind if I reach out to you again if I have any other questions about what we spoke of today? Thank you again for your time. I really appreciate it. Have a great day.

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Appendix H: Study 2 Construct Table

Construct Definition Items Academic Resources Lack of Restricted 1. Do you have access to a car to Burns, C., Bentley, R., Access To household food do your food shopping? Thornton, L., & Healthy Food access due to 2. Do you rely on public Kavanagh, A. 2011. lack of money, transportation to do your food Reduced food access and an inability shopping? due to a lack of money, to lift groceries 3. *Were there any times when inability to lift and lack and lack of you ran out of food and could of access to a car for access to a car to not travel to the supermarket food shopping: A do food to buy more food? multilevel study in shopping. Also, 4. *How long does it take you to Melbourne, Victoria. describes travel (roundtrip) to the closest Public Health associations supermarket? Nutrition, 14(6): 1017- between 5. *My local bus service is 1023. demographic, affordable. individual, socio- 6. *Visiting a supermarket is Coleman-Jensen, A., economic easy to do. Gregory, C., & Singh, variables that 7. I often use my local bus A. 2014. Household prevent the service to shop for food. food security in the purchase of * Access 3,4,5, and 6 - United States in 2013: healthy foods. Dropped September 1, 2014. USDA-ERS Economic Research Report Number 173, Available at SSRN: https://ssrn.com/abstract =2504067 or http://dx.doi.org/10.213 9/ssrn.2504067.

Malnutrition Dealing with 1. Has your household ever run Kleinman, R. E., undernutrition: a out food to make your meals? Murphy, J. M., Little, person's diet 2. Has anyone within your M., Pagano, M., which suffers household ever ate less than Wehler, C. A., Regal, from protein- they should in a day because K., & Jellinek, M. S. calorie there was not enough food? 1998. Hunger in malnutrition. 3. Has anyone within your children in the United household say they were States: potential Also, dealing hungry because there was not behavioral and with over enough food in the house? emotional correlates. nutrition or high 4. Does your household rely on Pediatrics, 101(1): e3- caloric intake of foods from fast food e3. foods and a vast restaurants, gas stations, consumption of convenience stores/corner Waterlow, J. 1972. energy dense stores for your meals? Classification and foods. 5. How often within the last 12 definition of protein- months, did you or any calorie malnutrition. member of your household not British Medical eat for a whole day because Journal, 3(5826): 566. there was not enough food?

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6. *Have you lost weight Coleman-Jensen, A., unintentionally because you Rabbitt, M. P., Gregory, were not eating enough food? C., & Singh, A. 2015. Statistical supplement * Malnutrition 4 and 6 – to household food Dropped security in the United States in 2014. United States Department of Agriculture, Economic Research Service. Social Feelings of 1. I feel a general sense of Gierveld, J. D. J., & Interaction connectedness emptiness because I feel Tilburg, T. V. 2006. A and belonging. alone. 6-item scale for overall, Having social 2. I feel lonely because I miss emotional, and social contact or having people around. loneliness: communication, 3. I do not feel there are people I Confirmatory tests on participation in can rely on. survey data. Research social activities, 4. There are not many people I on Aging, 28(5): 582- or having a can trust. 598. confidant. 5. I do not get together with people. Greenfield, T. K., Social Interaction 6. I do most activities by myself. Rehm, J., & Rogers, J. can also be D. 2002. Effects of understood as: depression and social access and integration on the participation. relationship between alcohol consumption and all-cause mortality. Addiction, 97(1): 29-38.

Gidley, J., Hampson, G., Wheeler, L., & Bereded-Samuel, E. 2010. Social inclusion: Context, theory and practice. The Australasian Journal of University- Community Engagement, 5(1): 6- 36.

Nonprofit It is 1. *Within the last 12 months I Herman, R. D., & Renz, Organizationa multidimensional turned to a food bank, a D. O. 1999. Theses on l and can include a church soup kitchen or a nonprofit organizational Effectiveness great variety of nonprofit for assistance? effectiveness. Nonprofit measures as the 2. When I am faced with a and Voluntary Sector study evolves. problem, there are plenty of Quarterly, 28(2): 107- For this study the people I can rely on at food 126. meaning is as banks or nonprofits. such: flexibility 3. I know of the nonprofits that Epstein, M. J., & regarding the service my neighborhood. McFarlan, F. W. 2011. continuum of Measuring the building efficiency and 145

relationships 4. * Within the last 12 months a effectiveness of a with nonprofit organization (s) has nonprofit's performance. stakeholders. helped me improve my life. Strategic Finance, Focus on the 5. * Within the last 12 months a 93(4): 27. emphasis on the nonprofit organization (s) has well-being helped me improve how I feel. Quinn, R. E., & development of 6. * Nonprofit organizations Rohrbaugh, J. 1981. A people, make a positive impact on my competing values encompasses the neighborhood. approach to process of organizational programs and * Nonprofit Organizational effectiveness. Public positive Effectiveness 1 and 4-6 –Dropped. Productivity Review, outcomes of such 5(2): 122-140. programs. M. Seligman’s 1. *I feel my relationships are Seligman, M. E., & Well-Being PERMA model supportive and rewarding. Csikszentmihalyi, M. with five core 2. *I actively contribute to the 2000. Positive elements of well- happiness and well-being of psychology: An being: positive others. introduction. American emotions, 3. When something good Psychologist, 55: 5-14. engagement, happens to me, I call a friend relationships, or family. Seligman, M. E. P., meaning and 4. Once I make a plan to get Ernst, R. M., Gillham, accomplishments something done I stick with it. J., Reivich, K., & , depression, 5. *Most days I feel a sense of Linkins, M. 2009. Anxiety accomplishment from what I Positive education: do. Positive psychology and 6. *Within the last 12 months classroom interventions. how often have you felt Oxford Review of hopeless? Education, 35(3): 293- 311. * Well-being 1,2, 5, and 6 – Dropped. Kern, M. L., Waters, L. E., Adler, A., & White, M. A. 2015. A multidimensional approach to measuring well-being in students: Application of the PERMA framework. The Journal of Positive Psychology, 10(3): 262- 271.

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Appendix I: Study 2 Final Pattern Matrix

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Appendix J: Study 2 Initial CFA Model

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Appendix K: Study 2 Model Common Method Bias Using Common Latent Factor

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Appendix L: Study 2 SEM Causal Latent Model

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Appendix M: Study 2 Final SEM Model

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Appendix N: Study 3 - Extended Sample Information

Had or Has COVID- Household: Underlying Disease, Number Household Employment 19 at the time of Health Issues Before COVID-19 Interview

1 Multi-Generational Unemployed Asthma, Depression No 2 2 Employed Depression No High Blood Pressure, Chronic 3 1 Unemployed Illness No 4 Partner, 3 Children Employed None No 5 Partner, 2 Children Unemployed None No 6 1 Retired None No 7 1 Employed None No 8 2 Employed None No 9 Multi-Generational Employed Cancer, Obesity No 10 Partner, 3 Children Employed None No 11 Partner, 2 Children Employed None No Single Mom, 2 12 Children Employed None No 13 Partner, 4 Children Employed Asthma No 14 Multi-Generational Employed Heart Disease No 15 2, Roommates Employed Disabilities No 16 Partner, 2 Children Employed Obesity No 17 Partner, 1 Child Employed Depression No 18 1, 1 Child Employed None No Single Mom, 5 19 Children Unemployed None No Single Mom, 2 20 Children Retired Autoimmune Disease, ADHD No Single Mom, 2 21 Children Unemployed None No 22 2, Roommates Unemployed Depression, Bi-Polar, Asthma No 23 Multi-Generational Unemployed Depression No 24 2 Employed None No 25 1 Unemployed Mental Illness No 26 Partner Employed Dementia No 27 Partner, 3 Children Employed None No 28 2 - Roommates Unemployed None No 29 Partner, 1 child Unemployed Depression No Mental Illness , High Functioning 30 Partner, 2 Children Unemployed Alcoholism, Depression No 31 Partner 1, 1 Child Employed None No 32 2 Unemployed None No 33 2 Employed Thyroid Issues No 34 1 Unemployed None No 35 1 Unemployed None No 36 1 Partner Employed None No 37 1 Unemployed Depression No 38 1 Unemployed Gastrointestinal Disorder No 39 Multi-Generational Unemployed None No 40 Multi-Generational Employed None Yes (All)

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Appendix O: Study 3 Research Interview Protocol and Questions

Introduction (interviewer): “Hello (name______). Thank you so much for taking the time to meet with me today. I’m really grateful. Before getting started, there are a couple of things I would like to cover.”

Purpose and Format for the Interview (Interviewer): “As a Case Western Reserve University Ph.D. candidate, I am interested in developing a greater understanding of residing within a food desert before and during Covid-19 and how that affects the social aspects of well-being. I will ask you a series of open-ended questions on this topic, and I will also ask one or more follow-up questions as you respond. The interview will last approximately 60 minutes.”

Confidentiality (Interviewer): ‘Everything you share in this interview will be kept in strictest confidence, and your comments will be transcribed anonymously – omitting your name, anyone else you refer to in this interview, as well as the name of your current organization and/or past organizations. Your interview responses will be included with all the other interviews I conduct."

Audio Taping (Interviewer): “To help me capture your responses accurately and without being overly distracting by taking notes, I would like to record our conversation with your permission. Again, your responses will be kept confidential. If at any time, you are uncomfortable with this interview, please let me know and I will turn the recorder off.”

“Any questions before we begin?”

Interview Questions:

Background - Tell Me about yourself.  Where do you live?  Education Background.  Work/Employment history – where do you currently work?  How many people are in your household?  What is your relationship with each person?

Social Before Covid-19  Tell me about your relationships (family and friends)?  How did these relationships affect your well-being?  Did you ever feel isolated from others or feel lonely? Why?  Now - during Covid-19, have your relationships changed? How?

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Health  Tell me about your health and your household’s health before Covid-19.  Has anything changed due to Covid-19?

Mobility  Tell me about your mobility before Covid-19.  Tell me about your mobility during Covid-19.  How does your ability to get around / be mobile or not affect your well-being?

Food  Tell me about a typical day shopping for food before Covid-19.  Tell me what it’s like now to shop for food during Covid-19.  How do food and food shopping contribute (or not) to your well-being?

Nonprofits  What are your thoughts on nonprofits that try to help your community before Covid-19?  What are your thoughts on nonprofits that try to help your community during Covid-19?

Nonprofit Organizational Effectiveness  Within the last 12 months, I turned to a food bank, church soup kitchen or a nonprofit for assistance? Always, Most of the time, About half the time, sometimes, never  When I am faced with a problem, there are plenty of people I can rely on at food banks or nonprofits. Strongly agree, somewhat agree, neither agree nor disagree, somewhat disagree, strongly disagree.  Within the last 12 months, a nonprofit organization (s) has helped me improve my life. Strongly agree, somewhat agree, neither agree nor disagree, somewhat disagree, strongly disagree.  Within the last 12 months, a nonprofit organization (s) has helped me improve how I feel. Strongly agree, somewhat agree, neither agree nor disagree, somewhat disagree, strongly disagree  Nonprofit organizations make a positive impact on my neighborhood. Strongly agree, somewhat agree, neither agree nor disagree, somewhat disagree, strongly disagree

Covid-19  Tell me about your overall well-being before Covid-19.  Tell me about your overall well-being during Covid-19.  How has the Covid-19 virus affected your life?

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Appendix P: Study 3 Interview Statements (Extracted from Study 2)

When I am faced with Within the last 12 Within the last 12 Nonprofit a problem, there are months a nonprofit months a nonprofit organizations make a plenty of people I can organization (s) has organization (s) has positive impact on my rely on at food banks helped me improve my helped me improve neighborhood. or nonprofits. Strongly life. Strongly Agree , how I feel. Strongly Strongly Agree , Interview Agree ,Somewhat Somewhat Agree, Agree , Somewhat Somewhat Agree , Agree , Neither Agree Neither Agree nor Agree, Neither Agree Neither Agree nor nor Disagree , Disagree, Somewhat nor Disagree , Disagree, Somewhat Somewhat Disagree, Disagree, Strongly Somewhat Disagree , Disagree, Strongly Strongly Disagree Disagree Strongly Disagree Disagree 1 Somewhat Agree Strongly Disagree Strongly Disagree Strongly Agree 2 Somewhat Agree Strongly Agree Strongly Disagree Somewhat Agree 3 Strongly Agree Strongly Agree Strongly Agree Strongly Agree 4 Somewhat Agree Somewhat Agree Somewhat Agree Strongly Agree 5 Neither Neither Strongly Agree Strongly Agree 6 Strongly Disagree Strongly Disagree Strongly Disagree Strongly Agree 7 Somewhat Agree Somewhat Agree Somewhat Agree Strongly Agree 8 Neither Neither Neither Strongly Agree 9 Strongly Agree Strongly Agree Strongly Agree Strongly Agree 10 Strongly Agree Strongly Agree Strongly Agree Strongly Agree 11 Strongly Agree Strongly Agree Strongly Agree Strongly Agree 12 Somewhat Agree Strongly Agree Strongly Agree Strongly Agree

13 Somewhat Disagree Somewhat Disagree Somewhat Disagree Somewhat Agree 14 Somewhat Agree Somewhat Agree Neither Somewhat Agree 15 Strongly Agree Neither Strongly Agree Strongly Agree 16 Somewhat Agree Neither Neither Neither 17 Somewhat Agree Strongly Agree Strongly Agree Strongly Agree 18 Neither Somewhat Agree Somewhat Agree Strongly Agree 19 Somewhat Agree Neither Somewhat Agree Strongly Agree 20 Somewhat Disagree Somewhat Agree Neither Strongly Agree 21 Somewhat Agree Strongly Agree Strongly Agree Strongly Agree 22 Strongly Agree Strongly Agree Strongly Agree Strongly Agree 23 Neither Neither Neither Somewhat Agree 24 Strongly Agree Strongly Agree Strongly Agree Strongly Agree 25 Strongly Agree Strongly Agree Strongly Agree Strongly Agree 26 Strongly Agree Strongly Agree Strongly Agree Strongly Agree 27 Somewhat Agree Neither Neither Somewhat Agree 28 Somewhat Agree Somewhat Agree Somewhat Agree Neither 29 Strongly Agree Strongly Agree Strongly Agree Strongly Agree 30 Strongly Agree Neither Somewhat Agree Strongly Agree 31 Somewhat Agree Strongly Agree Strongly Agree Strongly Agree 32 Strongly Agree Strongly Agree Strongly Agree Strongly Agree 33 Neither Neither Neither Neither 34 Strongly Agree Neither Somewhat Agree Neither 35 Somewhat Agree Strongly Agree Strongly Agree Somewhat Agree 36 Strongly Agree Strongly Agree Strongly Agree Neither 37 Somewhat Agree Strongly Agree Strongly Agree Somewhat Agree 38 Strongly Agree Strongly Agree Strongly Agree Neither 39 Strongly Agree Somewhat Agree Somewhat Agree Neither 40 Somewhat Agree Strongly Agree Strongly Agree Strongly Agree

155

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