Mixed-methods assessment of a local Meals on Wheels program

Community food and nutrition programs, such as home-delivered meals (HDM), support the health and well-being of older adults. The purpose of this study was to conduct a needs assessment of a local Meals on Wheels (MOW) program using a mixed-methods approach. Study One assessed nutritional risk (NR) and dietary intake frequencies (DIF) among newly enrolled MOW participants (n=167), utilizing the dietary screening tool. Participants were primarily female (62.9%), and enrolled in MOW during a winter month (85%). Nearly all (97.6%) were “at NR” or “at possible NR.” NR was attributed to “low” DIF of dairy, lean protein, and processed meat. Gender significantly influenced NR (p\u3c .05), with males averaging a higher nutritional risk score. Season of MOW enrollment and whether participants had access to cooking appliances did not have a meaningful impact on NR or DIF. Study Two evaluated factors influencing MOW or HDM participation. Four focus groups were conducted determining awareness, perceptions, motivators, barriers, and preferred program attributes; 31 older adults participated. All completed a sociodemographic questionnaire. Focus group sessions were audio-recorded, transcribed, and analyzed for themes using framework analysis. Sociodemographic questionnaires were analyzed using descriptive statistics. Participants were mostly retired, White females between ages 65-84 years. Over half (54.8%) were involved in a congregate meal program. A majority were responsible for their own transportation (80.6%), food purchases (80.6%), and meal preparation (77.4%). Most were aware of MOW, but not of other HDM services. MOW was positively associated with companionship, and negatively linked to loss of independence and poor food quality. Motivators to HDM participation were affordability, menu choice, involvement of dietitian/nutritionist, and positive testimonies from past clientele. Barriers included affordability, skepticism of program marketing claims, food safety concerns, and limited meal storage space. Preferred program attributes were convenience and quality menu options. Promotional references included brochures and in-person group presentations with taste testing. These findings demonstrate the high NR of newly enrolled MOW participants and highlight the pre-conceived perceptions influencing HDM participation. These findings can be used to modify MOW offerings to help reduce NR of participants as well as better promote the MOW program toward older adults