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Public Health Nutrition: 16(3), 535–543 doi:10.1017/S1368980012002753
Review Article
Social health and nutrition impacts of community kitchens:
a systematic review
Marina Iacovou, Deanna C Pattieson, Helen Truby and Claire Palermo*
Department of Nutrition and Dietetics, Monash University, Southern Clinical School, Monash Medical Centre,
Block E, Level 5, 246 Clayton Road, Clayton, Victoria 3168, Australia
Submitted 11 September 2011: Final revision received 29 March 2012: Accepted 30 March 2012: First published online 1 June 2012
Abstract
Objective: Community kitchens have been implemented by communities as a
public health strategy to prevent food insecurity through reducing social isolation,
improving food and cooking skills and empowering participants. The aim of the
present paper was to investigate whether community kitchens can improve the
social and nutritional health of participants and their families.
Design: A systematic review of the literature was conducted including searches of
seven databases with no date limitations.
Setting: Community kitchens internationally.
Subjects: Participants of community kitchens across the world.
Results: Ten studies (eight qualitative studies, one mixed-method study and one
cross-sectional study) were selected for inclusion. Evidence synthesis suggested
that community kitchens may be an effective strategy to improve participants’
cooking skills, social interactions and nutritional intake. Community kitchens
may also play a role in improving participants’ budgeting skills and address some
concerns around food insecurity. Long-term solutions are required to address
income-related food insecurity.
Conclusions: Community kitchens may improve social interactions and nutri-
tional intake of participants and their families. More rigorous research methods,
for both qualitative and quantitative studies, are required to effectively assess the
impact of community kitchens on social and nutritional health in order to con-
fidently recommend them as a strategy in evidence-based public health practice.
Keywords
Community kitchen
Social
Nutrition
Health
Food security
The term ‘community kitchens’ is used to describe com-
munity-focused and -initiated cooking-type programmes.
While there is some discrepancy around the definition,
community kitchens (CK) are known as providing an
opportunity for a small group of people to meet regularly
in order to prepare a meal
(1)
. They are generally initiated
by community facilitators and are planned to be self-
sustaining after an initial period of support
(2)
. CK focus on
developing participant resilience for those experiencing
food insecurity and social isolation, rather than creating
and supporting a cycle of dependency on emergency
food relief
(3)
. Their process aims to develop food skills
and empower individuals rather than focus only on
nutrition education or cooking skills
(2)
.
While most of the evaluation of CK has been based
upon process rather than impact or outcome evaluation,
the general consensus on the value of CK is positive and
therefore such programmes have been well supported as
a public health strategy
(3–9)
. It has been reported that CK
develop cooking skills, improve nutrition and food security,
and reduce participants’ social isolation
(9,10)
. However there
is a need to critically evaluate the literature to determine
the impact of CK and assess their effectiveness as a public
health strategy.
The present systematic review of the literature (SRL) is the
first to be conducted internationally. It aimed to determine
the impact of CK on participants’ social skills, community
connections and support, intake of nutritious food and food
security. It also aimed to identify any existing research gaps
and evaluate CK as a health promotion strategy.
Methods
Search methods
In April, 2011 seven databases (AGRICOLA, CINAHL Plus,
Web of Science with conference proceedings, Ovid
MEDLINE, PubMed, Scopus and Sociological Abstracts)
*Corresponding author: Email claire.palermo@monash.edu rThe Authors 2012
were searched without date restrictions, using search
terms relating to the question: ‘What are the social health
and nutritional benefits and impacts of community kitchens
internationally?’. These search terms (Table 1) were grouped
into three categories: (i) community kitchen; (ii) nutrition;
and (iii) social. Synonyms and alternative words within
each category were identified from current literature and
a thesaurus. If a known study was not retrieved, search
terms were expanded and relevant synonyms added.
Only published studies were retrieved.
Study retrieval and analysis
One investigator retrieved published studies and expor-
ted the citations directly into EndNote
R
version X3.
Titles and abstracts were assessed against the eligibility
criteria (Table 2) and coded in EndNote with the reason
for exclusion. For the purpose of the present review, CK
were defined as community-based cooking programmes
that aim to develop food skills, increase self-efficacy and
reduce food insecurity and/or social isolation
(11)
. ‘A key
feature of community kitchens that distinguishes them
from other food assistance programs is their participatory
format and potential to foster mutual support’
(11)
. Only
studies pertaining to this definition were included. Of the
remaining citations, complete publications were obtained,
read thoroughly and re-evaluated against the eligibility
criteria. Where there were aspects of doubt a second and
third opinion was sought from other investigators.
The data of retained studies was extracted by one
investigator, using the Cochrane guidelines for evidence-
based review of health promotion interventions
(12)
and
the National Health and Medical Research Council body
of evidence matrix
(13)
. Data extracted included title and
author, affiliation and source of funds, study design,
location or setting, intervention, sample size, population
characteristics, length of follow-up, outcome measured,
internal validity, applicability, sustainability and results.
Qualitative studies were further classified as one of four
types as described by Daly et al.
(14)
: (i) case studies
(studies that focus on a single situation or case – level IV
evidence); (ii) descriptive studies (studies that focus on a
specific sample – level III evidence); (iii) conceptual
studies that have a theoretical framework (level II evi-
dence); or (iv) generalisable studies, which are guided by
a comprehensive literature review, conceptual framework
and diversified sample (level I evidence). The data were
then summarised and then tabulated in Table 3.
The quality of quantitative studies was evaluated as
‘positive’,‘neutral’ or ‘negative’ using the Quality Assess-
ment Tool for Quantitative Studies
(15)
as suggested by the
Cochrane guidelines
(12)
(Table 4). The quality of qualitative
studies was evaluated based on judgement by two authors
as positive, neutral or negative using the Cochrane
checklist
(12)
(Table 4). Mixed-method studies were asses-
sed against both qualitative and quantitative criteria and
a judgement made on the overall quality based on both
assessments as well as the Mixed Methods Appraisal
Tool
(16)
(Table 4). Where there were aspects of doubt
during the review process a third opinion was sought
from investigators. After data extraction, data were ana-
lysed using a thematic analysis approach for synthesising
qualitative and quantitative evidence whereby the most
common and important themes were extracted from the
body of evidence summarised in results and outcomes of
each study
(17)
(Table 3).
Results
A total of 287 articles were retrieved from seven database
searches: AGRICOLA (n23), CINAHL Plus (n20), Web
of Science with conference proceedings (n48), Ovid
MEDLINE (n29), PubMed (n39), Scopus (n112) and
Sociological Abstracts (n16). Studies that did not qualify
for further review (n266) included duplicates, studies
not written in English, studies not relevant to the topic,
studies that investigated CK but did not have a relevant
outcome or intervention (i.e. a cooking group or
demonstration classes, or nutrition education initiative)
and publications not reporting a study (e.g. editorials).
The full publications were sought for the remaining
twenty-one studies. After review of each remaining study,
Table 1 Categories and search terms used to explore the asso-
ciation between community kitchens and social health and nutrition
Community kitchen Nutrition Social
Community kitchen* Nutrition* Social
Collective kitchen* Diet* Community
Collective cooking Intake
Cooking club* Health*
Food security
Food
Cooking
*Truncation.
Table 2 Inclusion and exclusion criteria
Inclusion criteria Exclusion criteria
Interventions Editorials
Narrative and systematic
reviews
Opinion papers
Randomised controlled trials Not written in English
Cross-sectional studies Cooking group classes
Cohort studies Cooking demonstration classes
Case studies Intervention not involving a CK
Evaluations Outcome not relating to social
skills, community connections
and support or nutritional intake
Developed and developing
countries
Written in English
Any population group
Intervention involving a CK
Outcome relating to social skills,
community connections and
support or nutritional intake
CK, community kitchen.
536 M Iacovou et al.
Table 3 Summary table of studies included in the present systematic literature review and narrative description
Study and
reference Study design Sample size Country
Population
characteristics Intervention
Data collection
methods Results/outcome Quality
Crawford &
Kalina
(1997)
(20)
Mixed method 24 participants Canada Low-income families
living on or below
the government’s
poverty line
Orientation included
supermarket tour and a
meeting where the group
set rules for working
together. They then
progressed into monthly
cooking sessions supported
by menu planning and
budgeting information.
Meals prepared were
shared among participants
equally
Pre-programme and
post-programme
questionnaires
CK programme enhanced the ability of
participants to provide themselves
and their families with nutritious
food. It created a healthy social
environment and provided
community support. The
programme increased public and
community awareness of food
insecurity issues. There was a
reduction in participants’ self-
reported perceived barriers to
participation and obtaining healthy
food (except for transport) and an
increase in the participants’
personal shopping skills pre-
and post-programme
O
Engler-Stringer
& Berenbaum
(2006)
(4)
Conceptual 37 CK leaders
and participants;
9 key informants
Canada Low-income single
women, men,
seniors, new
immigrants, people
with reduced
mobility or mental
disabilities and
homeless or under-
housed
Small groups of people pool
resources and labour to
produce large quantities of
food but may also involve
focus on social support,
food and nutrition education
and budgeting. Self-help
in nature
Semi-participant
observations and
focused in-depth
individual interviews
Participants reported excitement
about cooking new foods, increased
diversity when purchasing fruit and
vegetables, increased variety of
food in their diet in general and
increased self-confidence related to
cooking and nutrition. Participants
also reported sharing new ideas
and education with their family
members. Increased social
interaction among CK participants
was also noted
P
Engler-Stringer
& Berenbaum
(2007) (A)
(6)
Conceptual 37 CK leaders
and participants;
9 key informants
Canada Males and females Small groups of people pool
resources and labour to
produce large quantities of
food but may also involve
focus on social support,
food and nutrition education
and budgeting. Self-help
in nature
Semi-participant
observations and
focused in-depth
individual interviews
Themes that emerged from
participation in a CK included:
building friendships, breaking social
isolation, social and emotional
support, increased enjoyment in
cooking and eating, participation in
community activities and sharing of
community resources and
information
P
Engler-Stringer
& Berenbaum
(2007) (B)
(5)
Conceptual 63 CK groups.
Data reported
focused on
subset of
16 participants
Canada Low-income Small groups of people pool
resources and labour to
produce large quantities of
food but may also involve
focus on social support,
food and nutrition education
and budgeting. Self-help
in nature
Individual interviews Participation in a CK led to the
emergence of themes such as:
increased food variety, stretching
the budget, increased food
resources, increased dignity by not
having to access charitable
resources and decreased
psychological distress associated
with food insecurity. Overall
participants reported increased
food security
P
A systematic review of community kitchens 537
Table 3 Continued
Study and
reference Study design Sample size Country
Population
characteristics Intervention
Data collection
methods Results/outcome Quality
Fano et al.
(2004)
(19)
Cross-sectional 82 participants Canada Prenatal women and
food-insecure/low-
income adults
CK programme aims to increase
nutritional knowledge and
encourage healthy eating.
It provides the opportunity
to apply practical skills such
as budgeting and food
preparation, promotes
socialisation and social
support, and encourages
food safety
Individual questionnaire 75 % of participants reported that they
liked the social interactions and
support offered by the CK. 31 %
enjoyed the food prepared. 81 % of
participants said they learnt to feed
their families healthier foods.
Reported consumption of at least five
servings of fruit and vegetables daily
increased from 29 % to 47 % after
joining a CK programme. There was
also an increase in reported meal
planning from 25 % to 47 % after
participation in CK. 36 % said they
did not like the kitchen facility, 29 %
reported disliking CK due to
personality conflicts and language
barriers in the group. 29 % reported
not liking the food prepared
N
Lee et al.
(2010)
(9)
Descriptive 13 CK:
93 participants
in total (63 CK
participants,
20 facilitators,
10 project
partners)
Australia With a disability (46%),
Indigenous (6 %),
English a second
language (27 %),
receiving pension or
government benefits
as sole income (62 %)
Small group programme led
by a trained community
facilitator. They cook a
nutritious meal together
regularly and learn about
budgeting, menu planning
and cooking skills in a social,
community-based setting
Written survey, focus
groups and structured
telephone interviews
CK participation played a role in
enhancing food and cooking skills,
social skills and community
participation. CK are able to reach
and engage population subgroups
that face the greatest health
inequities
O
Marquis et al.
(2001)
(10)
Descriptive 14 participants Canada Low-income families
with children
20-week programme of
cooking and instruction
covering topics of feeding
children, meal planning,
budgeting, communication,
self-esteem and team
building. A small, participant-
led cooking group.
Programme is focused on
identifying and addressing
participants’ goals
Focus groups All participants who completed the
programme stated they had met their
food- and nutrition-related goals and
that attending a CK programme
benefited both themselves and their
families. Benefits of participation
included increased socialisation and
making new friends, having a break
from children, learning to budget and
save money, learning to shop wisely,
learning to make new foods,
increased cooking skills, eating less
often at fast-food outlets and
consuming healthier meals. Eight
months since attending the first
session, 50 % of participants were
still cooking in CK groups
N
538 M Iacovou et al.
Table 3 Continued
Study and
reference Study design Sample size Country
Population
characteristics Intervention
Data collection
methods Results/outcome Quality
Mundel &
Chapman
(2010)
(2)
Conceptual 10 in total;
5 project
leaders and
5 project
participants
Canada Indigenous residents
residing on
traditional territory of
the Musqueam
Aboriginal Nation,
Canada
Kitchen/garden project that
grows food in a garden
that is then prepared in
kitchens by the community
with the support of university
students. Participants eat at
the garden/kitchen and can
take leftovers home for other
meals
Semi-structured
questionnaires and
follow-up interviews
Empowerment and increased
capacities were reported among
participants. Participants reported:
enjoying and benefiting from the
sharing of skills, enhancing cooking
skills, learning how to cook healthy
inexpensive meals, enhancing food
growing skills, having social
interactions and support in a safe
environment, and accessing
important resources and community
services
O
Spence & van
Teijlingen
(2005)
(18)
Descriptive 6 participants Scotland Low-income parents Community-based ‘cook and
eat’ programme which
includes an 8-week course
on basic cooking, budgeting
and food hygiene and
demonstrates healthy meal
preparation. Health promotion
assistant leads the group
but is directed by the needs
of the participants who
socialise as part of the
programme
Face-to-face semi-
structured interviews
Participants improved their cooking
skills and gained opportunity to
socialise and develop their food
hygiene and budgeting skills.
Participants reported positive
dietary changes among their
children, family members and
themselves
N
Tarasuk &
Reynolds
(1999)
(1)
Descriptive 10 CK observed,
6 CK selected
for interviews.
14 participants
(1 male and
13 female) and
6 facilitators
Canada Low-income families A range of programmes with
the explicit goal of
improving income-related
food insecurity. Programmes
include small groups of
people cooking together
and/or pooling resources
and labour to produce
large quantities of food
and/or learning how to
cook and eat together and
socialising
Participant observations
and in-depth
interviews
CK participation is valued for providing
social support, enhancing coping
skills, increasing variety of food in
one’s diet, improving nutrition, and
improving management of food
spending dollars. CK participation
may lead to involvement in other
support services and groups. In
severe and chronic poverty, CK
programmes have limited potential
to resolve food security, as they do
not substantially alter the economic
status of households
O
CK, community kitchens.
Quality: P 5positive, O 5neutral, N 5negative (refer to Table 4).
A systematic review of community kitchens 539
eleven were excluded. Four were found not to be a study
(i.e. narrative review or editorial) and seven had irrele-
vant outcomes (i.e. four reported demographics of CK
participants only and three were not CK by definition,
with two describing an education intervention and
one describing a charitable communal meal programme;
Fig. 1). The remaining ten publications included in the
final review were predominantly qualitative studies
(n8)
(1,2,4–6,9,10,18)
, one cross-sectional study
(19)
(level IV)
and one mixed-methods study
(20)
. The qualitative studies
consisted of four level III evidence descriptive studies and
four level II conceptual studies. The one mixed-method
study was classified as level IV evidence as the data were
cross-sectional in nature, focused on process evaluation
and there was no attempt to triangulate the different
methodologies used in the study.
Summary of included studies
Table 3 provides a summary of each individual publication
included in the present review. Eight studies, ranging from
six to ninety-three participants, investigated the effectiveness
of CK as a health promotion strategy. Although data were
extracted from ten manuscripts, the three papers by Engler-
Stringer and Berenbaum
(4–6)
used the same study to report
three different aspects and findings. Various data collection
methods were used to gather and collate information:
participant observations, questionnaires (cross-sectional
and pre/post CK programme), individual interviews (face-to-
face, telephone, semi-structured, in-depth) and focus groups.
Four themes were identified from the analysis: (i) increase
in reported intake of nutritious food and food security;
(ii) increased self-reliance, dignity and engagement with
community services; (iii) improved social skills and enhanced
Table 4 Checklists used to assess quality of quantitative, qualitative and mixed-methods studies
Quantitative
(15)
Qualitative
(21)
Mixed methods
(16)
A. Selection bias: Are the individuals selected to
participate in the study likely to be representative of the
target population? What percentage of selected
individuals agreed to participate?
A. Method appropriate to
research question
A. Is there a combination of qualitative and
quantitative data collection techniques and/
or data analysis procedures? For example,
researchers describe the sampling and
sample, data collection and data analysis for
each method
B. Study design: If the study was randomised, was the
method of randomisation described and was the
method appropriate? If no go to C.
B. An explicit link to theory B. Do the researchers describe and justify
the mixed methods design? For example,
authors describe rationale for each method
and methods of implementation
C. Confounders: Were there important differences
between groups prior to the intervention? If yes,
indicate the percentage of relevant confounders.
C. Clearly stated aims and
objectives
C. Is there an integration of the qualitative
and quantitative data? For example, there is
evidence that the data gathered by both
research methods were brought together
D. Blinding: Was the outcome assessor aware of the
intervention or exposure of participants? Were study
participants aware of the research question?
D. A clear description of context
E. Data collection methods: Were data collection tools
shown to be valid? Reliable?
E. A clear description of sample
F. Withdrawals and drop-outs: Were withdrawals and
drop-outs reported in terms of numbers and reasons
per group? Indicate the percentage of participants
completing the study.
F. A clear description of
fieldwork methods
G. Intervention integrity: What percentage of
participants received the allocated intervention or
exposure of interest? Was the consistency of the
intervention measured? Is it likely that subjects
received an unintended intervention that may have
influenced the result?
G. Some validation of data
analysis
H. Analyses: Indicate the unit of allocation, analysis.
Are statistical methods appropriate for the study
design? Is the analysis performed by intervention
allocation status rather than actual intervention
received?
H. Inclusion of sufficient data
to support interpretation
Each section is rated as 1 (strong), 2 (moderate) or
3 (weak) and then the section scores are reviewed to
make an overall judgement, where the study quality is
strong (positive) if there are no weak ratings, moderate
(neutral) if one weak rating or weak (negative) if two or
more weak ratings
(15)
Positive, neutral or negative
rating applied using judgement,
after consideration of the above
criteria
(21)
, in discussion
between first and last authors
Each section (A to C above) rated as yes,
no, not applicable or not included. Positive,
neutral or negative rating applied using
judgement, after consideration of the above
criteria
(16)
, in discussion between first and
last authors
540 M Iacovou et al.
social support; and (iv) increased skills, confidence and
enjoyment in cooking. Participants were generally from low-
income families and communities with food security issues
mostly in Canada, but also Australia and Scotland.
Increase in reported intake of nutritious food and
food security
Studies reported participants of CK improved their intake of
nutritious food
(20)
, had a greater variety in their intake of
food
(1,4,5)
, increased the diversity of fruit and vegetables
purchased
(4)
and reported eating fast-food less often
(10)
.
There were reported flow-on effects to other family
members
(4,19)
.Fanoet al.
(19)
found that 81 % of participants
fed their families healthier foods and the proportion of
participants consuming at least five servings of fruit and
vegetables daily increased from 29 % to 47 % after joining
a CK programme. The study design and negative quality
rating of that study
(19)
should be taken into consideration
when reviewing these findings. Two studies reported that
further investigations are required to examine the ability of
low-income populations to change their diet and enhance
their nutritional intake
(9,18)
. CK were also reported to
improve food security
(5)
. However, three studies suggested
that the impact of CK to improve food security required
further investigation
(5,9,18)
. Tarasuk and Reynolds
(1)
sug-
gested that CK programmes have limited capacity to resolve
food insecurity issues, as they do not substantially alter the
economic status of households.
Increased self-reliance and dignity and engagement
with community
Studies also reported that CK improved access to commu-
nity services and resources
(1,2,6,9)
and increased participants’
dignity by not having to access charitable resources
(5)
.
Improved social skills and enhanced social support
Most studies reported improvements in social interac-
tions, skills and/or support following involvement in
CK
(1,2,4,6,9,10,18,20)
. Being in a safe environment
(2)
,breaking
social isolation and having access to social and emotional
support were more specific outcomes
(6)
.Makingnew
friends
(10)
mayalsobeabenefit.Fanoet al.’s
(19)
cross-sectional
study highlighted that social interactions and support were
the main reasons participants joined a CK programme.
Increased skills, confidence and enjoyment in cooking
Other benefits participants reported gaining from CK
programmes were increased enjoyment in cooking and
eating
(2,4,6)
, improved shopping skills
(10,20)
, cooking
skills and confidence
(2,4,9,10,18)
, and improved food bud-
geting skills
(1,5,10,18)
.
Discussion
Evidence from the present SRL suggests that CK may play an
important role in enhancing cooking skills and improving
social interactions and nutritional intake of participants
(2,9,10)
.
While income-related food insecurity requires long-term
solutions
(1,5)
, CK may increase community awareness of
such issues and provide nutritious food and food skills to
reduce food insecurity in the short term
(1,10)
.Bydecreasing
the need to access charitable food sources, CK have shown
to improve participants’ dignity
(5)
.
In further addressing the question ‘What are the social
health and nutritional benefits and impacts of community
kitchens internationally?’, the present review found that
participants increased the diversity of their choices when
purchasing fruit and vegetables
(4)
and established a healthy
social environment not only for themselves but also for their
families
(20)
. Improved cooking skills, positive dietary chan-
ges and an opportunity to socialise were also identified as
key benefits of CK participation
(18)
, although the cited
descriptive study with a negative quality rating limits the
ability to interpret these findings. These findings highlight
that CK programmes have potential to positively impact
social health and to provide nutritional benefits to partici-
pants who are socio-economically challenged.
The outcomes observed in the studies of the present
review highlight the importance of the context and
processes that have led to these positive and desirable
Retrieved
articles
n 287
Excluded*
n 266
Included
n 21
Included
n 10
Excluded*
n 11
Irrelevant
study
n 93
Not a
study
n 32
Irrelevant
outcome
n 11
Duplicate
n 121
Non-
English
n 9
Not a
study
n 4
Irrelevant
outcome
n 7
Qualitative
n 8
Quantitative
n 1
Mixed
methods
n 1
Fig. 1 Flow diagram representing studies included in the present systematic literature review and reasons for exclusion (*stems
below the excluded box indicate reasons for exclusion)
A systematic review of community kitchens 541
outcomes. The self-help or voluntary and community-run
nature of the cooking interventions appears to be an
important element for success. For CK to result in
improved social and nutritional health they need to be
built on the definition of being participatory and promote
social support
(11)
. Under these conditions they could be
encouraged as a valuable health promotion strategy.
Despite the varied study locations (Canada, Scotland,
Australia) the present review demonstrates that low-
income groups face similar challenges, in relation to food
and nutrition, across the developed world. Therefore the
review supports that CK initiatives may be successfully
implemented across other developed nations.
The sustainability of CK was extracted from all included
manuscripts as part of the review process. While manu-
scripts inferred that community participation and self-help
enhanced the sustainability of the programmes, only one
study by Crawford and Kalina in 1997 specifically descri-
bed the presence of a community worker to organise and
facilitate the group as important for sustainability
(20)
.
Although not specifically asked in the review, there were
also other outcomes of CK, including access to employ-
ment
(10)
and reorientation of health service programmes
(20)
for example, which may be relevant for public health
policy. The issue of sustainability is an important con-
sideration to note when planning to implement a CK as a
public health intervention or strategy.
Of the studies included in the present SRL, three of the
studies were assessed to have a positive rating, four were
neutral and three were negative (Table 3). The main
reasons for not achieving a positive rating were the lack
of data saturation and lack of theoretical underpinnings
and methodological rigor in qualitative studies and not
describing how subject refusals or errors were dealt with
in quantitative studies. The lack of randomised controlled
trials reduces the ability to interpret these findings into
policy and practice in health promotion. The quality of
the papers included in the review should be considered
when making conclusions around their findings and as
the basis for the development of public health policy.
Studies in the review employed a range of evaluation
methods to assess the outcomes of CK. Although there is
no claim that any of these methods is validated or
necessarily most effective in such studies, the consistency
of data collection methods used in qualitative, quantita-
tive and mixed-method designs heightens credibility of
the combined results and suggests that these methods
may be most suitable in application to the CK environ-
ment and its participant groups.
For CK to be shown as an effective intervention in
reducing the impact of and preventing food insecurity,
more robust data are needed. While data collection and
evaluation methods may be appropriate for local pro-
grammes, they do not enable comparisons to be made
external to the CK programme. The studies that have
been undertaken on CK have several weaknesses. These
include the low number of studies found to have investi-
gated the impact of CK and the lack of high-level evidence
in quantitative and qualitative studies. Furthermore,
recruitment for CK studies often occurred with existing
participants or only within known low socio-economic
communities, consequently selecting groups that may not
represent all low-income, vulnerable and disadvantaged
families. The present SRL acknowledges that there is a lack
of higher-quality studies such as randomised controlled
trials or conceptual qualitative studies that are sufficiently
robust to show a causal effect. However, the authors
recognise that studies such as randomised controlled trials
which may produce stronger levels of evidence may be
viewed as unethical to perform in vulnerable and dis-
advantaged groups where an untreated control group
denies participants the intervention. Furthermore, blinding
of randomised controlled trials with educational interven-
tions is difficult and likely to introduce recruitment bias.
One of the main strengths of the present review is the
vigorous and systematic nature of its methodology.
Introduction of bias was minimised by using the same
data extraction table and quality assessment checklist for
each qualitative, quantitative and mixed-method study.
Additionally due to the rigorous search of numerous
databases and the inclusion of studies with evidence
levels of IV and above, this SRL is very comprehensive. As
study designs varied a meta-analysis could not be con-
ducted; however the findings have important implications
for public health practitioners and policy makers as the
evidence suggests that CK may be an appropriate strategy
to address food insecurity and its accompanying social
exclusion.
Conclusions
The present SRL found that CK may provide benefits to
the social and nutritional health of low-income partici-
pants and their families. It is evident that there is a lack of
high-level evidence that would be required to establish
causal links. The review identifies the need for rigorous
research methods to attain a greater understanding and a
more conclusive outcome on the actual effectiveness of
CK. Despite the lack of long-term prospective studies, the
present SRL suggests that CK may improve social, nutri-
tional and food security issues of participants and their
families who are often vulnerable and disadvantaged.
This evidence has the potential to recommend that
communities implement such public health strategies, to
improve the nutritional health and well-being of vulner-
able and disadvantaged populations.
Acknowledgements
The present SRL was supported by funding from Peninsula
Health Community Health, health promotion program.
542 M Iacovou et al.
Peninsula Health Community Health had no involvement in
the study design, data collection, interpretation of results, or
writing of the current report. The authors have no com-
peting interests to declare. H.T. and C.P. were responsible
for the design of the SRL. D.C.P. performed the original
search and supported data extraction. M.I. completed data
extraction, quality ratings and drafted the manuscript.
C.P.andH.T.providedanalyticalsupportandcontributedto
the manuscript. The authors would like to acknowledge the
guidance provided by Robin Ralston in the conduct of the
SRL and preparation of the manuscript.
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