Methods: A nutrition equity framework was used throughout each step of the menu redesign and involved participatory feedback from the community partner and mealtime guests. First, we conducted a nutrition needs assessment of individuals who were unsheltered and accessing soup kitchen prepared meal services. With input from the community partner, we developed and administered a 13-item survey to assess nutrition-related health needs, dental issues, food preferences, menu satisfaction, and recommendations for menu improvement. Additionally, we conducted a nutrition analysis of 7 randomly selected meals to identify any macro- and micronutrient gaps within the existing menus at baseline. To further guide the menu redesign process, we conducted a series of weekly taste test evaluations of potential recipes we developed to address key nutritional gaps and health issues identified in the nutrition needs assessment.

Results: A total of 114 surveys were collected. Most respondents had at least one chronic health condition with the most prevalent self-reported conditions being depressive disorder (50.9%) and cardiovascular conditions (49.1%). Respondents commonly (43.1%) reported avoiding certain foods due to dental issues. While the majority of guests indicated their food preferences were generally being met, most respondents indicated they would like to receive more fruits and vegetables. Results from the menu analysis revealed opportunities to lower the sodium, saturated fat, and added sugar content of meals and to raise micronutrient and omega-3 content to better align immune, mental, and cardiac health nutrition guidelines. Results from the participatory taste testing and final menu cycle will also be shared.

Discussion: Survey findings are consistent with other studies assessing nutritional risks in populations affected by homelessness. Nutrient gaps identified in the menu analysis also reflect dietary intake deficiencies described in other studies of this high-risk population. Hunger safety net providers serving people affected by homelessness can play a major role in meeting critical nutrition needs, particularly those for optimizing cardiovascular and mental health.