Study design

An exploratory qualitative descriptive approach was adopted in the present study. Given the paucity of literature describing the role of CKs and their impact on the food security status of vulnerable groups in the context of conflict and displacement, we opted for an exploratory descriptive approach. This method provides a thick contextual description of the phenomenon, as experienced by study participants, and it is based on the general principles of naturalistic inquiry that has a broad range of choices for theoretical or philosophical orientations, sampling techniques and data collection strategies [12]. A conceptual framework outlined by Freedman et al. (2013) guided the data collection and analysis in the present study [13]. The study was conducted in accordance with the Declaration of Helsinki, and the ethical approval was secured from the Institutional Review Board at the American University of Beirut prior to recruitment and data collection.

Population, eligibility criteria, and recruitment approach

Two groups constituted the target population: community kitchen workers (CWs) involved in the preparation of food and SR families receiving food assistance in the form of ‘food pots’ (cooked food). The target population was recruited from four CKs located in four different areas within two regions in Lebanon known to have the largest population of refugees in the country: the North of Lebanon (26% of refugees) and the Bekaa (36%) [9]. Eligibility criteria for CWs included: adult women (18–65 years), either Lebanese or Syrian nationality, and being involved in the local CK for at least six months. As for the SR group, criteria included being a Syrian woman of child bearing age, having at least one child, living in an Informal Tented Settlement (ITS), and received/or currently receiving food assistance in the form of hot pots from a local CK for at least six months. Based on previous studies [1,14], the six months cut-off point considered in the present study was set to be the minimum period to observe changes in household finances and food security status after receiving food assistance.

A purposeful and geographical variation recruitment approach was used. To recruit CWs, the research team first contacted the administrations of CKs to get their preliminary approval prior to arranging for a site visit to meet with the CWs. As for SR women, the research team contacted the humanitarian agency involved in delivering ‘food pots’ to the beneficiaries in order to identify the location of their ITSs. The CK administration and humanitarian agency did not have any direct or indirect role in the recruitment of study participants or access to any of the collected data. Direct recruitment approach was used on site to invite women from both the CWs and SR groups to participate in the Focus Group Discussions (FGDs).

Conceptual framework

A conceptual framework previously outlined by Freedman et al. (2013) was adopted in the present study [13]. This multicomponent model was originally developed to assess the access of individuals to nutritious food in the United States, and it was based on five main constructs: economic aspect, service delivery, spatial-temporal features, social aspects, and personal aspects [13]. We used these constructs when developing the two topic guides for our focus group discussions with the study participants: one for CWs (see S1 Table) and second for the SR group (S2 Table).

Data collection

Data collection for the study took place between July and October 2017. A total of eight focus groups were conducted during that time period after which we reached data saturation: four with CWs and four with SRs. FGDs with CWs were held between July and August 2017. During that period, the CKs were not operating due to fund interruptions, yet they were expected to resume work beginning September 2017. FGDs with the SR group took place between September and October 2017. During this period, CK services had resumed again, but the implementing organization selected new ITSs and different families to participate in the new phase of the CK project. Therefore, in order to meet the six months inclusion criteria of our study, we chose to collect data from ITSs that were involved in the CK project prior to the two-month-interruption of the kitchens in the summer. Thus, the recruited SR families were not receiving services from the CKs at the time of data collection.

The researcher (NI) received training on the ethical and responsible conduct of research and FGD moderation prior to data collection. NI moderated the FGDs and the P.I. (LJ), co-P.I. (GHA) and Research Assistant (MDH) were present as observers and took written and mental notes. All focus groups were audio-recorded after securing the consent of study participants. Verbal consent of the participants was obtained in case the participant was illiterate; a witness assigned by the participant explained the content of the oral consent form as well as the objectives and activities of the projects in a culturally sensitive, easy and comprehensible language and manner.

After obtaining participants’ consent, the moderator proceeded to circulate a short survey that included questions related to the demographic and socio-economic characteristics of the study participants, such as age, marital status, educational attainment, employment status, family monthly income and expenditures, and form of assistance received in the past three months, if any. In addition, crowding index was calculated, as a proxy measure for the socioeconomic status of households, through dividing the total number of household members by the total number of chambers in a household (excluding kitchens, bathrooms and balconies). This index was previously used to assess the socioeconomic status of refugees in Lebanon and similar contexts showing reliable results [15–17].

Data analysis

Data collected from the short questionnaire was analyzed using SPSS 19 software. Descriptive analyses included means and standard deviations for continuous variable sand frequencies and proportions for categorical variables. As for the analysis of the FGDs, thematic deductive analytical approach was adopted. All FGDs were first transcribed verbatim in Arabic (language used to conduct the focus groups). The transcripts reflected the factual account of the discussion including the pauses, laughter, and emphases. Each participant was given an ID on the focus group (e.g. FG1P1). For the SR group and due to voice interference with children being present at the time of the focus groups, we couldn’t identify the different participants in the recorded discussions; hence, the identifiers did not include the participant’s number (e.g. FG1). The second step was conducting the analysis using a thematic approach framed by Freedman’s conceptual framework. The thematic analysis consisted of 6 phases: phase 1, two researchers were immersed in the data by reading and re-reading each transcript in order to familiarize themselves with the information provided; phase 2, the data coding started and was based on the concepts of Freedman’s conceptual framework (economic, service delivery, spatial–temporal features, social and personal aspects) (Open coding); phase 3, the list of codes were refined through discussions among the two researchers and with the P.I. in order to identify the links between them; In phase 4, themes that match the framework and those that expand or merge with existing concepts were identified along with the associated sub-themes (axial coding); in phase 5, the final themes and subthemes were refined through discussions; finally in phase 6, a complete narrative of the findings was provided [18]. The research team supported these findings with relevant quotes for each theme and sub-theme. Deviant cases were included in the final narrative and noted as “one”, “a couple”, or “a few participants indicated”, hence giving voices to singular opinions. The observation notes and interviewer’s mental notes from the focus groups were maintained to describe the interactions that surrounded the focus group discussions.

Demographic and socio-economic characteristics of study participants

A total of 15 participants were from the CWs group and 49 were from the SR community. All participants were women and the majority were married (n = 53) with an average age of 36.9 ± 10.7 years. A total of 40 participants completed at least primary level schooling, yet only few completed secondary education or higher (n = 14). Significant socio-economic differences were noted between both groups (CWs and SR women) in the present study. CWs had higher monthly income (93.3% vs 19.6% earning ≥ $ 200, p<0.001) and higher total monthly expenditures as compared to the SR group ($714.7 ± 400 vs. $318.6 ± 171, p = 0.002). On the other hand, SRs had on average higher crowding index (4.2 ± 2 vs. 2.3 ± 2, p = 0.002), reflecting lower socio-economic status, and higher dependence on the World Food Programme (WFP) e-card assistance as compared to the CWs (66.7% vs 13.3%, p<0.001, respectively). In addition, 39 out of 49 SRs in the study sample reported severe food insecurity, whereas only 6 out of 15 CWs reported a severe level of food insecurity (p<0.001).

Emerging themes

The thematic analysis from the focus groups revealed four main themes that describe the experience with CKs: a) motivation to work in CKs (among CWs group only), and three themes that were in common between CWs and SRs, namely b) perception towards CKs, c) impact (impact of CKs and the impact of the CK interruption, and the d) sustainability of CKs. Within each theme, we identified several sub-themes (see Fig 1 for a graphical representation of the emerging themes).

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Fig 1. Summary of main themes and subthemes from FGDs with CWs and SRs.

https://doi.org/10.1371/journal.pone.0210814.g001

a) Motivation to work in CKs

CWs pointed to financial, internal, and societal drivers for participating in CKs. Some CWs also reported being motivated by the type of work. With respect to the financial drivers, being the head of the household and the “high cost of living” (FG3P1, FG3P3) were the two major reasons that led CWs to work in these kitchens. CWs needed the income to attend to their family needs. In addition, financial independence and avoiding charity motivated them to secure a stable monthly income. “I don’t ask anyone for assistance and I don't wait until someone knocks at my door to help us. I always try to avoid dependency even if it was at the expense of my health and wellbeing, or even my time” (FG1P1).

One of the main internal drivers that motivated many CWs to participate in CKs was the urge for altruism: “I was not working in the CK only for the sake of getting paid. My goal was to help the Syrian refugees. We are ready to help them to the best of our abilities” (FG4P3). For other CWs, self-development was another internal driver for working in CK. Their participation in these kitchens allowed them to gain experience and achieve self-realization: “I feel more confident when I work. I can feel my self-worth when I receive an income at the end of the month and that’s probably not only due to financial reasons” (FG1P1). Some CWs also reported that working in the kitchens enabled them to make the best use of their free time and to organize their life better.

With respect to the societal drivers, CWs pointed that their participation in CKs improved their social life and reduced their sense of loneliness “I thought I would feel happy spending some time with companions here because at home I’m lonely all the time” (FG4P4). Also, some expressed that their involvement in the CKs made them feel socially valuable.

The type of work was also a motivator for some CWs due to factors such as convenience, the enjoyable nature of cooking and the loyalty of some kitchen workers to the kitchen. One CW acknowledged that the team is very passionate about cooking: “We love cooking and our food smells amazing! We tell everyone who comments on the smell of our cooking that we are not just working to get paid at the end of the month, we cook with passion!” (FG1P1). In terms of convenience, most CWs reported living near the kitchens, which also motivated their choice of work. In addition, few women stated that cooking is the most convenient type of work for housewives.

b) Perception towards CKs

One of the themes that emerged from the focus groups with the CWs and SRs was an overall positive perception towards CKs. CWs considered working in kitchens to be a culturally acceptable type of work: “cooking is a female job” (FG4P2). It was also perceived as charitable work helping many refugees, thus it was “an honorable job”: “People used to say that we should be proud of ourselves because we were doing a charitable work” (FG3P1). In addition, most CWs reported that their families and local communities supported them showing more respect when they started working in the CKs “People showed us more respect because we started supporting more families in addition to the families we used to support before the CK project” (FG4P4). Such a supportive and positive attitude towards CKs motivated other women within their local communities to consider joining the cooking team.

Although the majority of SRs were familiar with the concept of CK, which emerged mainly during the war period in Syria over the last few years, a few said that it was a new experience for them. Overall, SRs appreciated the CK concept and services and expressed their interest in implementing similar kitchens within their local communities once they return back to Syria.

CKs were negatively perceived by only few CWs and SRs. Among CWs, some pointed to fatigue “Our work is physically demanding indeed and we feel extremely tired especially during the month of Ramadan"(FG3P1). Few SR women in one of the visited ITSs indicated that the process of choosing families to benefit from CK was neither transparent nor fair, causing confusion and dissatisfaction among the refugee community: “My neighbor is a school teacher and her husband is a full-time employee and she was registered for the project!” (FG3).

CWs agreed that the atmosphere in the kitchens was overall positive and joyful: “We used to have a lot of fun here. The atmosphere was always joyful” (FG4P3). Other positive aspects of the work environment included supportive administration and positive team culture, which strengthened social cohesion between the workers from different religious and cultural backgrounds (for example between the SR and Lebanese women working in the same kitchens). CK workers emphasized that they spent most of their time together in the kitchen, which strengthened the bond between them and reduced tension and conflicts among team members. A sense of trust and confidentiality between the CWs developed, which provided them with needed psychological support. Finally, some women reported that the overall positive environment created a sense of belonging to the kitchen, where they felt like they are all part of one family.

c) Impact of CKs

This theme was further divided into two subthemes: 1) impact of being involved in the CK services and the impact of CK interruption. With respect to the impact of CK services, both groups considered CKs to have a positive impact on the food security, financial, personal/ ] psychological, and societal aspects of their lives. In addition, CWs reported learning new skills due to their involvement in these kitchens.

CKs provided both groups with food pots on a regular basis, which helped meet their needs for food and cut down on their food expenditures. Almost all the SR beneficiaries included in the present study reported that CKs fulfilled a dire need for food for all family members, especially for children. CKs allowed them to consume a wider variety of food items and in larger quantities, and that this improved their nutritional and health status. “It was an opportunity for us to consume foods that we couldn’t afford on a weekly basis such as beef and chicken” (FG3). Another Syrian woman reported: “We used to be weak and our children were slim. When we started receiving food, our health became much better” (FG4).

In terms of the financial implications of the CK, the food pots had a cost opportunity impact. They allowed the families of both groups of women to cut their spending on food in order to buy other necessities such as medicine and fuel: “The food pots that I took to my home helped me cut the spending on bread and food" (FG4P2). “We used the money that we saved to cover our house rental fees and electricity bills” (FG3). Most CWs indicated that the steady monthly income they received in return for their work with the CK helped them achieve financial independence and preserved their dignity by not having to rely on charity: “The kitchen supported me a lot. I used to have headaches before and my brother used to take me to the doctor and pay the fees. Now it's different. I don’t ask anyone for help, even if it was my son. I am still able to work and be productive and I don’t want to be dependent on anyone” (FG1P2). In addition, most SRs reported that the CK services saved them from falling into debt.

CWs and SR participants reported personal and psychological benefits from their involvement in the CK. The kitchens provided CW and SRs with a “peace of mind” by not having to worry constantly about their food security and how to provide food for their families. SR noted that by receiving food pots, they were able to dedicate more time for other activities, including house chores, sleeping, or socializing. CWs noted that the financial independence gained from participating in the CK empowered them psychologically “The kitchen did really give us strength and motivation” (FG3P2).

The social capital impact that the CK gave to CW was unequivocally stated. The kitchens gave them the opportunity to socialize with fellow workers inside and outside the kitchens “Now we have stronger relations with each other also outside the kitchen” (FG3P3). A few CW only indicated that their work in the kitchens limited their time to socialize outside the kitchen. As for the social impact of the CK on SRs, study participants reported that having the same food pots served to all beneficiaries created a sense of unity, agency and equity within their community: “We were satisfied and content because we were all eating the same type of food. Previously, the smell of cooking from our neighbor’s house used to make us crave for food that we couldn’t afford buying” (FG4).

Another impact of the CKs noted among CWs was learning new skills for food preparation and financial management. CWs reported acquiring a variety of new skills such cooking food in bulk amounts, preparing a diversity of new dishes, and learning and practising basic food hygiene and food safety principles. Learning important financial management skills were also noted among CWs: “My Colleague told me things about how she managed the money she had on hand. I listened to her because I learned from her. When I listen to others, I become more aware of how to manage my finances” (FG1P1).

Despite the overall benefits of working in CKs, few CWs reported that their participation in these kitchens had also some negative impact on their health, family time and social life and family time. Some reported that working in CKs caused tiredness leading to the emergence of new physical conditions and the worsening of already existing physical conditions. In addition, some CWs who have young children reported that working at the CKs limited the time they could spend with their children, which was a negative impact of CKs. Few CWs reported that their work in these kitchens limited their time for socialization, while others disagreed on whether this is considered a drawback of their work, as they viewed it as a positive matter: “I don’t consider this as something negative. Sometimes when I used to see people around me only interested in gossiping, I felt very thankful that I had my own interests and that my time was organized. The most important thing is that your family is doing well” (FG1P1).

The second sub-theme under the impact of CKs that emerged during the FGDs with women from both CW and SR groups was the impact of having the CK services being interrupted during the summer months prior to the data collection, and its negative implications on their household finances, food and nutrition security status, and their overall psychological health.

In terms of the financial and food security implications, both groups stated an increase in their financial burden when CK services were interrupted, which resulted in spending all saved money among CWs and the failure of the SR beneficiaries in fulfilling their family’s basic needs. In addition, the majority of SRs in the study reported exacerbated debts and loss of cost opportunity to purchase something else during that period: “We had to spend all the money that we saved before because we are jobless” (FG4P4), “I feel weak because I don’t have money and I am worried about providing for my children” (FG1). During the interruption of the CK, the amount of food available for individuals to consume decreased among families in both groups, particularly among SRs. They reported that food quality and quantity deteriorated among household members, which negatively affected their nutritional and health status, mainly children: “We used to consume meat 2 times per week. Now we can afford it only twice per month” (FG4); “Recently, my children started to look pale and I couldn’t figure out the reason. So I took my child to a health center and his blood test showed that he’s anemic” (FG1).

In terms of personal and psychological health, overall, the discontinuation of kitchens had a negative psychological impact on all study participants and this impact was more pronounced among the SR group. Women from both groups reported feeling helpless and depressed as a result of the interruption of kitchen services: “For me, there's no life anymore. I don’t know if it's the same for others. Although I don’t have any family responsibilities, I'm really in need. I cry many times because I feel sorry for myself and I try to hide it from my parents. I’m the one who’s suffering the most” (FG4P3). “We became psychologically and financially distressed” (FG2). CWs and SRs reported that the halting of the CK services affected their social lives and daily routines. For SRs, the disruption of the kitchen services created tension within their families: “I have four children, together with my husband we are six. We have to pay 200$ house rental fees and almost 65$ electricity charges. I am left with only 260$ which I have to use wisely and this creates tension inside my home” (FG3). Women had to deal mostly with this difficult situation and they reported adopting different coping mechanisms such as saving food for children and depleting limited assets. Similarly, CWs had to think of alternatives, such as searching for a different job or urging their respective kitchen’s administration not to stop. It was also noted from the FGDs with SRs that the halting of the CK services adversely exacerbated social tension between refugees with the local host community and caused confusion as to what services are offered to each of the groups: “We [SR] ask them [non-governmental agencies] to give us assistance unit but they tell us you are Syrians and this assistance is only for the Lebanese. They give them meat!” (FG3).

d) Sustainability of CKs: Facilitators and barriers

Both CWs and SRs showed interest in the sustainability of the CK model. SRs, in particular, showed interest in initiating SR-led kitchens inside their ITSs, where the whole community would be able to participate in activities aimed at food provision.

Women from both CWs and SR groups also identified facilitators/opportunities, barriers, and threats for the sustainability of the CKs in their current set-up. In terms of the facilitators and opportunities for the sustainability of the CKs, both groups reported that having the basic cooking skills is a major facilitator for their involvement in CK. Among CWs, the sense of belonging and “ownership” of the kitchens were perceived as important factors for moving forward: “We were among the founding members when the cooperative was officially registered” (FG1P1). Participants noted that access to funding from non-governmental organizations (NGOs), can be an opportunity for them to ensure the continuity of their local CKs. The cultural acceptability of this type of work for women was also identified by participants as an opportunity that allows them to expand on the current CK model. Opportunities for SR women to start CK initiatives within their communities included catering for big events that take place within the ITSs, such as weddings and funerals. As for CWs, the suggested business options included farmer’s markets where they can prepare Mouneh (local and traditional food items), frozen vegetables, desserts and pastries, and frozen Mezze items (small-sized Mediterranean appetizers), in addition to catering for events.

With respect to the barriers and threats that may limit the continuity of the CKs, both groups (CWs and SRs) mentioned the lack of personal funds as a major barrier for moving forward if the CK are no longer supported by funding from humanitarian organizations. A CW reported “You know we all have limited resources, if someone supports us with funds, we would start working and selling our produce” (FG1P3); whereas a SR stated “We like the idea of initiating a CK however funds are missing and we don’t have the guts to propose this idea to donors” (FG4). Other barriers reported amongst CW were their limited entrepreneurial and leadership skills or training to be able to move forward “Another obstacle we used to struggle with was the problem of marketing our products” (FG1P1); “We don't have a say in this because the kitchen administration is the final decision maker” (FG3P1). In addition, CWs mentioned that because CKs are NGO-driven, the threat to their sustainability was bound to happen at any time. The financial support of NGOs was crucial for space, tools, ingredients, and distribution. Without this support, they cannot have a sustainability plan.

For additional quotes supporting themes and sub-themes depicted from focus groups with CWs and SRs respectively, please refer to Tables 1 and 2.

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Table 1. Complete list of themes, subthemes and supportive quotes for community workers (CWs).

https://doi.org/10.1371/journal.pone.0210814.t001

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Table 2. Complete list of themes, subthemes and supportive quotes for Syrian refugees' focus groups.

https://doi.org/10.1371/journal.pone.0210814.t002

Strengths and limitations

The present study has a number of strengths. To our knowledge, this study is the first to qualitatively explore the impact of CK within a conflict-affected setting. The purposeful recruitment approach adopted in the present study allowed our research team to assess the impact of CK operating in different geographical regions in Lebanon on low-income participants. In addition, data triangulation was possible through exploring the CKs from the perspective of the CWs and the SR beneficiaries. We also adopted a number of measures to increase the trustworthiness of the study and its results including increasing credibility, reflexivity, and objectivity. Nevertheless, the study findings need to be interpreted in light of few limitations. Interviews were not conducted with key informants, such as representatives from the administration of CKs and humanitarian agency involved in the planning, implementation, and funding of the program. The latter could have allowed for a more comprehensive examination of the CK impact. Given the sensitive nature of the topic and study population, the risk of social desirability bias cannot be ruled out; CK workers and SR beneficiaries may have overstated the positive impact and benefits of the CKs. Nevertheless, every attempt was exerted by the research team to ensure impartiality and reflexivity at each stage of the study.