DNP Scholarly Projects



Introduction: Evidence suggests poor-quality diets and high levels of stress have negative impacts on health, especially in low-income families in the southern United States. Nutrition-based food assistance programs were developed to meet nutritional needs of food insecure clients. The purpose of this scholarly project was to explore the relationship between perceived stress and diet quality among low-income families engaged with a nutrition-based food assistance program.

Methods: A retrospective and observational design was used to analyze previously collected survey responses from clients participating in a nutrition-based food assistance program in Nashville, TN (N = 425). Descriptive statistics and Spearman’s correlation were used to explore relationships between the variables of fruit intake, vegetable intake, Perceived Stress Scale-4 (PSS-4) score, and total number of visits to the nutrition-based food assistance program from change between pre- and post-survey responses (n = 120).

Results: The mean change in fruit intake was 0.16 (n = 119) and the mean change in vegetable intake was 0.08 (n = 119). A negative correlation was found between change in fruit intake and change in PSS-4 score (rs = -.182; p = .053), as well as change in vegetable intake and change in PSS-4 score (rs = -.026; p = .786).

Conclusion: As found in other studies, diet quality for low-income families improved with consistent access to free healthy foods. PSS-4 scores also declined with increased engagement with a nutrition-based food assistance program. Further research should explore perceived stress and diet quality during a non-pandemic year.


Spring 6-13-2022

First Advisor

Kathryn Dambrino, DNP, APRN, FNP-BC

Scholarly Project Team Member

David Phillippi, PhD

Scholarly Project Team Member

Laura Gray, PhD, RN


Nursing, School of


Health Sciences & Nursing, Gordon E. Inman College of

Document Type



Doctorate of Nursing Practice (DNP)

Degree Level


Degree Grantor

Belmont University


Nutrition; Food Insecurity; Diet Quality; Perceived Stress; Low Income; Nursing; Food Assistance Program; Food Bank; Stress; Public Health