Abstract
Introduction: Given that nutrition status is directly related to a variety of health outcomes, nutrition screening is a prime focus of public health nutrition practice. 
 Objectives: The purposes of this pilot study were to develop and pilot test a Rural Adult Nutrition Screen (RANS) that includes criteria addressing social determinants of health and to explore possible applications of the screen development methodology in other settings.
 Methods: Mixed-methods research including interviews and survey dissemination was conducted among a rural southern Appalachian population in the United States. Themes identified in the research were used to construct a preliminary rural adult nutrition screen (RANS-1). The RANS-1 was pilot-tested among a sample of community-dwelling rural residents (n = 83), and was revised based on participant, administrator, and nutrition practitioner comments. The revised screen, the RANS, was pilot-tested among a sample of attendees of a free community medical clinic (n = 37). Nutrition risk as determined by the RANS was compared with the Nutrition Triage Score of the Patient-Generated Subjective Global Assessment (PG-SGA), the United States Department of Agriculture 6-item Household Food Security Survey Module (USDA-6), and nutrition assessment performed by a Registered Dietitian Nutritionist who was also credentialed as a Physician Assistant (RDN, PA). Non-parametric statistical tests were used to compare the results of the PG-SGA NTS and the USDA-6 with the RANS regarding “at risk” and “low risk” status.
 Results: In this small pilot study, no statistically significant differences were found among either comparative instrument and the RANS in determination of “at risk” and “low risk” status. The RDN, PA’s agreement with the RANS was 100%. 
 Conclusion: This pilot study provides some evidence that the RANS may be used to screen rural, community-dwelling adults for nutrition needs in light of social determinants of health common in rural settings. Further research and formal validation of the RANS are needed in order to establish this tool as a valid nutrition screen for use in the rural community setting. Procedures used to develop the RANS may be applicable to the development of population-specific nutrition screens in other rural and urban global populations.
Highlights
Given that nutrition status is directly related to a variety of health outcomes, nutrition screening is a prime focus of public health nutrition practice
The residents and nutrition practitioners (RDNs), PA agreed with the results of the Rural Adult Nutrition Screen (RANS) for all patients receiving the screen, highlighting the potential of the RANS to help identify rural clients who could benefit from nutrition care targeted toward general nutrition education, chronic disease management, and/or amelioration of food insecurity. This exploratory pilot study provides some evidence that the RANS may be effective in screening rural, community-dwelling adults for nutrition status in light of social determinants of health common in rural settings
There were no significant differences between the RANS and the Patient Generated-Subjective Global Assessment tool (PG-SGA) screening results in terms of at-risk status, or between the RANS and the USDA-6 regarding risk for food insecurity
Summary
Given that nutrition status is directly related to a variety of health outcomes, nutrition screening is a prime focus of public health nutrition practice. Conclusion: This pilot study provides some evidence that the RANS may be used to screen rural, community-dwelling adults for nutrition needs in light of social determinants of health common in rural settings. Rural residency is associated with amplified risk factors for nutrition problems These include but are not limited to financial barriers to obtaining an adequate supply of nutritious food, lack of access to health care, limited opportunities for living wage employment, living situations lacking appropriate equipment for food storage and preparation, transportation challenges, and, in many cases, increased rates of chronic disease and oral health problems compared with urban settings (Ghimire, Kumar Baral, & Callahan, 2017; Gutschall et al, 2018; Zeng et al, 2015). Rural residents may be subject to disparities related to limited access to equitable and high-quality nutrition services (Balcha, Phillips, & Trimble, 2018; Gutschall et al, 2018)
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