Quantitative and qualitative results from implementation of a two-item food insecurity screening tool in healthcare settings in Connecticut.

Abstract

Millions of Americans face food insecurity, yet a universal screening tool is not in place. Food insecurity is known to be associated with poor health outcomes such as heart disease, diabetes mellitus, and hypertension in adults, and low school performance and mental illness in children. From January 2017 through February 2017, we utilized a validated two-item screening tool to assess the prevalence of households at risk for food insecurity and conducted a focus group of pediatricians. Patients at a Federally Qualified Health Center in New Haven, Connecticut were screened. Pediatricians of the American Academy of Pediatricians comprised the focus group. 534 of 1272 screening tool respondents were at risk for food insecurity (41.4%). Male respondents had higher prevalence than females (46.3% vs 38.9%, p=0.009), and Hispanics (34.4%) less than Whites (54.4%) and Blacks (53.8%) (p<0.001). Moreover, we executed a qualitative study of pediatricians' perception of food insecurity screening via a focus group. Themes that emerged from the focus group were agreement on the high importance of food insecurity screening, concern from caregivers about child neglect, and the difficulty of implementing the screening tool due to time constraints. We achieved successful implementation of the screening tool into the electronic medical record with a high completion rate of 97.9%. Identified barriers to universal screening for food insecurity include lack of efficient methods to direct food-insecure patients to resources and continued stigma regarding food insecurity.