Food Insecurity in Primary Care: Patient Perception and Preferences

Abstract

Background and Objectives: Screening for and addressing food insecurity in primary care may improve associated comorbidities. The purpose of this study was to explore patient attitudes regarding screening for food insecurity and to elicit patient preferences for intervention in a primary care setting. Methods: Patients (N=284) completed a brief, voluntary survey in a university-based clinic and two community-based clinics over a 5-month period. Respondents were classified as either food-secure or food-insecure based on their responses to a validated food insecurity screener. Results: Participants stated that screening for food insecurity was valuable in the primary care setting (83.9%). Patients preferred having a nurse ask the screening questions (41.2%). The most popular intervention preference, regardless of food security status or clinic type, was to provide a list of food bank locations (76.4%) and local community organizations (71.6%) and to have referral to financial assistance programs (75.4%). There were no differences in preferences for screening or attitudes toward screening by food security status or clinic type (all P≥.05). Conclusions: Screening for food insecurity is not yet standard practice, partly due to concerns over potentially alienating patients with the screening questions. Based on our surveyed patient population and their indicated preferences, screening and providing resource referrals for food insecurity is not likely to damage the clinician-patient relationship.

Food insecurity and cardiovascular disease: Current trends and future directions

“…A review of FI screening programs based in US hospitals, clinics, and health centers found that most programs received funding from multiple short-term sources, with several program managers expressing concern about long-term sustainability [ 100 ]. FI screening is also not yet standard clinical practice despite evidence indicating food-insecure patients appreciate being screened and referred to resources [ 101 ]. Analysis of Food for Families (a hospital-run program that connects food-insecure patients with SNAP, WIC, and food pantries) found that participants experienced moderately improved blood pressure, suggesting an association between referral to aid programs and better cardiovascular health [ 102 ].…”

“…Implementing patient navigation teams can help patients apply for SNAP, WIC, and other benefits ( Fig. 3 ) [ 100 , 101 ]. Some clinics also provide medically-tailored meals and fruit and vegetable “prescriptions” (usually vouchers or coupons to be redeemed at farmers markets or food pantries), which can further help patients obtain nutritious foods that suit their treatment and improve their cardiovascular risk profile [ 100 ].…”

Consensus from an expert panel on how to identify and support food insecurity during pregnancy: A modified Delphi study

“…While screening for food insecurity does not exist in the Australian health care setting, screening exists in health care settings in other countries, where it has been found to be part of a successful approach when seeking to address food insecurity [51][52][53]. Both the American Academy of Family Physicians, and the American Academy of Paediatrics recommend that food insecurity is routinely screened [54].…”

Food Insecurity and its Impact on Body Weight, Type 2 Diabetes, Cardiovascular Disease, and Mental Health

“…Specifically, there was a disconnect in the acknowledgement of FI and the knowledge of resources and community organizations that offer programs and services to address FI [ 69 , 81 ]. A recent study by Runkle and Nelson in 2021 [ 81 ] found family medicine and pediatric physicians expressed concern over the stigma associated with discussing FI in the clinic; however, another study by Kopparapu and colleagues in 2020 [ 82 ] showed that 83.9% of primary care patients stated that asking about FI was important and 82.7% felt it demonstrated that the clinic cared about their well-being. Another important consideration is a patient’s preferences for FI screening.…”

“…Another important consideration is a patient’s preferences for FI screening. Kopparapu and colleagues [ 82 ] also identified that primary care patients preferred having a nurse ask the screening questions, and Palakshappa and colleagues [ 83 ] found that patients preferred a written questionnaire versus a face-to-face screening method [ 82 , 83 ]. These challenges represent opportunities for future research to design interventions that target FI training, screening uptake, and closed-loop referral management with tracking of local resources…”