“I Felt Like I Had Something I Could Do About It”: Pediatric Clinician Experiences With a Food Insecurity-Focused Produce Prescription Program

Johnson, Sheryl; Fischer, Laura K.; Gupta, Simran; Lazerov, Jessica; Singletary, Judith; Essel, Kofi

doi:10.1177/00099228221150604

Cited by 7 publications

(15 citation statements)

References 94 publications

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“…Thirty-one sources published between 2014 and 2024 were included in the narrative review (Supplemental Table 1), 18, with 84% being published since 2019. 18,[38][39][40][41]43,45,[47][48][49][50][51][52][53][54][55][56][58][59][60][62][63][64][65][66][67] Sources included 22 peer-reviewed articles (71%), 18,38,39,41,43,44,46,[48][49][50][51][52][53]55,56,58,60,61,63,64,66,67 four reports, 45,…”

Section: Resultsmentioning

confidence: 99%

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Implementation of Food is Medicine Programs in Healthcare Settings: A Narrative Review

Houghtaling,

Short,

Shanks

et al. 2024

J GEN INTERN MED

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Food is Medicine (FIM) programs to improve the accessibility of fruits and vegetables (FVs) or other healthy foods among patients with low income and diet-related chronic diseases are promising to improve food and nutrition security in the United States (US). However, FIM programs are relatively new and implementation guidance for healthcare settings using an implementation science lens is lacking. We used a narrative review to describe the evidence base on barriers and facilitators to FIM program integration in US healthcare settings following the Exploration, Preparation, Implementation, and Sustainment (EPIS) Framework. Evidence surrounding the EPIS Inner Context was a focus, including constructs Leadership, Organizational Characteristics, Quality and Fidelity Monitoring and Support, Organizational Staffing Processes, and Individual Characteristics. Peer-reviewed and grey literature about barriers and facilitators to FIM programs were of interest, defined as programs that screen and refer eligible patients with diet-related chronic disease experiencing food insecurity to healthy, unprepared foods. Thirty-one sources were included in the narrative review, including 22 peer-reviewed articles, four reports, four toolkits, and one thesis. Twenty-eight sources (90%) described EPIS Inner Context facilitators and 26 sources (84%) described FIM program barriers. The most common barriers and facilitators to FIM programs were regarding Quality and Fidelity Monitoring and Support (e.g., use of electronic medical records for tracking and evaluation, strategies to support implementation) and Organizational Staffing Processes (e.g., clear delineation of staff roles and capacity); although, barriers and facilitators to FIM programs were identified among all EPIS Inner Context constructs. We synthesized barriers and facilitators to create an EPIS-informed implementation checklist for healthcare settings for use among healthcare organizations/providers, partner organizations, and technical assistance personnel. We discuss future directions to align FIM efforts with implementation science terminology and theories, models, and frameworks to improve the implementation evidence base and support FIM researchers and practitioners.

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Section: Resultsmentioning

confidence: 99%

“…18,[38][39][40][41]43,45,[47][48][49][50][51][52][53][54][55][56][58][59][60][62][63][64][65][66][67] Sources included 22 peer-reviewed articles (71%), 18,38,39,41,43,44,46,[48][49][50][51][52][53]55,56,58,60,61,63,64,66,67 four reports, 45,47,59,62 four toolkits, 40,…”

Section: Resultsmentioning

confidence: 99%

Implementation of Food is Medicine Programs in Healthcare Settings: A Narrative Review

Houghtaling,

Short,

Shanks

et al. 2024

J GEN INTERN MED

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“… 16 , 17 “Food as Medicine” interventions, including medically tailored meals/groceries and produce prescriptions, are frequently integrated into clinical systems and are an emerging and promising method to address not only FI but also nutrition security. 18 , 19 , 20 …”

Section: Discussionmentioning

confidence: 99%

Feasibility and Impact Assessment of a Food Insecurity Protocol in a Large Urban Pediatric Primary Care Network

Kim,

Fischer,

Gross

et al. 2024

J Prim Care Community Health

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Introduction/Objectives: In 2022, 1 in 6 households with children experienced food insecurity (FI) in the United States. The negative impact of FI on child health is well documented and pediatric clinicians are encouraged to actively screen and intervene in clinical settings. This study aims to evaluate the feasibility and impact of a FI management protocol implemented in 2017 at a pediatric primary care health network serving patients who are Medicaid-eligible in Washington, DC. Methods: In 2019, an 18-item electronic survey was sent to a convenience sample of 42 pediatric clinicians within the health network to understand their knowledge, attitudes, and behaviors surrounding implementation. Both quantitative and qualitative responses were collected and analyzed. We report frequencies of the Likert-type responses, including perceived compliance with protocol components and intervention efficacy. We evaluated the relationship between FI knowledge level and rates of clinician documentation compliance by chi square and Cramer’s V statistic for effect size. Open-ended responses were reviewed, and common themes were identified and used to provide context for quantitative results. Results and Conclusions: Out of 42 clinicians invited to complete the survey, 35 completed responses. All respondents reported universal screening for FI (100%) at routine examinations, 80% reported frequently electronically documenting FI in medical records, and 91% of clinicians reported frequently referring families who screened positive for FI to at least one FI resource, with 24% reporting that resources met families’ needs. Open-ended responses revealed increased awareness of FI prevalence and of patient experiences in households experiencing FI, increased satisfaction with clinical management of FI, but also concerns around having limited clinical time to do the protocol and the usefulness and accessibility of referred resources. In conclusion, implementing this pilot FI protocol was feasible, but clinicians perceived limited impact of the protocol on alleviating FI and desired more robust intervention options. Further improvements include shifting the burden of performing the protocol away from the clinician, such as by streamlining the protocol or identifying a resource staff member, and establishing more accessible and effective FI interventions such as “Food as Medicine” offerings in partnership with community organizations.

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“…Healthcare providers engaged in these programs have reported that although there were challenges related to staff time, they perceived an increase in knowledge, confidence, and motivation to screen and address food insecurity. They also appreciated that programs provided a tangible way to assist their patients, especially for under-resourced patients who might not qualify for other assistance programs or in times of emergency ( 25 , 26 ).…”

Section: Introductionmentioning

confidence: 99%

Caregiver perceptions of a pediatric produce prescription program during the COVID-19 pandemic

Li,

Zhang,

Cash

et al. 2024

Front. Nutr.

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IntroductionProduce prescription programs are rapidly expanding as a type of Food is Medicine intervention with prospects for mitigating food insecurity and reducing diet-related health disparities. Gaining insight into participant perspectives on program logistics and perceived impacts is crucial to program success and improvements.MethodsBetween May and June 2021, we conducted individual and small group interviews with 23 caregivers with children aged 1–5 years who participated in a produce prescription program from 2020 to 2021 in Texas, U.S. They were provided with a gift card to a major national grocery retailer to purchase fresh produce. The card was reloaded $60 monthly for 8 months with automatic roll-over of unused funds to the next month. Participants also received nutrition education in the form of two videos. A deductive analysis approach was employed, and NVivo qualitative data analysis software was used to perform coding and to assist with subsequent analyses.ResultsAll 23 participants were female, with an average age of 37.5 years, and the majority identified as Hispanic/Latino (83%). About 43% of the families had three or more children. Six themes were generated from interviews. Three of these themes were related to program logistics: (1) ease of program use; (2) participant satisfaction with the incentive; and (3) desire for additional store options. The remaining main themes pertained to program impact: (1) the enhanced ability to purchase produce; (2) the usefulness of the nutrition education; and (3) persistent challenges encountered when preparing the produce for picky eaters and young children.ConclusionA pediatric produce prescription program was perceived as logistically easy and a helpful source of financial support for accessing fresh produce. Program features such as card-based incentive system and partnership with major grocery retailer were favored by participants. For future program design, it may be beneficial to consider collaborating with multiple grocery outlets and enhancing the intensity and targeting of nutrition education.

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“I Felt Like I Had Something I Could Do About It”: Pediatric Clinician Experiences With a Food Insecurity-Focused Produce Prescription Program

Cited by 7 publications

References 94 publications

Implementation of Food is Medicine Programs in Healthcare Settings: A Narrative Review

Implementation of Food is Medicine Programs in Healthcare Settings: A Narrative Review

Feasibility and Impact Assessment of a Food Insecurity Protocol in a Large Urban Pediatric Primary Care Network

Caregiver perceptions of a pediatric produce prescription program during the COVID-19 pandemic

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