Social Determinants of Health in Maternity Care: A Quality Improvement Project for Food Insecurity Screening and Health Care Provider Referral

Abstract

Purpose: This quality improvement project evaluated implementation of social determinants of health screening and referral for food insecurity. Methods: Four obstetric providers used study-developed resources to screen and refer English-speaking patients ( n =14) during clinic visits. Providers and patients completed post-visit questionnaires. Provider feedback informed improvements to the intervention approach for consecutive study shifts. Results: Providers and patients reported high satisfaction with encounters. Referrals were made for four patients. Challenges to implementation included resource organization, time constraints, and integration into clinic workflow. Conclusion: Processes for universal screening and tailored information provision are areas to continue to strengthen for establishing equitable health care.

Views and preferences of food‐insecure pregnant women regarding food insecurity screening and support within routine antenatal care

“…One previous study has reported high participant satisfaction with a healthcare‐based intervention to address food insecurity during pregnancy. In this small, quasi‐experimental study, Fitzhugh et al 74 offered an emergency food package to pregnant women who answered affirmatively to the Health Vital Sign, a validated two‐item food insecurity screening tool, as well as a third item that aimed to identify urgent need for food. Survey‐measured participant satisfaction was ‘positive’, with over 71% of participants rating their healthcare experience as ‘extremely’ satisfactory 74 .…”

“…In this small, quasi‐experimental study, Fitzhugh et al 74 offered an emergency food package to pregnant women who answered affirmatively to the Health Vital Sign, a validated two‐item food insecurity screening tool, as well as a third item that aimed to identify urgent need for food. Survey‐measured participant satisfaction was ‘positive’, with over 71% of participants rating their healthcare experience as ‘extremely’ satisfactory 74 . Further research into the efficacy and acceptability of healthcare‐based interventions is needed to ensure that the needs of food‐insecure pregnant women can be met within the resource limitations of antenatal clinics.…”

“…Survey‐measured participant satisfaction was ‘positive’, with over 71% of participants rating their healthcare experience as ‘extremely’ satisfactory. 74 Further research into the efficacy and acceptability of healthcare‐based interventions is needed to ensure that the needs of food‐insecure pregnant women can be met within the resource limitations of antenatal clinics. Given the potential challenges that some women may face if they choose to disclose, such as domestic tension or violence, the types of supportive strategies are important to consider for women's safety and dignity.…”

Social determinants and inequitable maternal and perinatal outcomes in Aotearoa New Zealand

“…25,36 Similarly, there are limitations in the international literature. While these studies may have larger cohorts, there is a focus on a few specific determinants, such as food insecutity 37 and homelessness 38 or specific populations. 39 A systematic review of birth outcomes in high-income countries found common determinants of poor outcome, such as poverty, but confirmed studies were usually focussed on a few variables or general population indicators (e.g.…”