Food Insecurity Screening in Pediatric Clinical Settings: A Caregivers’ Perspective
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Food insecurity (FI) has serious academic, social, and physical health consequences for children. A recent clinical recommendation suggests FI screening during child well visits. While FI screening research has considered clinician feedback, little is known about caregivers’ experience of disclosing FI to health care providers. Our paper explores caregivers’ barriers and facilitators to FI disclosure.
A survey on factors influencing FI disclosure was completed in a pediatric clinic waiting room in St. Louis, MO. Among households with FI, 15 caregivers participated in a qualitative interview. Caregivers were asked about experiences discussing FI with health care providers. We calculated frequencies for survey responses and analyzed interview data using thematic content analysis.
Caregivers highlighted stigma, fear of child being taken away, and shame as barriers to FI disclosure. Caregivers identified strong interpersonal skills, open body language, and empathy as facilitators to disclosure at the interpersonal level. Provider initiated conversations, consideration of FI disclosure in the presence of a child, and normalization of FI discussions within the clinic were described as ways to encourage FI disclosure at the organizational level. In response to FI disclosure, caregivers would like providers to offer resources including referrals to community-based resources extending beyond food.
Conclusions for Practice
Our study identifies considerations for FI screening in health care settings, spanning the social-ecological model, from the perspective of caregivers. To successfully screen and address FI, multifaceted health care interventions should address barriers and promote facilitators across multiple levels and in consideration of multiple social needs.
KeywordsFood insecurity Well child screening Social needs Family preferences Qualitative
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The work presented was completed with support from corresponding author’s institution.
Compliance with Ethical Standards
Conflict of interest
The authors declare that they have no conflict of interest.
- Alaimo, K., Olson, C. M., & Frongillo, E. A. (2001). Food insufficiency and American school-aged children’s cognitive, academic, and psychosocial development. Pediatrics, 108(1), 44–53.Google Scholar
- American Academy of Pediatrics, & Food Research & Action Center. (2017). Addressing food insecurity: A toolkit for pediatricians. Retrieved August 13, 2019, from http://frac.org/aaptoolkit.
- Beck A., Henize, A., Kahn, R., & Klein, M. (2015). Curtailing food insecurity with clinical-community collaboration. Health Affairs Blog. Retrieved August 13, 2019, from https://www.healthaffairs.org/do/10.1377/hblog20150709.049172/full/.
- Oregon State University. (2019). Childhood Food Insecurity. Retrieved August 13, 2019, from https://pace.oregonstate.edu/catalog/childhood-food-insecurity.
- Coleman-Jensen, A., Rabbitt, M., Gregory, C., & Singh, A. (2016). Household food security in the United States in 2015: USDA-ERS. Retrieved August 13, 2019, from https://www.ers.usda.gov/publications/pub-details/?pubid=79760.
- Feeding America. (2016). Map the Meal Gap 2016. Retrieved August 13, 2019, from https://www.feedingamerica.org/sites/default/files/research/map-the-meal-gap/2014/map-the-meal-gap-2014-exec-summ.pdf.
- Health Leads. (2017). Health Leads. Retrieved April 6, 2017, from https://healthleadsusa.org/.
- Lundeen, E. A., Siegel, K., Calhoun, H., Kim, S., Garcia, S. P., Hoeting, N., et al. (2017). Clinic-community partnerships to identify patients with food insecurity and address food needs. Preventing Chronic Disease, 14, E113.Google Scholar
- Miles, M., & Huberman, A. (1994). Qualitative data analysis (2nd ed.). Thousand Oaks, CA: Sage.Google Scholar
- Miles, M., Huberman, A. M., & Saldaña, J. (2014). Qualitative data analysis (3rd ed.). Los Angeles, CA: Sage.Google Scholar
- Nord, M. (2009). Food Insecurity in households with children: Prevalence, severity, and household characteristics. Economic Information Bulletin Number 56. Retrieved August 13, 2019, from https://www.ers.usda.gov/publications/pub-details/?pubid=44421.
- Saldaña, J. (2009). The coding manual for qualitative researchers. Los Angeles, CA: Sage.Google Scholar
- Stenmark, S., Solomon, L., Allen-Davis, J., & Brozena, C. (2015). Linking the clinical experience to community resources to address hunger in colorado. Health Affairs Blog. Retrieved August 13, 2019, from https://www.healthaffairs.org/do/10.1377/hblog20150713.049277/full/.