ORIGINAL RESEARCH
Julia I. Caldwell, PhD, MPH; Alina Palimaru, PhD, MPP; Deborah A. Cohen, MD, MPH; Dipa Shah, MPH, RDN; Tony Kuo, MD, MSHS
Corresponding Author: Julia I. Caldwell, PhD, MPH; Nutrition and Physical Activity Program - Division of Chronic Disease and Injury Prevention - Los Angeles Department of Public Health.Email: jcaldwell@ph.lacounty.govDOI: 10.3122/jabfm.2022.220175R2Keywords: Food Assistance, Food Insecurity, Primary Health Care, Public Health, Qualitative Research, Safety-net Providers, Social Determinants of HealthDates: Submitted: 05-10-2022; Revised: 07-27-2022; 11-11-2022; Accepted: 11-28-2022Status: In production for ahead of print.
INTRODUCTION: Food insecurity is a major public health problem in the United States which was exacerbated by the COVID-19 pandemic. We used a multi-method approach to understand barriers and facilitators to implementing food insecurity screening and referrals at safety net healthcare clinics in Los Angeles County prior to the pandemic.
METHODS: In 2018 we surveyed 1,013 adult patients across eleven safety-net clinic waiting rooms in Los Angeles County. Descriptive statistics were generated to characterize food insecurity status, attitudes towards receiving food assistance, and use of public assistance programs. Twelve interviews with clinic staff explored effective and sustainable approaches to food insecurity screening and referral.
RESULTS: Patients welcomed the opportunity to access food assistance in the clinic setting; 45% preferred discussing food issues directly with the doctor. Missed opportunities to screen for food insecurity and refer patients to food assistance were identified at the clinic level. Barriers to these opportunities included: competing demands on staff and clinic resources, difficulty establishing referral pathways, and doubts surrounding data.
DISCUSSION: Integrating food insecurity assessment in clinical settings requires infrastructure support, staff training, clinic buy-in, and more coordination and oversight from local government, health center entities, and public health agencies.