Themes, Perspectives across Stakeholder Groups, and Illustrative Quotations for Qualitative Findings on Screening, Referral, and Closing the Loop to Address Food Insecurity (FI) in Primary Care Practice
| Themes | Stakeholder Perspectives* | Illustrative Quotations |
|---|---|---|
| Findings on Screening | ||
| Recognition that FI affects health | Patients: Sometimes surprised to be asked the screening questions, but understand the health connection HCWs: Believe it's important to understand social situation and needs FAO staff: Believe that FI affects health and understand the connection | [Screening] is more of a health check than a food check. —patient, #1† If [patients] can't access meals in a way that corresponds with their health care needs, we have to figure something out. It's…an integral part of what primary care physicians should do. —HCW, #25 Housing and food are basics. [Our organization] I believe helps families be healthy and to make good decisions. —FAO staff, #32 |
| Comfort with screening and its implementation in primary care | Patients: Generally comfortable discussing FI but some concerns about potential consequences of screening HCWs: Unsure how to fit screening approaches that patients are comfortable with into busy clinic workflow FAO staff: Concern that patients will not feel comfortable discussing FI | [The questions] made me feel kinda uncomfortable because I have had past experience with, like CPS…I just don't want…a reason for them to take my daughter away. —patient, #4 There's a lot of other things to talk about during the visit, and [there's] just not the time to identify social determinants. —HCW, #23 People believe that they should rely on each other, their family, versus coming in and asking for help. We sometimes call it the Western mentality and pride comes into play when it comes to food insecurity, too. —FAO staff, #34 |
| Importance of using screening information to help people | Patients: Want to know that the purpose of data collection is to suggest resources HCWs: Concern that data collected may not be used | I [would feel comfortable with the screening] if it were related to the services that we were getting that day. But if it was just kind of off the fly, I would kind of question their motives. —patient, #13 There's lots of good intentions, but putting something in a database in a computer I don't think actually helps people. —HCW, #28 |
| Findings on Referral | ||
| Recognition of value if confidentiality is ensured | Patients: Generally recognize benefits but request for permission and confidentiality are necessities HCWs: Concern about the Health Insurance Portability and Accountability Act (HIPAA), although some data sharing already happeningFAO staff: Generally recognize benefits | I think I'd feel fairly comfortable as long as they keep their confidentiality. —patient, #4 I think the main issue is that there isn't some type of a patient privacy or HIPAA violation with sharing that information to try and connect them with the resources —HCW, #26 |
| Concerns about workload and capacity | HCWs: Concerns about lack of staff time and lack of compensation for referral work FAO staff: Concerns about time and capacity to respond to referrals | Physicians are overloaded with information right now…so that care coordination piece for physicians is taking a lot of time and energy. —HCW, #26 We're definitely looking at caps and what we can reasonably do. Once we hit those caps it would just be wait-lists, and I mean it's all we can do. —FAO staff, #33 |
| Barriers to accessing resources | Patients: Encounter challenges accessing resources even if they are referred FAO staff: Many factors can deter access, even when people are referred | Usually I have to take my kids with me ‘cause it takes all of their hands, plus mine [to get the food home from the food bank without a car]. But then it's bus fare for all of them, too.” —patient, #2 I think a challenge for people getting in here is transportation. Or when we've tried to call the numbers they give us, they're disconnected or no longer in service.” —FAO staff, #35 [Many people] are just scared that they will affect applying for their citizenship or residence. FAO staff, #31 |
| Findings on Closing the Loop | ||
| Differing perspectives on value and acceptability | Patients: Generally recognize benefits but request for permission a necessity and strong privacy concerns among a minority of respondents HCWs: Strong positive view of benefits FAO staff: Recognize potential benefits but concern for client privacy | I don't guess it would bother me…but you know, I think that we need to know that they're doing that…sign a paper or something. —patient, #14 I really don't want anybody to know that I'm on [SNAP]. It's really nobody's business…I'm not proud of it. —patient, #7 I think that closing the referral is great. Then you know what you're saying is helping or not. —HCW, #21 I think it would be helpful, but I don't know if [our clients] would. I feel like some people might be judged if they shared that information. By the providers. —FAO staff, #35 |
| Logistics and implementation | Patients: Concern about data security HCWs: Importance of integration into existing data systems and workflows FAO staff: Concerns about time, cost, and regulations | I think the only thing I get nervous about is just the fact that everything's being hacked lately. —patient, #2 We need to put it into our EMR, or just think about where [the information] would go, and how would that be done. —HCW, #24 We're overstretched as it is, and adding like another piece of data entry onto it, would be something that we'd have to really look at to make sure that it was worthwhile for us to kind of do that extra work. —FAO staff, #32 There could be the confirmation…that the referral's been received. We just can't confirm if [the person is] eligible for the program or not due to federal privacy regulations. —FAO staff, #36 |
HCWs, health care workers; FAO, food assistance organizations; EMR, electronic medical record; CPS, child protective services.
↵* If a stakeholder group is not included for a theme, it indicates that particular theme did not emerge among that stakeholder group.
↵† Numbers indicate specific interview participant (patients numbered 1-20, HCW numbered 21-30, FAO staff numbered 31-42).