166 - “It can be confusing as to why the question Is being asked”: Family Perspectives on Food Insecurity Screening at Two Urban Pediatric Primary Care Clinics

Poster Number: 166
Publication Number: 166.316

Jennifer O'Neil Lambert, Children's National Hospital, Washington, DC, United States; Kofi Essel, Children's National Health System, Washington, DC, United States; Samantha Crawley, George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Emilia Kaslow-Zieve, George Washington University School of Medicine and Health Sciences, Washington, DC, United States; Olanrewaju O. Falusi, Children's National Hospital, Washington, DC, United States

Background: Food insecurity (FI) is known to have deleterious effects on child physical, behavioral, academic, and emotional health. In 2015, the American Academy of Pediatrics recommended pediatricians implement a highly-sensitive, two-item screen to assess for FI at well-child visits. The rate of FI found by this screening tool at a network of pediatric primary care clinics in Washington, DC in 2020 was approximately equal to the national average despite many risk factors for FI in this under-resourced population.

Objective: This qualitative study sought to understand the lived experiences of individuals participating in FI screening in order to determine how pediatric primary care clinics can best screen families and intervene effectively for those facing FI.

Design/Methods: Forty-three semi-structured interviews were conducted following well visits at two clinics with English- and Spanish-speaking caregivers of publicly-insured pediatric patients and young adult patients. Spanish-speaking families and families who screened positive for FI were oversampled to adequately capture the experiences of these lower prevalence groups. Interviews were recorded, transcribed, and coded using Dedoose qualitative analysis software. Thematic analysis was used to identify salient themes.

Results: Nearly half of participants (47%) screened positive for FI at their recent well visit and/or during the semi-structured interview. Through qualitative thematic analysis, three major themes emerged: (1) families found universal FI screening at pediatric primary care visits acceptable; (2) FI screening triggered challenging emotions including shame, fear, and guilt, especially when the purpose of screening was unclear; and (3) families expressed that a warm handoff to nutritional resources was necessary in order for FI screening to have a positive impact.Conclusion(s): While families find universal FI screening in pediatric primary care acceptable, there is considerable confusion among families as to the purpose of screening and the result of a positive screen. Clinicians should clearly communicate the purpose of screening and should provide warm handoffs to comprehensive resources for families who screen positive in order to enhance the efficacy and family experience of FI screening.
Jennifer O'Neil Lambert CVJOL CV.pdf