Food for Thought: A Randomized Trial of Food Insecurity Screening in the Emergency Department

Despite the growing interest in screening for food insecurity in the clinical setting, little evidence exists regarding screening formats that maximize disclosure and caregiver comfort.

In this randomized trial, we asked English-speaking adult caregivers of pediatric patients in the emergency department at an urban, freestanding children's hospital to complete a validated, 2-question screen for food insecurity. Respondents were assigned via block randomization to complete the survey by either verbal interview or electronic tablet. Caregivers reported the perceived importance of the screening questions, comfort level with screening in the emergency department or in their child's primary care site, and their preferred screening modality.

Of the 1818 participants, 20.6% screened positive for food insecurity. There was a significantly higher rate of reported food insecurity for those screened by tablet (23.6%) compared to those screened verbally (17.7%) (P = .002). Of those who had a preference of screening modality, 83.2% of all participants and 84.5% of patients reporting food insecurity preferred the tablet-based screen over verbal interview. Overall, more participants reported comfort completing the screen in the emergency department compared to their child's doctor's office; however, comfort in both of these setting was rated highly (86.1% vs 80.2%; P < .001).

Although both verbal interview and tablet-based screening modalities were effective in identifying food insecurity, tablet-based screening had a higher disclosure rate and was the participants' preferred screening method. There is a high level of comfort with screening regardless of clinical setting; it is possible that an added level of anonymity in the emergency department enhanced participants' comfort levels.