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Written Versus Verbal Food Insecurity Screening in One Primary Care Clinic
Deepak Palakshappa1, Meggan Goodpasture2, Laurie Albertini2
1Department of Internal Medicine, Wake Forest School of Medicine (D Palakshappa), Winston-Salem, NC; Department of Pediatrics, Wake Forest School of Medicine (D Palakshappa, M Goodpasture, L Albertini, CL. Brown, K Montez, and JA Skelton), Winston-Salem, NC; Public Health Sciences, Wake Forest School of Medicine (D Palakshappa, CL Brown, and JA Skelton), Winston-Salem, NC.
Insights
Implementing a written questionnaire for food insecurity (FI) screening significantly increased parent disclosure rates in a pediatric clinic. This method is more effective than verbal screening for identifying families facing food insecurity.
Area of Science:
- Public Health
- Pediatric Primary Care
- Health Services Research
Background:
- Clinics face challenges in implementing effective food insecurity (FI) screening.
- Limited data exists on optimal methods for FI screening in clinical settings.
Purpose of the Study:
- To compare food insecurity disclosure rates between written questionnaires and verbal screening methods.
- To evaluate the impact of transitioning from verbal to written FI screening in a pediatric clinic.
Main Methods:
- A pediatric primary care clinic utilized the 2-item Hunger Vital Sign for FI screening.
- An interrupted time series analysis assessed the change in FI disclosure rates before and after implementing a written questionnaire.
- Data from 7996 well-child visits (April 2017-October 2018) were analyzed.
Main Results:
- Overall, 14.3% of patients screened positive for FI.
- Written questionnaires yielded significantly higher FI disclosure rates (16.3%) compared to verbal screening (10.4%, P < .001).
- The transition to a written questionnaire was associated with a significant increase in FI disclosure rates (β=.04, P=.02).
Conclusions:
- Written questionnaires are more effective than verbal screening for identifying food insecurity in pediatric primary care.
- Implementing written FI screening can overcome barriers and improve the identification of at-risk families.
- This change led to an immediate and significant increase in reported food insecurity.
Objective:
Clinics are increasingly interested in identifying food insecurity (FI), but there are limited data on how to implement FI screening. Our objective was to determine the difference in FI disclosure rates by parents/guardians screened by a written questionnaire compared to verbally.
Methods:
The study occurred in 1 pediatric primary care clinic in which we screened for FI using the 2-item Hunger Vital Sign. We used interrupted time series to evaluate the effect of changing from the clinician verbal screening to a written questionnaire. Screening results were extracted for all well-child visits from 4/2017 to 10/2018 for children age 0 to 18 years. The outcome was the proportion who screened positive for FI 9 months before and 9 months after the implementation of the written questionnaire. We estimated the difference in the level and trend of positive screens using ordinary least squares regression using Newey-West standard errors and adjusting for autocorrelation.
Results:
In 7996 well-child visits, 1141 patients (14.3%) screened positive. In bivariate analysis, there was a significant difference in the FI disclosure rates between patients screened by written questionnaire compared to verbally (16.3% vs 10.4%, P < .001). In interrupted time series, changing to the written questionnaire was associated with a significant increase in FI disclosure rates (β = .04, 95% confidence interval: 0.01, 0.07; P = .02). There was no significant change in the trend in disclosure rates.
Discussion:
Multiple barriers exist to effectively implementing FI screening in clinical care. Changing from a verbal to a written questionnaire resulted in an immediate and significant increase in the number of parents/guardians who reported FI.
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