An embedded multiple case study: using CFIR to map clinical food security screening constructs for the development of...

Area of Science:

• Public Health
• Health Services Research
• Implementation Science

Background:

• Food insecurity (FI) is a significant social determinant of health in the U.S., impacting diet and disease management.
• Healthcare professionals advocate for validated screening tools in primary care to link FI patients with food resources.
• Limited standardized practices hinder the widespread adoption of FI screening initiatives.

Purpose of the Study:

• To examine the processes and outcomes of primary care-based FI screening programs.
• To identify factors that can guide the broader implementation of these initiatives.

Main Methods:

• An embedded multiple case study design was employed across two diverse health systems.
• Qualitative data were collected via semi-structured interviews with 19 healthcare staff.
• The Consolidated Framework for Implementation Research guided data analysis to identify barriers, facilitators, and themes.

Main Results:

• Program outcomes included patient screening rates, FI identification, and participation in food assistance programs.
• Limited internal resources presented implementation barriers.
• Community collaborations and an aligned implementation climate were crucial facilitators, enabling adaptable program activities.

Conclusions:

• Adaptable programs and the healthcare context are vital for implementation feasibility.
• These adaptable characteristics can promote uptake in new settings, with attention to program fidelity.
• The study produced a foundational model for developing and testing standard clinical practices for FI screening.