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Food Insecurity Screening in High-Income Countries, Tool Validity, and Implementation: A Scoping Review
Sabine Baker1,2, Danielle Gallegos1,2, Megan A Rebuli3
1Centre for Childhood Nutrition Research, Faculty of Health, Queensland University of Technology, South Brisbane, QLD 4101, Australia.
This review synthesizes evidence on household food insecurity screening tools and implementation strategies. The Hunger Vital Sign is the most validated tool, but low screening rates persist due to various barriers.
Area of Science:
- Public Health
- Nutrition Science
- Health Services Research
Background:
- Household food insecurity poses significant risks throughout life.
- Routine screening is recommended, especially in healthcare, but lacks standardized guidelines for tool selection and non-stigmatizing implementation.
- Evidence on screening tool psychometrics, implementation, and user experiences is synthesized.
Purpose of the Study:
- To conduct a scoping review of evidence on household food insecurity screening tools.
- To examine tool psychometrics, implementation across diverse settings, and experiences of screening.
- To identify practical strategies for optimizing screening and disclosure.
Main Methods:
- A scoping review was conducted using four electronic databases.
- Studies published from 1990 to June 2023 in English were included.
- 58 papers were analyzed, focusing on tool development, validation, implementation, and perceptions.
Main Results:
- The two-item Hunger Vital Sign is the most frequently used and validated tool.
- Most studies were from the USA, focusing on healthcare settings, with limited data on Indigenous populations.
- Low screening rates were observed despite minimal participant discomfort; barriers and facilitators were identified at multiple levels.
Conclusions:
- Practical strategies can optimize food insecurity screening and disclosure.
- Addressing barriers at setting, system, provider, and recipient levels is crucial for improving screening rates.
- Further research is needed on screening in underrepresented settings, particularly for Indigenous communities.
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