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Roll-Out Implementation Optimization (ROIO) trial to develop and test the implementation of a food security screening
Kyung E Rhee1,2,3, Sarah Hiller-Venegas4, Clare Viglione4
1Department of Pediatrics, University of California San Diego, La Jolla, CA, USA. K1rhee@health.ucsd.edu.
Insights
This study refines a food insecurity (FI) screening and referral program for pediatric clinics. It aims to create a sustainable model to improve nutrition-related health outcomes for low-income children.
Area of Science:
- Implementation Science
- Pediatric Health
- Public Health Nutrition
Background:
- Food insecurity (FI) negatively impacts children's health, psychosocial functioning, and academic achievement.
- Integrating nutrition support into healthcare is recommended but faces implementation challenges in clinical settings.
- Existing workflows for FI screening and referral are inconsistently implemented and difficult to sustain.
Purpose of the Study:
- To refine, adapt, and optimize a comprehensive FI screening and referral program (I-FRESH) for pediatric healthcare systems.
- To identify effective implementation strategies for successful adoption and long-term sustainability of FI programs.
- To generate a scalable, context-responsive implementation model for addressing FI in pediatric settings.
Main Methods:
- A RollOut Implementation and Optimization (ROIO) trial design will be used across 4 pediatric clinics.
- The I-FRESH program includes FI screening, needs assessment, referral/navigation support, and follow-up.
- The Pragmatic, Robust Implementation and Sustainability Model (PRISM) and RE-AIM framework will guide adaptation and evaluation.
Main Results:
- Preliminary effectiveness will be assessed on family-level food security and pediatric nutrition-related health outcomes.
- Implementation strategies will be identified to enhance the likelihood of successful program implementation and sustainability.
- Data will inform a future Type 2 Hybrid Effectiveness-Implementation Trial.
Conclusions:
- This study will yield a scalable, context-responsive model for addressing FI in pediatric healthcare.
- Findings will guide sustainable strategies to connect families with nutrition support and improve child health outcomes.
- The research integrates PRISM and RE-AIM within an iterative ROIO design for robust evaluation.
Background:
Food insecurity (FI) is associated with poorer physical and mental health outcomes, exacerbation of chronic diseases, and decreased access to healthcare. Children experiencing FI face additional risks, including lower psychosocial functioning and reduced academic achievement. Although national initiatives call for integrating nutrition support services into healthcare, clinical workflows for FI screening and referral remain inconsistently implemented and difficult to sustain. The goal of this study is to refine, adapt, and optimize a comprehensive FI screening and referral program, and identify effective implementation strategies for pediatric healthcare systems.
Methods:
We will use a RollOut Implementation and Optimization (ROIO) trial design to iteratively implement and refine the implementation strategies for our FI screening and referral program (I-FRESH: Implementing Food Referrals for Equity and Sustained Health) across 4 pediatric clinics. I-FRESH includes: (1) FI screening; (2) assessment of family needs and readiness to access services; (3) referral and navigation support to community nutrition programs; and (4) follow-up to assess fit, utilization, and ongoing needs. The Pragmatic, Robust Implementation and Sustainability Model (PRISM) will guide adaptation and evaluation of contextual determinants, while RE-AIM will guide assessment of outcomes (implementation feasibility and acceptability, fidelity, adoption, reach, effectiveness, and maintenance). We will identify several implementation strategies to increase the likelihood that I-FRESH can be successfully implemented and sustained in a pediatric healthcare system. We will enroll 240 participants and assess preliminary effectiveness on family‑level food security and pediatric nutrition‑related health outcomes (e.g. weight status, blood pressure, lipids, HbA1c, liver function tests). The information gathered in this trial will be utilized in the development of a fully powered Type 2 Hybrid Effectiveness-Implementation Trial that will test the effectiveness of the identified implementation strategies and impact of the FI program on clinical outcomes.
Discussion:
By integrating PRISM and RE-AIM within an iterative ROIO design, this study will generate a scalable, contextresponsive implementation model for addressing FI in pediatric healthcare settings. Findings will inform sustainable strategies that link families to highquality nutrition support programs and improve nutritionrelated health outcomes for lowincome children.
Trial Registration:
NCT06661538.
