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Roll-Out Implementation Optimization (ROIO) trial to develop and test the implementation of a food security screening

Kyung E Rhee^1,2,3, Sarah Hiller-Venegas⁴, Clare Viglione⁴

¹Department of Pediatrics, University of California San Diego, La Jolla, CA, USA. K1rhee@health.ucsd.edu.

Implementation Science Communications

|June 19, 2026

Summary

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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:

Keywords:

Food insecurity Nutrition insecurity PRISM Pediatrics RE-AIM Roll-Out Implementation and Optimization (ROIO) trial

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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.