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Food Insecurity Screening in Pediatric Clinical Settings: A Caregivers’ Perspective

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Abstract

Objectives

Food insecurity (FI) has serious academic, social, and physical health consequences for children. A recent clinical recommendation suggests FI screening during child well visits. While FI screening research has considered clinician feedback, little is known about caregivers’ experience of disclosing FI to health care providers. Our paper explores caregivers’ barriers and facilitators to FI disclosure.

Methods

A survey on factors influencing FI disclosure was completed in a pediatric clinic waiting room in St. Louis, MO. Among households with FI, 15 caregivers participated in a qualitative interview. Caregivers were asked about experiences discussing FI with health care providers. We calculated frequencies for survey responses and analyzed interview data using thematic content analysis.

Results

Caregivers highlighted stigma, fear of child being taken away, and shame as barriers to FI disclosure. Caregivers identified strong interpersonal skills, open body language, and empathy as facilitators to disclosure at the interpersonal level. Provider initiated conversations, consideration of FI disclosure in the presence of a child, and normalization of FI discussions within the clinic were described as ways to encourage FI disclosure at the organizational level. In response to FI disclosure, caregivers would like providers to offer resources including referrals to community-based resources extending beyond food.

Conclusions for Practice

Our study identifies considerations for FI screening in health care settings, spanning the social-ecological model, from the perspective of caregivers. To successfully screen and address FI, multifaceted health care interventions should address barriers and promote facilitators across multiple levels and in consideration of multiple social needs.

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References

  • Adeoye-Agboola, D. I., Evans, H., Hewson, D., & Pappas, Y. (2016). Factors influencing HIV disclosure among people living with HIV/AIDS in Nigeria: A systematic review using narrative synthesis and meta-analysis. Public Health,136, 13–28.

    Article  CAS  Google Scholar 

  • Alaimo, K., Olson, C. M., & Frongillo, E. A. (2001). Food insufficiency and American school-aged children’s cognitive, academic, and psychosocial development. Pediatrics,108(1), 44–53.

    CAS  PubMed  Google Scholar 

  • Allen, H., Wright, B., Harding, K., & Broffman, L. (2014). The role of stigma in access to health care for the poor. Milbank Quarterly,92(2), 289–318.

    Article  Google Scholar 

  • American Academy of Pediatrics, & Food Research & Action Center. (2017). Addressing food insecurity: A toolkit for pediatricians. Retrieved August 13, 2019, from http://frac.org/aaptoolkit.

  • Barnidge, E., LaBarge, G., Krupsky, K., & Arthur, J. (2016). Screening for food insecurity in pediatric clinical settings: Opportunities and barriers. Journal of Community Health,42(1), 51–57.

    Article  Google Scholar 

  • Beck A., Henize, A., Kahn, R., & Klein, M. (2015). Curtailing food insecurity with clinical-community collaboration. Health Affairs Blog. Retrieved August 13, 2019, from https://www.healthaffairs.org/do/10.1377/hblog20150709.049172/full/.

  • Beck, A. F., Henize, A. W., Kahn, R. S., Reiber, K. L., Young, J. J., & Klein, M. D. (2014). Forging a pediatric primary care–community partnership to support food-insecure families. Pediatrics,134(2), e564–e571.

    Article  Google Scholar 

  • Oregon State University. (2019). Childhood Food Insecurity. Retrieved August 13, 2019, from https://pace.oregonstate.edu/catalog/childhood-food-insecurity.

  • Coleman-Jensen, A., Rabbitt, M., Gregory, C., & Singh, A. (2016). Household food security in the United States in 2015: USDA-ERS. Retrieved August 13, 2019, from https://www.ers.usda.gov/publications/pub-details/?pubid=79760.

  • Council on Community Pediatrics & Committee on Nutrition. (2015). Promoting food security for all children. Pediatrics,136(5), e1431–e1438.

    Article  Google Scholar 

  • Eisenmann, J. C., Gundersen, C., Lohman, B. J., Garasky, S., & Stewart, S. D. (2011). Is food insecurity related to overweight and obesity in children and adolescents? A summary of studies, 1995–2009. Obesity Reviews,12(5), e73–e83.

    Article  CAS  Google Scholar 

  • Feeding America. (2016). Map the Meal Gap 2016. Retrieved August 13, 2019, from https://www.feedingamerica.org/sites/default/files/research/map-the-meal-gap/2014/map-the-meal-gap-2014-exec-summ.pdf.

  • Feder, G. S., Hutson, M., Ramsay, J., & Taket, A. R. (2006). Women exposed to intimate partner violence: Expectations and experiences when they encounter health care professionals: A meta-analysis of qualitative studies. Archives of Internal Medicine,166(1), 22–37.

    Article  Google Scholar 

  • Fram, M. S., Frongillo, E. A., Jones, S. J., Williams, R. C., Burke, M. P., DeLoach, K. P., et al. (2011). Children are aware of food insecurity and take responsibility for managing food resources. Journal of Nutrition,141(6), 1114–1119.

    Article  CAS  Google Scholar 

  • Hager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., et al. (2010). Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics,126(1), e26–e32.

    Article  Google Scholar 

  • Hamm, M., & Bellows, A. C. (2003). Community food security: Background and future directions. Journal of Nutrition Education and Behavior,35(1), 37–43.

    Article  Google Scholar 

  • Health Leads. (2017). Health Leads. Retrieved April 6, 2017, from https://healthleadsusa.org/.

  • Hegarty, K. L., & Taft, A. J. (2001). Overcoming the barriers to disclosure and inquiry of partner abuse for women attending general practice. Australian and New Zealand Journal of Public Health,25(5), 433–437.

    Article  CAS  Google Scholar 

  • Jyoti, D. F., Frongillo, E. A., & Jones, S. J. (2005). Food inecurity affects school children’s academic performance, weight gain, and social skills. The Journal of Nutrition,135(12), 2831–2839.

    Article  CAS  Google Scholar 

  • Kleinman, R. E., Murphy, J. M., Little, M., Pagano, M., Wehler, C. A., Regal, K., et al. (1998). Hunger in children in the United States: Potential behavioral and emotional correlates. Pediatrics,101(1), e3.

    Article  CAS  Google Scholar 

  • Laraia, B. A. (2013). Food insecurity and chronic disease. Advances in Nutrition,4(2), 203–212.

    Article  Google Scholar 

  • Lundeen, E. A., Siegel, K., Calhoun, H., Kim, S., Garcia, S. P., Hoeting, N., et al. (2017). Clinic-community partnerships to identify patients with food insecurity and address food needs. Preventing Chronic Disease,14, E113.

    PubMed  PubMed Central  Google Scholar 

  • Lutenbacher, M., Cohen, A., & Mitzel, J. (2003). Do we really help? Perspectives of abused women. Public Health Nursing,20(1), 56–64.

    Article  Google Scholar 

  • Miles, M., & Huberman, A. (1994). Qualitative data analysis (2nd ed.). Thousand Oaks, CA: Sage.

    Google Scholar 

  • Miles, M., Huberman, A. M., & Saldaña, J. (2014). Qualitative data analysis (3rd ed.). Los Angeles, CA: Sage.

    Google Scholar 

  • Moses, S., & Tomlinson, M. (2013). The fluidity of disclosure: A longitudinal exploration of women’s experience and understanding of HIV disclosure in the context of pregnancy and early motherhood. AIDS Care,25(6), 667–675.

    Article  Google Scholar 

  • Nord, M. (2009). Food Insecurity in households with children: Prevalence, severity, and household characteristics. Economic Information Bulletin Number 56. Retrieved August 13, 2019, from https://www.ers.usda.gov/publications/pub-details/?pubid=44421.

  • Qiao, S., Li, X., Zhou, Y., Shen, Z., Tang, Z., & Stanton, B. (2015). Factors influencing the decision-making of parental HIV disclosure: A socio-ecological approach. AIDS,29(Suppl 1), S25–S34.

    Article  Google Scholar 

  • Reutter, L. I., Veenstra, G., Love, R., Raphael, D., & Makwarimba, E. (2009). “Who do they think we are, anyway?” Perceptions of and responses to poverty stigma. Qualitative Health Research,19(3), 297–311.

    Article  Google Scholar 

  • Saldaña, J. (2009). The coding manual for qualitative researchers. Los Angeles, CA: Sage.

    Google Scholar 

  • Stenmark, S., Solomon, L., Allen-Davis, J., & Brozena, C. (2015). Linking the clinical experience to community resources to address hunger in colorado. Health Affairs Blog. Retrieved August 13, 2019, from https://www.healthaffairs.org/do/10.1377/hblog20150713.049277/full/.

  • Tong, A., Sainsbury, P., & Craig, J. (2007). Consolidated criteria for reporting qualitative research (COREQ) a 32-item checklist for interviews and focus groups. International Journal for Quality in Health Care,19(6), 349–357.

    Article  Google Scholar 

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Acknowledgements

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The work presented was completed with support from corresponding author’s institution.

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Authors and Affiliations

  1. College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO, 63104, USA

    Ellen Barnidge & Kathryn Krupsky

  2. Department of Pediatrics, Saint Louis University School of Medicine at SSM Health Cardinal Glennon Children’s Hospital, 1465 South Grand Boulevard, St. Louis, MO, 63104, USA

    Gene LaBarge & Joshua Arthur

Authors
  1. Ellen Barnidge
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  2. Kathryn Krupsky
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  3. Gene LaBarge
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  4. Joshua Arthur
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Correspondence to Ellen Barnidge.

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Barnidge, E., Krupsky, K., LaBarge, G. et al. Food Insecurity Screening in Pediatric Clinical Settings: A Caregivers’ Perspective. Matern Child Health J 24, 101–109 (2020). https://doi.org/10.1007/s10995-019-02785-6

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  • DOI: https://doi.org/10.1007/s10995-019-02785-6

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