Implementation Context of Food Insecurity Screening Initiatives in Primary Care: A Multiple Case Study

Food insecurity (hereafter, FI) is an economic condition where access to nutritious food prevents individuals from leading active and healthy lives. FI is associated with poor nutrition, diet-related health conditions and adverse health outcomes. The cost to treat FI related health conditions is roughly $160 billion dollars a year. Federal, state and local food assistance programs remain underutilized because at-risk patients cannot gain access to them. Emerging research points to the unique and critical role primary care providers can play to help FI patients navigate participation barriers. What has evolved are food insecurity screening and referral initiatives in clinical settings where primary care providers act as connecters to food assistance programs. Together, a healthcare organization and food assistance program form a clinical-community partnership to address FI in low-income patient populations. Providers screen for food insecurity during routine patient visits and refer patients to a food assistance partner program that provides immediate and long-term access to food, as well as wrap-around services. Even though the major components for these programs have been identified, standard practices for how these components are implemented have yet to be developed. This limits program upscale and the ability to measure program effectiveness. This study applied an embedded, multiple case-study design and a cross-case analysis to understand implementation facilitators and barriers across two programs implemented across five primary care clinics located in different jurisdictions within Chicago and suburban Cook County. The purpose was to establish a foundation for the development of standard practices. The key take away from this study is that because healthcare organizations have limited financial and human resources to dedicate to food insecurity screening initiatives, primary care practices need to be supported in their ability to implement programs in a feasible way. In this study, the high level of adaptability and trialability of food insecurity screening initiatives allowed each case to implement their program using existing financial and human capital, as well as structural support. Future studies may continue to build on and refine the proposed conceptual model, which is formative in nature and sets the stage for the development of standard program practices.