An embedded multiple case study: using CFIR to map clinical food security screening constructs for the development of primary care practice guidelines

Background Food insecurity (FI), the limited access to healthy food to live an active and healthy life, is a social determinant of health linked to poor dietary health and difficulty with disease management in the United States (U.S.). Healthcare experts support the adoption of validated screening tools within primary care practice to identify and connect FI patients to healthy and affordable food resources. Yet, a lack of standard practices limits uptake. The purpose of this study was to understand program processes and outcomes of primary care focused FI screening initiatives that may guide wide-scale program implementation. Methods This was an embedded multiple case study of two primary care-focused initiatives implemented in two diverse health systems in Chicago and Suburban Cook County that routinely screened patients for FI and referred them to onsite food assistance programs. The Consolidated Framework for Implementation Research and an iterative process were used to collect/analyze qualitative data through semi-structured interviews with N = 19 healthcare staff. Intended program activities, outcomes, actors, implementation barriers/facilitators and overarching implementation themes were identified as a part of a cross-case analysis. Results Programs outcomes included: the number of patients screened, identified as FI and that participated in the onsite food assistance program. Study participants reported limited internal resources as implementation barriers for program activities. The implementation climate that leveraged the strength of community collaborations and aligned internal, implementation climate were critical facilitators that contributed to the flexibility of program activities that were tailored to fill gaps in resources and meet patient and clinician needs. Conclusion Highly adaptable programs and the healthcare context enhanced implementation feasibility across settings. These characteristics can support program uptake in other settings, but should be used with caution to preserve program fidelity. A foundational model for the development and testing of standard clinical practice was the product of this study.

The Impact of Climate-Change-Related Disasters on Africa’s Economic Growth, Agriculture, and Conflicts: Can Humanitarian Aid and Food Assistance Offset the Damage?

This study analyzed the impact of climate-related natural disasters (droughts, floods, storms/rainstorms) on economic and social variables. As the Africa-specific empirical literature is limited, this study used panel data from 1961–2011 on Africa. The study used a panel data regression model analysis. The results showed that climate change-related natural disasters affected Africa’s economic growth, agriculture, and poverty and caused armed conflicts. Among the disasters, droughts are the main cause of negative impact, severely affecting crops such as maize and coffee and resulting in increased urban poverty and armed conflicts. In contrast, international aid has a positive effect but the impact is insignificant compared to the negative consequences of climate-related natural disasters. Cereal food assistance has a negative crowding-out effect on cereal production. International donors should review their interventions to support Africa’s adaptative capacity to disasters. Government efficiency has reduced the number of deaths, and this is an area that supports Africa’s adaptative efforts.

The Impact of Climate-Change-Related Disasters on Africa’s Economic Growth, Agriculture, and Conflicts: Can Humanitarian Aid and Food Assistance Offset the Damage?

This study analyzed the impact of climate-related natural disasters (droughts, floods, storms/rainstorms) on economic and social variables. As the Africa-specific empirical literature is limited, this study used panel data from 1961–2011 on Africa. The study used a panel data regression model analysis. The results showed that climate change-related natural disasters affected Africa’s economic growth, agriculture, and poverty and caused armed conflicts. Among the disasters, droughts are the main cause of negative impact, severely affecting crops such as maize and coffee and resulting in increased urban poverty and armed conflicts. In contrast, international aid has a positive effect but the impact is insignificant compared to the negative consequences of climate-related natural disasters. Cereal food assistance has a negative crowding-out effect on cereal production. International donors should review their interventions to support Africa’s adaptative capacity to disasters. Government efficiency has reduced the number of deaths, and this is an area that supports Africa’s adaptative efforts.

Who really counts in Iran’s National Food Assistance Program? Lessons from multi-stakeholder processes in the wicked policy area of food security

Multi-stakeholder processes - as a necessary part in the development of public policies - can provide diverse perspectives to inform and to improve food security policy-making. Iran’s National Food Assistance Program (NFAP) is one of the major welfare programs in Iran that reduces food insecutiry to low-income households. This study aimed to identify and to categorize actual and potential stakeholders in NFAP using the stakeholder salience model. According to Mitchell’s theory, stakeholders’ attributes (power, legitimacy, and urgency) were assessed based on the nature of their interactions, roles, and level of engagement. Results revealed a number of significant but marginalized stakeholders, including Iranian Ministry of Health (office of community nutrition improvement), academia, center for food and nutrition research, target group, charities, and international organizations, who have not received any targeted organizational attention and priority to their claims. The unbalanced attention provided to some stakeholder groups characterized as “definitive” and “dominant” and ignoring some important ones will jeopardize long-term viability and undermine support for the program with inevitable declines in legitimacy. Understanding the change in the stakeholders’ characteristics is the main variable to determine the allocation of organizational resources in response to different and rising stakeholders’ demands and possibly the projects outcomes. This will facilitate and enhance the possibility of knowledge exchange and learning, and greater trust among stakeholders during the food and nutrition policy-making process.

Shining a light on food insecurity in Aotearoa New Zealand: Modification of a food security scale for use with individuals who have extreme food security needs

INTRODUCTION: Food insecurity in Aotearoa New Zealand is a growing concern but quantitative evidence focused on those in most need of support is scarce in the Aotearoa New Zealand context. This limits policy and practice decisions.METHODS: We modified Parnell and Gray’s (2014) Aotearoa New Zealand based food security scale to better capture the severity of food insecurity for individuals living in poverty and used a questionnaire to collect data from a sample of individuals seeking food assistance from foodbanks in Tāmaki Makaurau (Auckland). We used confirmatory factor analysis to assess the psychometric validity of the modified scale. We also tested group differences in food insecurity by gender and ethnicity using analysis of variance and investigated correlations between age, household size and food insecurity.FINDINGS: We found a six-item version of Parnell and Gray’s (2014) scale to be psychometrically robust for use with the study population. The sample participants reported concerning and chronic levels of food insecurity. We did not find any group differences.CONCLUSIONS: At the severe end of the food insecurity continuum, gender and ethnic subgroups appear to suffer at similar levels; however, this does not suggest that different approaches are not required to best meet the needs of different demographic subgroups. Further research is needed to ascertain how similar levels of food insecurity may produce differential effects on wellbeing outcomes for different groups. We recommend more widespread and regular use of the modified scale to assess the experience and impact of food insecurity for individuals living in poverty because it provides a more fine-grained understanding of the severity of food insecurity challenges experienced by individuals seeking food assistance. Fit for purpose measures enable accurate assessments that can better inform policymaking and practice decisions to reduce inequality and promote economic justice.

Comparison of Emergency Preparedness Practices between Food Assistance Program Participants and Non-Participants in the United States

Background: Previous research has suggested many households are meeting the Federal Emergency Management Agency’s 3-day emergency food and water storage recommendations. The impact of limited economic household resources on emergency preparedness practices related to food and water is uncertain. The purpose of this study was to compare emergency preparedness practices in households participating in United States’ food assistance programs with households not participating in these programs. Methods: A convenience sample of adults (n = 572) completed an online Qualtrics survey. Descriptive statistics, chi-square statistics, and independent t-tests were used to measure differences between households participating in food assistance programs vs. non-participating households. Results: Most households participating in food assistance programs felt prepared to provide household members with food and water during an emergency, which did not significantly differ from non-participating households. Households using food assistance programs had less accessible cash but had similar foods on-hand for an emergency compared to non-participating households. However, they more frequently reported having baby formula/food and less frequently reported having vitamin/mineral supplements compared to non-participating households. Conclusions: Food assistance programs may be effective in providing enough food and water to help low-income families be prepared for an emergency.

The Impact of the COVID-19 Pandemic on Food Distribution at Emergency Food Assistance Organizations in the Southwestern United States: A Qualitative Investigation

This study aimed to identify changes in food distribution operations at emergency food assistance organizations (EFAOs) during the COVID-19 pandemic. EFAOs across the Houston metro area, TX (human service centers and food pantries) as well as the Houston Food Bank (HFB) participated in the qualitative study. Data were collected via individual semi-structured interviews and focus group (December 2020–February 2021), and coded using semi-structured thematic analysis. Categories were pre-identified based on the interview questions. Direct quotes supported subcategories. Directors from 18 EFAOs were interviewed; 8 HFB leadership staff participated in a focus group. Four major categories of change due to COVID-19 included new safety measures, changes in food distribution process, changes in volunteerism and staffing, and changes in amounts of food distributed. This study helps identify susceptibilities in EFAOs’ food distribution chain should be addressed to manage future emergency food insecurity crises more effectively. An understanding of the changes/challenges incurred by EFAOs during the COVID-19 pandemic can inform policymakers to ensure local food distribution organizations are prepared to fill the needs during future a crisis of food insecurity.

Improving Food Security Through the Providing of Shoppes for Communities Affected by Covid 19

This Community Service provides a solution to the above problems, namely by improving nutrition to the community through the provision of basic food ingredients to people affected by COVID-19. The expected benefits of this Community Service are helping the economy, especially to meet the needs of its staples, and the welfare of people affected by COVID-19 in Cemandi Village, Sedati District, Sidoarjo Regency. The method applied is to provide direct food assistance to people affected by COVID-19. The results of the implementation of Community Service in the form of documentation and citizen responses to basic food assistance, among others. The implementation of community service as an effort to increase food security through the provision of basic necessities for the people affected by Covid 19 which was carried out to the residents of Cemandi village, Sidoarjo Regency received a positive response by providing basic necessities from the Community Service team and feeling that it was sufficient for their family's food needs in the next few days and had already right on target because residents desperately need basic food assistance due to decreased income and unable to fulfill their family's nutrition.

Patient Perspectives: Valuable Food Insecurity Interventions

Introduction: Food insecurity (FI), defined as “limited or uncertain availability of nutritionally adequate and safe foods, or limited or uncertain ability to acquire acceptable foods in socially acceptable ways,” affects over 12% of US households. Embarrassment persists for patients with FI, and due to the potential consequences of FI, including increased utilization of the health care system, it is important to find causes and potential interventions for FI. The purpose of this project was to better understand FI from the patient perspective, including contributing factors, perceived health effects, and helpful interventions. Methods: Interviews (N=21) were conducted with suburban community residency clinic patients who screened positive for FI in the last 12 months. Six open-ended questions and a ranking question examined contributors to FI, effects of FI, perceptions of clinic intervention helpfulness, and ideas for novel interventions. Results: Patients identified lack of income (85.7%) as the primary issue they faced. Secondary identified issues were lack of transportation (38.1%), too much debt (33.3%), and food assistance programs not providing for all needs (33.3%). FI effects on patients’ health included difficulty adhering to specialized diets and the need to modify eating patterns due to lack of food. Surprisingly, 28.6% perceived no FI related-health effects. Patients felt that the most valuable clinic intervention was provision of urgent need food boxes, followed by FI screening and referrals to community food resources. Conclusions: Frequent FI screening is in itself useful to patients. Screening paired with community food resource referrals and urgent-need food boxes are the most helpful interventions according to patients.