Food insecurity is consistently more prevalent in households of people living with diabetes, and particularly high among households of children with diabetes. With healthy eating at the cornerstone of all diabetes care strategies for both adults and children, FI can have a significant negative impact on diabetes management. Hence, there is growing recognition of the importance of FI routine screening to help clinicians tailor diabetes management plans for FI households. For instance, knowledge of FI could guide clinicians to provide FI families with more realistic dietary recommendations, adjust medication regimens, and identify patients at increased risk of poor FI-related health outcomes, such as asthma, depression, and obesity. A positive screen could direct patients to affordable sources of healthy foods.
The Council on Community Pediatrics recommends universal screening for FI in children. The American Diabetes Association recommends clinicians to assess FI, apply that information to treatment decisions, and refer patients to community resources, while the Canadian Diabetes Association guidelines recognize that individuals’ ability to adopt healthy lifestyles is influenced by their social conditions. Nevertheless, despite its implications for children’s health, FI screening is not yet part of routine clinical practice, while how to screen and the efficacy of screening strategies are still understudied.
Our research projects have evaluated the implementation of two FI screening initiatives in a diabetes pediatric clinic and in a community health center by assessing the acceptability and the feasibility of these screening initiatives from the perspective of both families and clinicians. Results show that screening provides FI families an opportunity to express their concerns and become aware of affordable food resources. Most FI families feel comfortable answering screening questions, although some of them may describe stigma and fear of judgment by clinicians. Findings also show that clinicians are willing to incorporate FI screening, especially if a standardized tool is available and effective referral resources to address social adversities exist.
To increase screening uptake and minimize the disruption of clinicians’ workflow, FI screening can be administered in self-reported computer-based formats, which in turn facilitate the integration of FI screening into families’ electronic medical records (EMR). An automated EMR default process may also support routine screening and continuity of practice among clinicians, as it helps them to share information about families.
This research encourages the implementation of similar FI screening initiatives in other clinical, community and primary care settings as part of routine clinical practice, which will ensure that FI individuals and children receive treatment plans tailored to their FI circumstances and are linked to community resources.
Food Insecurity Screening Toolkit for Care Providers
Clinic Setting Posters