Clinical care and referral pathways for food security screening in health care: A scoping review

BACKGROUND: Food and nutrition insecurity are linked to poor health outcomes and disparities, yet how health care systems implement screening and referrals remains poorly understood. 

METHODS: We searched for studies evaluating screening and referral processes for food and nutrition insecurity for patients of all ages in US health care settings. Searches were performed through May 2025 in MEDLINE (via PubMed), Cochrane (via Ovid), Cumulative Index of Nursing and Allied Health (EBSCO), and Social Interventions Research and Evaluation Network Evidence and Resource Library. Studies were included if they reported both a screening process and referral mechanism. Findings were synthesized narratively. 

RESULTS: Of 11 406 records identified, 136 studies met the inclusion criteria; all screened for food insecurity, and none screened for nutrition insecurity. Most studies screened general populations across age, sex, race, and ethnicity, with few restricting by socioeconomic status or clinical conditions. Screening primarily used tools embedded within broader social determinants of health screenings (46%) and integrated into electronic health records (48%), typically in outpatient settings (49%). Screening methods varied, most commonly self-administered by patients (21%) or by clinic staff (20%) and were unspecified in one fifth of studies (21%). A total of 129 studies described 39 unique referral strategies across 4 categories: community-based resources (46%), health care-embedded services (35%), federal nutrition programs (12%), and Food Is Medicine interventions (7%), with 46% spanning multiple categories. While about half of studies (46%) reported referral rates, only about one third (37%) reported referral completion. 

CONCLUSIONS: These findings highlight current practices and evidence gaps, informing priorities to strengthen screening and referral systems that advance food security, nutrition, health, and health equity.