Food insecurity prevalence and perspectives among healthcare clinicians and staff in rural western Colorado

Background

Healthcare workers’ attitudes about food insecurity shape how they screen patients for food insecurity and refer to assistance programs.

Objective

We measured prevalence of and perspectives on food insecurity among staff and clinicians at western Colorado healthcare organizations.

Methods

In collaboration with an Accountable Health Communities (AHC) community bridge organization, we distributed an online survey to 61 organizations. Following descriptive and confirmatory factor analyses, we used structural equation modeling to examine the associations among perceived causes of food insecurity, perceived assistance program misuse, and respondent characteristics.

Results

We received responses from 347 clinicians, support workers, and operations staff across 14 rural counties. Eighteen percent reported current food insecurity; 46% reported past food insecurity. Sixty-nine percent of respondents attributed food insecurity in part to factors that blame the individual (e.g., “people who don’t want to work”). Up to 55% believed that some people exploit food assistance programs by using them when they don’t really need them. The confirmatory factor analysis and structural equation models evidenced good model fit, supporting the idea that attributing food insecurity to individual causes and perceiving assistance program exploitation are separate but related aspects of stigma. The structural equation model also indicated respondent characteristics (age, familiarity with assistance programs) that likely influence stigmatizing perspectives. 

Conclusion

Many healthcare workers in this population may be biased against individuals with food insecurity, harbor misinformation about assistance program misuse, and be experienced with food insecurity themselves. These findings raise questions about how to ensure that healthcare workers can address food insecurity in an effective and de-stigmatizing manner, and are themselves earning a living wage. Our findings indicate a need for further study of poverty and of anti-poverty bias among rural healthcare workers and how these impact healthcare sector strategies to address health-related social needs.