Food for thought: A qualitative evaluation of caregiver preferences for food insecurity screening and resource referral

Background/Objective: Although there is growing interest in screening for Food Insecurity (FI) in the clinical setting, little research exists describing the effect of screening practices on caregiver comfort and willingness to disclose social risk, or what factors affect eventual engagement with food resources. Methods: In this qualitative study, we conducted 40 semi-structured interviews with caregivers of pediatric patients who reported FI in the Emergency Department of an urban, freestanding children's hospital. All interviews were digitally recorded and transcribed. We used content analysis with constant comparison to code interviews inductively and identified emerging themes through an iterative process. Results: Three primary themes emerged as factors affecting caregiver comfort in FI screening and engagement with resources: perceived negative repercussions associated with screening, perception of need, and effective connection with food resources. While most caregivers reported comfort with FI screening, intentional steps to provide anonymity and reduce stigma in the screening process were important in facilitating disclosure of social need. Engagement with resources was influenced by caregiver prioritization of food access within a milieu of life stressors, and the perception of personal need relative to their peers. Furthermore, caregivers suggested practices to facilitate effective connection with food resources such as use of mobile health technology, geographically based resources, and personalized connections. Conclusions: This study demonstrates the importance of screening methods that reduce judgement and preserves caregiver privacy, referring families to resources that are geographically accessible, and developing creative strategies that enhance families' connection to resources, such as with use of mobile technology.