Written versus verbal food insecurity screening in one primary care clinic

Objective: Clinics are increasingly interested in identifying food insecurity (FI), but there is limited data on how to implement FI screening. Our objective was to determine the difference in FI disclosure rates by parents/guardians screened by a written questionnaire compared to verbally. Methods: The study occurred in one pediatric primary care clinic in which we screen for FI using the 2-item Hunger Vital Sign™. We used interrupted time series to evaluate the effect of changing from the clinician verbal screening to a written questionnaire. Screening results were extracted for all well-child visits from 4/2017-10/2018 for children age 0-18 years. The outcome was the proportion who screened positive for FI 9 months before and 9 months after the implementation of the written questionnaire. We estimated the difference in the level and trend of positive screens using ordinary least squares regression using Newey-West standard errors and adjusting for autocorrelation. Results: In 7,996 well-child visits, 1,141 (14.3%) patients screened positive. In bivariate analysis, there was a significant difference in the FI disclosure rates between patients screened by written questionnaire compared to verbally (16.3% vs 10.4%, p<0.001). In interrupted time series, changing to the written questionnaire was associated with a significant increase in FI disclosure rates (β=0.04, 95% CI: 0.01, 0.07; p=0.02). There was no significant change in the trend in disclosure rates. Discussion: Multiple barriers exist to effectively implementing FI screening in clinical care. Changing from a verbal to a written questionnaire resulted in an immediate and significant increase in the number of parents/guardians who reported FI.