Abstract Background Food insecurity (FI) is associated with negative health outcomes and increased healthcare utilization. Rural populations face increased rates of FI and encounter additional barriers to achieving food security. We sought to identify barriers and facilitators to screening and interventions for FI in rural primary care practices. Methods We conducted a mixed-methods study using surveys and semi-structured interviews of providers and staff members from rural primary care practices in northern New England. Survey data were analyzed descriptively, and thematic analysis was used to identify salient interview themes. Results Participants from 24 rural practices completed the survey, and 13 subsequently completed an interview. Most survey respondents (54%) reported their practices systematically screen for FI and 71% reported food needs were “very important” for their patients and communities. Time and resource constraints were the most frequently cited barriers to screening for and addressing FI in practices based on survey results. Interview themes were categorized by screening and intervention procedures, community factors, patient factors, external factors, practice factors, process and implementation factors, and impact of FI screening and interventions. Time and resource constraints were a major theme in interviews, and factors attributed to rural practice settings included geographically large service areas, stigma from loss of privacy in small communities, and availability of food resources through farming. Conclusions Rural primary care practices placed a high value on addressing food needs but faced a variety of barriers to implementing and sustaining FI screening and interventions. Strategies that utilize practice strengths and address time and resource constraints, stigma, and large service areas could promote the adoption of novel interventions to address FI.
Food insecurity during pregnancy has important implications for maternal and newborn health. There is increasing commitment to screening for social needs within health care settings. However, little is known about current screening processes or the capacity for prenatal care clinics to address food insecurity among their patients. We aimed to assess barriers and facilitators prenatal care clinics face in addressing food insecurity among pregnant people and to identify opportunities to improve food security among this population.We conducted a qualitative study among prenatal care clinics in New Hampshire and Vermont. Staff and clinicians engaged in food security screening and intervention processes at clinics affiliated with the Northern New England Perinatal Quality Improvement Network (NNEPQIN) were recruited to participate in key informant interviews. Thematic analysis was used to identify prominent themes in the interview data.Nine staff members or clinicians were enrolled and participated in key informant interviews. Key barriers to food security screening and interventions included lack of protocols and dedicated staff at the clinic as well as community factors such as availability of food distribution services and transportation. Facilitators of screening and intervention included a supportive culture at the clinic, trusting relationships between patients and clinicians, and availability of clinic-based and community resources.Prenatal care settings present an important opportunity to identify and address food insecurity among pregnant people, yet most practices lack specific protocols for screening. Our findings indicate that more systematic processes for screening and referrals, dedicated staff, and onsite food programs that address transportation and other access barriers could improve the capacity of prenatal care clinics to improve food security during pregnancy.
Primary care practices can address food insecurity (FI) through routine screening, practice-based food programmes, and referrals to community resources. The COVID-19 pandemic had disproportionate impacts on health outcomes for food-insecure households.
Food insecurity (FI) is associated with adverse health outcomes across the lifespan. Primary care and prenatal practices can identify and address FI among patients through screening and interventions. It is unclear how practices and communities responded to FI during the COVID-19 pandemic, and how the pandemic may have impacted practices' FI strategies. We aimed to understand how practices providing primary care or prenatal care in northern New England experienced changes in FI during the COVID-19 pandemic.We conducted a web-based survey of clinicians and staff from 43 unique practices providing primary care or prenatal care in northern New England.Most practices (59.5%) reported at least 1 new food program in the practice or community since the pandemic began. Practices reporting new practice- or community-based food programs were more likely to be rural, federally qualified health centers, and have greater confidence in practice and community capacity to address FI (chi-square tests, P < .05).Results suggest that practices and surrounding communities in northern New England responded to FI during the pandemic by increasing food support programs. Future work is needed to examine the impact of food programs initiated during the pandemic and determine optimal strategies for practices to address FI among patients.
Primary care practices are well-suited to address food insecurity (FI) in patients by conducting routine screening, hosting practice-based food programs, and connecting patients to community resources. Rural practices face unique barriers addressing FI, which may have been impacted by changes in clinic processes, resources, and food needs due to the COVID-19 pandemic.
Objective:
We sought to understand the impact of the COVID-19 pandemic on FI screening and interventions in rural primary care practices.
Study Design and Analysis:
We conducted thematic analysis of semi-structured qualitative interviews with practice staff using data from a larger mixed-methods study on FI in rural primary care during the pandemic.
Setting:
Rural areas of New Hampshire, Vermont, and Maine, USA.
Population Studied:
Clinicians and staff from rural (Rural-Urban Commuting Area Code >= 4) primary care practices in northern New England were recruited through three networks: a practice-based research network, a clinical and translational research network, and a practice-based network for federally qualified health centers.
Instrument:
A semi-structured interview guide created by the study team included questions regarding: 1) impact of the pandemic on FI screening and interventions; 2) changes to community resources and clinic-community partnerships; and 3) impact of the pandemic on patient food needs.
Outcome Measures:
Themes and exemplar quotes related to the impact of the pandemic on identifying and addressing FI in rural primary care were identified.
Results:
Thirteen staff and clinicians from unique rural primary care practices participated in interviews. Themes were organized around categories of Screening/Intervention Processes, Community Factors, Patient Factors, External Factors, and Practice Factors.
Key themes included:
1) changes in screening and interventions due to telemedicine; 2) new and stronger connections between practices and community programs; 3) decreased patient stigma around accessing food resources; 4) new practice-based food programs facilitated by state and federal funding; and 5) greater practice prioritization of FI.
Conclusions:
Barriers to FI screening and interventions during the pandemic included geographic distance and loss of existing food programs. Facilitators included new community connections, decrease in stigma, and increased funding. Identifying and addressing FI was a priority for rural primary care practices during the pandemic.
