Food for Thought: Food Insecurity Screening in the Emergency Department

Study Overview
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Brief Summary
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This study compares food insecurity disclosure rates in face-to-face interviews versus electronic formats, and explores caregiver preferences regarding screening modality and location, in a large, urban pediatric emergency department. Half of the participants were screened for food insecurity verbally, face-to-face by a research assistant, and half of the participants were screened electronically by a tablet.

Detailed Description
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Children are disproportionately affected by the rise in poverty rates in the United States, and economic hardships can compromise their development, negatively affect their overall health, and adversely affect their abilities to succeed in school and in life. Food insecurity (FI)-the limited or uncertain availability of nutritionally adequate or safe foods- while strongly associated with poverty, is an independent predictor of poor health outcomes for children. The Emergency Department (ED) of academic medical centers often serves as a point of care entry for impoverished and high-risk families. Although there is a growing interest in the healthcare system's ability to address Social Determinants of Health (SDH), little is known about food insecurity in the pediatric ED. Additionally, there are limited data on how to implement FI screening into practice in a way that maximizes elicitation of social need, while assuring patient and family comfort.

Official Title
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Food for Thought: A Randomized Trial of Food Insecurity Screening in the Emergency Department

Conditions
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Hunger, Child Nutrition Disorders

Intervention / Treatment
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* Other: Food Insecurity Screening Tablet
* Other: Food Insecurity Screening Verbal


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: English speaking Adult caregiver accompanying pediatric patient in the Children's Hospital of Philadelphia (CHOP) emergency department Exclusion Criteria: Patient (child) in critical condition Patient (child) >18 years of age Previously enrolled in study

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Screening
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Active Comparator: Tablet Screening<br>Food insecurity screening conducted via electronic tablet | Other: Food Insecurity Screening Tablet<br>* The intervention is the type of screening modality used to identify food insecurity: verbal face-to-face, or tablet-based screening<br>|
| Active Comparator: Verbal Screening<br>Food insecurity screening conducted via verbal face-to-face interview | Other: Food Insecurity Screening Verbal<br>* The intervention is the type of screening modality used to identify food insecurity: verbal face-to-face, or tablet-based screening<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Presence of Food Insecurity | Affirmative response to either of the two, validated screening questions for food insecurity. Investigators measured food insecurity using the validated two-question Hunger Vital Sign screening tool, with yes/no responses. These two questions are: within the past 12 months we worried whether our food would run out before we got money to buy more and the food we bought just didn't last and we didn't have money to get more. | 12 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Preferred Screening Modality | Report of screening modality preference: verbal, tablet, or no preference | 4 weeks | 
| Comfort level with screening location | Report of comfort with screening in the emergency department and in the primary care setting | 4 weeks | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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social determinants of health, food insecurity, screening, pediatrics