Addressing food insecurity in the inpatient setting: Results of a postdischarge pilot study.

BACKGROUND AND OBJECTIVES: With a growing interest in screening for food insecurity (FI) during pediatric hospitalization, there is a parallel need to develop interventions. With input from caregivers experiencing FI, we sought to identify interventions to assist with short-term FI after discharge and evaluate their feasibility, acceptability, and appropriateness. METHODS: We first employed qualitative methods to identify potential interventions. Next, we conducted a pilot study of selected interventions for families experiencing FI. Seven days postdischarge, caregivers rated the intervention's feasibility, acceptability, and appropriateness. We also assessed for ongoing FI. We summarized the median and proportion of "completely agree" responses to feasibility, acceptability, and appropriateness questions, and we compared in-hospital and postdischarge FI using McNemar's test. RESULTS: In the qualitative stage, 14 caregivers prioritized three interventions: grocery store gift cards, grocery delivery/pick-up, and frozen meals. In the pilot study, 53 caregivers (25% of those screened) endorsed FI during their child's hospitalization and received one or more of the interventions. Every caregiver selected the grocery gift card option; 37 families (69.8%) also received frozen meals. Seven days after discharge, most caregivers rated the intervention as "completely" feasible (76%), acceptable (90%), and appropriate (88%). There was a significant decrease in caregivers who reported FI after discharge compared to during the hospitalization (p < .001). CONCLUSIONS: This study demonstrates the feasibility, acceptability, and appropriateness of inpatient interventions to address FI, particularly at the time of pediatric hospital discharge and transition home. Randomized trials are needed to further evaluate the efficacy of interventions employed during hospitalization.

Evaluating Screening to Assess Endorsement of Food Insecurity in the Inpatient Setting.

OBJECTIVE: Rates of food insecurity (FI) from screening in the inpatient setting is often not reflective of community prevalence, indicating that screening likely misses families with FI. We aimed to determine the combination of FI screening questions and methods that would result in identifying a percentage of FI families that matched or exceeded our area prevalence (approximately 20%). METHODS: Research staff approached eligible English- and Spanish-speaking families across 4 inpatient units once weekly and screened for FI using a randomly selected method (face-to-face, phone, paper, and tablet). We asked questions from the 6-Item USDA Survey, Hunger Vital Sign screener, and questions utilized by our social workers. RESULTS: We screened 361 families; 19.4% (N = 70) endorsed FI. Differences in rates were not significant by method. Differences in FI rates based on screening questions were: 17.7% for the 6-item USDA survey, 16.0% for Hunger Vital Sign, and 3.1% for the social work questions. When considering method and screening questions together, the 6-Item USDA on paper had the highest positivity rate of 20.9%. A higher percentage of Spanish-speaking families endorsed FI (61.1%) compared to 17.2% of English-speaking families (P < .01). Positivity also varied significantly by self-identified race (P < .01). Caregivers that identified as Hispanic or Latino were significantly more likely to endorse FI than those that did not (P < .01). CONCLUSIONS: The positivity rate for FI while screening inpatient families using the 6-Item screening questions on paper matched our community prevalence of FI (approximately 20%).