Food for Thought: Food Insecurity Screening in the Emergency Department

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

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.

Study Overview

• Status: Completed
• Conditions: Child Nutrition Disorders; Hunger
• Intervention / Treatment: Other: Food Insecurity Screening Tablet; Other: Food Insecurity Screening Verbal

Detailed Description

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.

• Study Type: Interventional
• Enrollment (Actual): 1818
• Phase: Not Applicable

Contacts and Locations

Study Locations

• United States
  • Pennsylvania
    • Philadelphia, Pennsylvania, United States, 19104
      • Children's Hospital of Philadelphia

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 18 years and older (Adult, Older Adult)
• Accepts Healthy Volunteers: Yes
• Genders Eligible for Study: All

Description

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

Study Plan

How is the study designed?

Design Details

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

Number of Arms

2

Arms and Interventions

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

What is the study measuring?

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

Collaborators and Investigators

• Sponsor: Children's Hospital of Philadelphia
• Collaborators: University of Pennsylvania

Study record dates

Study Major Dates

• Study Start (Actual): May 15, 2017
• Primary Completion (Actual): November 28, 2017
• Study Completion (Actual): January 18, 2018

Study Registration Dates

• First Submitted: August 28, 2018
• First Submitted That Met QC Criteria: August 30, 2018
• First Posted (Actual): September 4, 2018

Study Record Updates

• Last Update Posted (Actual): March 16, 2023
• Last Update Submitted That Met QC Criteria: March 14, 2023
• Last Verified: March 1, 2023

More Information

Terms related to this study

• Keywords: pediatrics; screening; social determinants of health; food insecurity
• Additional Relevant MeSH Terms: Pathologic Processes; Disease Attributes; Emergencies; Nutrition Disorders; Child Nutrition Disorders
• Other Study ID Numbers: 17-013696

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No