Table 2

Process Outcomes of Interventions to Address Food Insecurity in Health Care Settings (N = 17)

Study	Design	Population	Sample	Intervention	Process Outcomes	Statistics
Intervention type: referrals
Garg,¹⁶ 2007	RCT	Caregivers of pediatric patients aged 2 months to 10 years at well-child visits	98 intervention, 95 control	Intervention caregivers screened with 10-item questionnaire for social needs in waiting room before well-child visits	Referral to food resource (pantry, foods stamps, WIC)	1.42 (0.28-2.56), 0.34^a

Garg,²² 2015	Cluster RCT	Adult caregivers of pediatric patients aged ≤6 months at well-child visits in 8 urban community health centers	336 mothers (168 per study arm)	Intervention familes screened with WE CARE tool for referral to social resources	Enrollment in community resources Referral to food resources	Food assistance program: 0.14 (–0.30 to 0.58), 0.05^a Food pantry: 0.40 (–0.38 to 1.17), 0.16^a 0.67 (0.25-1.09), 0.05^a

Fleegler,³⁵ 2007	Cross-sectional	Families of children aged 0-6 years who attended well-child visits at 2 urban pediatric clinics	205 parents (68 with FI)	Families screened with computer-based questionnaire for referrals to resources	Referral to food resources Frequency of contacting referral agency	35% (24/68) of FI patients referred 67% (16/24) contacted food resource; 94% (15/16) deemed referral helpful

Fox,²⁹ 2016	Pre-/post-intervention, pilot	New patients at a pediatric weight management clinic	116 patients	Intervention to partner clinic with Second Harvest Heartland food bank with SNAP enrollment outreach	Enrollment in SNAP	34% (40/116) eligible for referral; 75% (30/40) accepted; 20% (3/15) completed enrollment^b

Hassan,³⁷ 2015	Prospective observational	Patients aged 15-25 years at an urban adolescent/young adult clinic	401 youth	Web-based screening and referral tool	Frequency of contacting any referral agency (not food specific)	40% (104/259)

Knowles,³⁴ 2018	Mixed methods	Caregivers of pediatric patients aged <5 years eligible for benefits	103 families	Integrated clinic-based referral intervention	Enrollment in SNAP	42% (43/103) eligible completed 85 applications; 32% (27/85) approved; 8% (7/85) denied; 60% (51/85) unknown 63% (12/19) enrolled

Martel,⁴⁰ 2018	Retrospective observational	Patients of urban county hospital/emergency department	1,519 patients	Clinic parntership with Second Harvest Heartland food bank	Frequency of contacting referral agency Enrollment in SNAP	74% (1,129/1,519) successfully contacted; 63% (954/1519) accepted; 92% (878/954) connected with >1 food resource 76% (338/446) of SNAP eligible completed applications

Morales,²⁴ 2016	Retrospective observational cohort with propensity score matching	Pregnant patients with food insecurity at obstetrical clinic	145 adult female patients	Integrated screening and referral to Food for Families; program for referral to food resources	Enrollment in benefits	67% (97/145) enrolled

Nguyen,²⁷ 2016	Retrospective observational, pre-/post-intervention, pilot	Self-identified Hispanic patients aged ≥60 years with DM, at FQHC	18/28 participants followed up at 3 months	Referrals from clinic integrated Health Connector Program	Frequency of contacting referral agency	33% (6/18) requested food referral; 22% (4/18) contacted food resources

Patel,³⁰ 2018	Pre-/post-intervention, pilot	Adult patients with DM at endocrinology clinic with access to telephone and documented financial difficulties	104 patients	Financial burden resource tool	Increase in use of farmers markets, groceries that accept food assistance	0.12 (–0.16 to 0.40), 0.02^a

Sege,²¹ 2015	RCT	Families with newborns aged <10 weeks at pediatric primary care clinic	167 intervention, 163 control	Intervention group was paired with a trained family specialist who provided support (including home visits) and direct assistance accessing resources	Food resource use	0.18 (–0.08 to 0.43), 0.02^a

Weintraub,²⁸ 2010	Prospective cohort	Pediatric patients at Peninsula family advocacy program	109 participants of family advocacy program, 102 enrolled, 54 completed follow-up	Integrated clinic- and hospital-based legal services	Increase in use of food support	WIC: 0.73 (0.18-1.28), 0.08^a; CalWORKS: 0.65 (0.11-1.20), 0.08)^a; Food stamps: 0.73 (0.18-0.28), 0.08^a

Intervention type: referrals & food
Beck,³¹ 2014	Observational	Families with infants aged <1 year with FI that stretched formula or infants with failure-to-thrive at large, urban, academic pediatric primary care clinic	1,042 families	Supplemental formula and educational materials for as-needed referrals were provided directly (eg, to social workers, MLP, or food pantries)	Use of social resources (social work and MLP)	0.11 (0.05-0.16), <0.01^a

Cohen,¹⁷ 2017	Quasi-experimental; pre-/post-intervention	SNAP-enrolled adult primary care patients	177 patients	Brief clinic-based intervention associated with increase in uptake of SNAP incentive program	Double-up food bucks use	Unadjusted OR 9.2 (95% CI, 6.1-13.8); Adjusted OR 19.2 (95% CI, 0.3-35.5)

Freedman,²⁶ 2014	Pre-/post-intervention	Adult patients of FQHCs with farmers markets	336 patients enrolled in Shop N Save (financial incentive for farmers market)	Intervention to increase use of clinic-based farmers market and government food resources	Farmers market revenue Use of government food assistance	Increased from $14,285.60 to $15,719.73 (P <.001) Use of all forms food assistance: 0.51 (0.44-0.59), <0.01^a; Senior farmers market nutrition program: 0.76 (0.65-0.86), <0.01^a; SNAP: 0.64 (0.48-0.81), 0.01^a

Gany,³⁸ 2015	Nested cohort, observational	Hospital-based food pantries at 5 cancer clinics	351 adult patients	Use of hospital-based food pantry after enrollment in program	Repeat use of food pantry	Median return visits = 2; mean = 3.25 (SD = 3.07)

Smith,³⁹ 2017	Cross-sectional	Student-run free clinic	463 adult patients	Integrated FI screening and intervention at free clinic	Use of onsite food boxes, off-site food pantry, and SNAP enrollment	43% (201/463) receiving monthly boxes of food; 14% (66/463) using off-site food pantry; 14% (64/463) enrolled in SNAP

CalWORKS = Calif. work opportunities and responsibilities to kids program; DM = diabetes mellitus; FI = food insecurity; FQHC = Federally Qualified Health Center; MLP = medical-legal partnership; OR = odds ratio; RCT = randomized controlled trial; SD = standard deviation; SMD = standardized mean difference; SNAP = supplemental nutrition assistance program; WE CARE = Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education; WIC = women, infants, and children supplemental nutrition assistance program.
↵a Statistical results for standard mean differences are shown in format with SMD, (95% CI), varience.
↵b Follow-up available for only 15 participants.