Table 2

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

StudyDesignPopulationSampleInterventionProcess OutcomesStatistics
Intervention type: referrals
Garg,16 2007RCTCaregivers of pediatric patients aged 2 months to 10 years at well-child visits98 intervention, 95 controlIntervention caregivers screened with 10-item questionnaire for social needs in waiting room before well-child visitsReferral to food resource (pantry, foods stamps, WIC)1.42 (0.28-2.56), 0.34a
Garg,22 2015Cluster RCTAdult caregivers of pediatric patients aged ≤6 months at well-child visits in 8 urban community health centers336 mothers (168 per study arm)Intervention familes screened with WE CARE tool for referral to social resourcesEnrollment in community resources
Referral to food resources
Food assistance program: 0.14 (–0.30 to 0.58), 0.05a
Food pantry: 0.40 (–0.38 to 1.17), 0.16a
0.67 (0.25-1.09), 0.05a
Fleegler,35 2007Cross-sectionalFamilies of children aged 0-6 years who attended well-child visits at 2 urban pediatric clinics205 parents (68 with FI)Families screened with computer-based questionnaire for referrals to resourcesReferral to food resources Frequency of contacting referral agency35% (24/68) of FI patients referred 67% (16/24) contacted food resource; 94% (15/16) deemed referral helpful
Fox,29 2016Pre-/post-intervention, pilotNew patients at a pediatric weight management clinic116 patientsIntervention to partner clinic with Second Harvest Heartland food bank with SNAP enrollment outreachEnrollment in SNAP34% (40/116) eligible for referral; 75% (30/40) accepted; 20% (3/15) completed enrollmentb
Hassan,37 2015Prospective observationalPatients aged 15-25 years at an urban adolescent/young adult clinic401 youthWeb-based screening and referral toolFrequency of contacting any referral agency (not food specific)40% (104/259)
Knowles,34 2018Mixed methodsCaregivers of pediatric patients aged <5 years eligible for benefits103 familiesIntegrated clinic-based referral interventionEnrollment in SNAP42% (43/103) eligible completed 85 applications; 32% (27/85) approved; 8% (7/85) denied; 60% (51/85) unknown 63% (12/19) enrolled
Martel,40 2018Retrospective observationalPatients of urban county hospital/emergency department1,519 patientsClinic parntership with Second Harvest Heartland food bankFrequency of contacting referral agency Enrollment in SNAP74% (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 2016Retrospective observational cohort with propensity score matchingPregnant patients with food insecurity at obstetrical clinic145 adult female patientsIntegrated screening and referral to Food for Families; program for referral to food resourcesEnrollment in benefits67% (97/145) enrolled
Nguyen,27 2016Retrospective observational, pre-/post-intervention, pilotSelf-identified Hispanic patients aged ≥60 years with DM, at FQHC18/28 participants followed up at 3 monthsReferrals from clinic integrated Health Connector ProgramFrequency of contacting referral agency33% (6/18) requested food referral; 22% (4/18) contacted food resources
Patel,30 2018Pre-/post-intervention, pilotAdult patients with DM at endocrinology clinic with access to telephone and documented financial difficulties104 patientsFinancial burden resource toolIncrease in use of farmers markets, groceries that accept food assistance0.12 (–0.16 to 0.40), 0.02a
Sege,21 2015RCTFamilies with newborns aged <10 weeks at pediatric primary care clinic167 intervention, 163 controlIntervention group was paired with a trained family specialist who provided support (including home visits) and direct assistance accessing resourcesFood resource use0.18 (–0.08 to 0.43), 0.02a
Weintraub,28 2010Prospective cohortPediatric patients at Peninsula family advocacy program109 participants of family advocacy program, 102 enrolled, 54 completed follow-upIntegrated clinic- and hospital-based legal servicesIncrease in use of food supportWIC: 0.73 (0.18-1.28), 0.08a; CalWORKS: 0.65 (0.11-1.20), 0.08)a; Food stamps: 0.73 (0.18-0.28), 0.08a
Intervention type: referrals & food
Beck,31 2014ObservationalFamilies with infants aged <1 year with FI that stretched formula or infants with failure-to-thrive at large, urban, academic pediatric primary care clinic1,042 familiesSupplemental 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), <0.01a
Cohen,17 2017Quasi-experimental; pre-/post-interventionSNAP-enrolled adult primary care patients177 patientsBrief clinic-based intervention associated with increase in uptake of SNAP incentive programDouble-up food bucks useUnadjusted OR 9.2 (95% CI, 6.1-13.8); Adjusted OR 19.2 (95% CI, 0.3-35.5)
Freedman,26 2014Pre-/post-interventionAdult patients of FQHCs with farmers markets336 patients enrolled in Shop N Save (financial incentive for farmers market)Intervention to increase use of clinic-based farmers market and government food resourcesFarmers market revenue Use of government food assistanceIncreased from $14,285.60 to $15,719.73 (P <.001) Use of all forms food assistance: 0.51 (0.44-0.59), <0.01a; Senior farmers market nutrition program: 0.76 (0.65-0.86), <0.01a; SNAP: 0.64 (0.48-0.81), 0.01a
Gany,38 2015Nested cohort, observationalHospital-based food pantries at 5 cancer clinics351 adult patientsUse of hospital-based food pantry after enrollment in programRepeat use of food pantryMedian return visits = 2; mean = 3.25 (SD = 3.07)
Smith,39 2017Cross-sectionalStudent-run free clinic463 adult patientsIntegrated FI screening and intervention at free clinicUse of onsite food boxes, off-site food pantry, and SNAP enrollment43% (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.