Table 3

Non-Process Outcomes of Interventions to Address Food Insecurity in Health Care Settings (n = 11)

StudyDesignPopulationSampleIntervention or Experimental ConditionOutcomesEffect Size: SMD, (95% CI), variancea
Intervention type: referrals
Hassan,37 2015Prospective observationalPatients aged 15-25 years at an urban adolescent/young adult clinic401 youthWeb-based screening and referral toolFood security: Complete resolution of food as priority problem58% (7/13)
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 ProgramSelf-efficacy: Change in mean scores on the Stanford Diabetes Self-efficacy Scale
Diabetes self-efficacy
Diet/healthy eating plan: –0.14, (–0.79 to 0.51), 0.11
Physical activity: –0.07, (–0.73 to 0.58), 0.11
Diabetes self-efficacy: 0.30, (–0.35 to 0.96), 0.11
General self-efficacy: 0.13, (–0.52 to 0.79), 0.11
Morales,24 2016Retrospective observational cohort with propensity score matchingPregnant patients with FI at obstetrical clinic145 adult female patients enrolled; 145 matched not referredIntegrated screening and referral to Food for Families; program for referral to food resourcesHealth: Blood glucose Health: SBP Health: DBP0.10, (–0.13, to 0.33), 0.01 0.33, (0.09-0.56), 0.01 0.27 (0.04-0.51), 0.01
Intervention type: referrals & food/food vouchers
Beck,31 2014ObservationalFamilies with infants aged <1 year with FI that stretched formula or infants with failure-to-thrive at large, urban, academic primary care clinic1,042 families with infantsSupplemental formula and educational materials for as-needed referrals were provided directly (eg, to social workers, MLP, or food pantries)Utilization: Completed preventative care
Utilization: ED visits
Completed lead test and ASQ: 0.09, (0.04-0.15), <0.01
Received full set of well-infant visits by 14 months: 0.11, (0.05-0.16), <0.01
0.11, (0.05-0.16), <0.01
Bryce,32 2017Pre-/post-interventionAdult, non-pregnant patients with type 2 DM and HbA1c >6.5 in last 3 months referred by medical provider65 patientsVoucher for fruits and vegetables, and health education/coaching at health center-based farmers marketHealth: Weight change Health: SBP change Health: DBP change Health: Drop in HbA1c–0.08, (–0.30 to 0.13), 0.01 –0.04, (–0.26 to 0.17), 0.01 0.15, (–0.06 to 0.37), 0.01 0.39, (0.17-0.60), 0.01
Cavanagh,25 2017Retrospective matched cohort; pre-/post-interventionAdult low-income patients with obesity, hypertension, and/or type 2 DM54 intervention, 54 matched controlsVoucher (prescription coupon) for weekly mobile produce marketHealth: BMI change–0.11, (–0.18 to –0.05), <0.01
Cohen,17 2017Quasi-experimental, pre-/post-interventionSNAP-enrolled adult primary care patients177 patientsBrief clinic-based intervention associated with increase in use of SNAP incentive programHealth behavior: Increased fruits/vegetable consumptionb0.49, (0.25-0.73), 0.01
Freedman,33 2013Pre-/post-intervention, pilotAdult patients of FQHCs with farmers markets with DM41 patientsCommunity-based participatory research approach for onsite farmers market; financial incentive program to purchase food at marketHealth behavior: Increased fruits/vegetable consumptionc0.41, (–0.02 to 0.85), 0.05 at 2-3 months 0.15, (–0.28 to 0.58), 0.05 at 5 months
Saxe-Custak,36 2018QualitativeAdult caregivers of pediatric patients at an urban pediatric clinic32 caregiversProvided vouchers for farmers market or bag of food when market closed; cooking/nutrition classesAcceptability
Health behavior: Increased fruits/vegetable consumption
Food security
Appreciated convenience of clinic within farmers market building
Preferred prescription vouchers over food bags Reported increased
Improved food security and access to healthy foods
Watt,18 2015Quasi-experimental prospectiveAdult Hispanic pregnant women at low-income Texas primary care clinic32 intervention, 29 controlPrenatal care-based nutrition education, food resources education, and farmers market vouchersHealth behavior: Increased fruits/vegetable consumptiond
Health: Depression (mean gain PHQ2 score)
Health: Excess maternal weight gain Health: Breastfeeding at age 6 months
Health: Pass ASQ screening
Fruits: d = 0.47e,f
Vegetables: –0.71, (-1.19 to -0.22), 0.06 d-0.34,(–0.91 to 0.22), 0.08f
–0.19, (–0.80 to 0.41), 0.09
0.64, (–0.06 to 1.34), 0.13
0.71, (–0.05 to 1.48), 0.15
Intervention type: food only
Berkowitz,23 2018Matched cohortAdult patients with dual Medicaid/Medicare eligibility; members of Common-wealth Care AllianceMedically tailored meals program: 133 intervention, 1,002 matched controls. Nontailored food program: 624 intervention, 1,318 matched controlsProvided food: impact of medically tailored meal delivery and Meals on WheelsUtilization: ED visits, inpatient admissions, use of ET
Cost: Medical spending
Medically tailored: ED visits: –0.26, (–0.4 to –0.10), 0.01; Inpatient admissions: –0.09, (–0.27 to 0.09), 0.01; Use of ET: –0.15, (–0.34 to 0.03), 0.01
Non-medically tailored: ED visits: –0.15, (–0.25 to –0.06), <0.01; Inpatient admissions: –0.03, (–0.13 to 0.06), <0.01; Use of ET: –0.07, (–0.17 to 0.02), <0.02
Medically tailored: lower medical spending; net savings $220 per participant
Nontailored: lower medical spending: Net savings $10 per participant
  • ASQ = Ages and Stages Questionnaire; BMI = body mass index; DBP = diastolic blood pressure; DM = diabetes mellitus; ED = emergency department; ET = emergency transportation; FI = food insecurity; FQHC = Federally Qualified Health Center; HbA1c = glycated hemoglobin; MLP = medical-legal partnership; PHQ2 = Patient Health Questionnaire-2; SBP = systolic blood pressure; SMD = standard mean differences; SNAP = supplemental nutrituion assistance program.

  • a Effect sizes are presented as standardized mean differences (d) unless sufficient alternatives were provided in the reviewed manuscripts (eg, Odds Ratios [ORs]). Effect sizes were not calculated when a plausible control/comparison group was not available to compare with the intervention group and/or if insufficient details were provided in the manuscript and we did not receive responses to requests for further information from study authors.

  • b Increase in fruit/vegetable consumption (servings/day) at 5-month follow-up (n = 138).

  • c Servings/day.

  • d Reported as change from less than 3 servings to 3 or more servings per day; raw data unavailable to adjust results to report as servings per day, as would need to adjust standard deviation.

  • e 95% CI and varience not calculable as mean gain for control group = 0.

  • F Author provided additional data points to enable effect size calculation.