College for Public Health and Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO, 63104, USA.
Department of Pediatrics, Saint Louis University School of Medicine at SSM Health Cardinal Glennon Children's Hospital, 1465 South Grand Boulevard, St. Louis, MO, 63104, USA.
Matern Child Health J. 2020 Jan;24(1):101-109. doi: 10.1007/s10995-019-02785-6.
Food insecurity (FI) has serious academic, social, and physical health consequences for children. A recent clinical recommendation suggests FI screening during child well visits. While FI screening research has considered clinician feedback, little is known about caregivers' experience of disclosing FI to health care providers. Our paper explores caregivers' barriers and facilitators to FI disclosure.
A survey on factors influencing FI disclosure was completed in a pediatric clinic waiting room in St. Louis, MO. Among households with FI, 15 caregivers participated in a qualitative interview. Caregivers were asked about experiences discussing FI with health care providers. We calculated frequencies for survey responses and analyzed interview data using thematic content analysis.
Caregivers highlighted stigma, fear of child being taken away, and shame as barriers to FI disclosure. Caregivers identified strong interpersonal skills, open body language, and empathy as facilitators to disclosure at the interpersonal level. Provider initiated conversations, consideration of FI disclosure in the presence of a child, and normalization of FI discussions within the clinic were described as ways to encourage FI disclosure at the organizational level. In response to FI disclosure, caregivers would like providers to offer resources including referrals to community-based resources extending beyond food.
Our study identifies considerations for FI screening in health care settings, spanning the social-ecological model, from the perspective of caregivers. To successfully screen and address FI, multifaceted health care interventions should address barriers and promote facilitators across multiple levels and in consideration of multiple social needs.
食品不安全（FI）会对儿童的学业、社交和身体健康造成严重后果。最近的临床建议建议在儿童健康访视期间进行 FI 筛查。虽然 FI 筛查研究已经考虑了临床医生的反馈，但对于照顾者向医疗保健提供者披露 FI 的体验却知之甚少。我们的论文探讨了照顾者披露 FI 的障碍和促进因素。
在密苏里州圣路易斯的一家儿科诊所候诊室完成了一项关于影响 FI 披露因素的调查。在有 FI 的家庭中，有 15 名照顾者参加了定性访谈。要求照顾者讨论与医疗保健提供者讨论 FI 的经验。我们计算了调查回复的频率，并使用主题内容分析对访谈数据进行了分析。
照顾者强调污名化、担心孩子被带走和羞耻感是 FI 披露的障碍。照顾者认为人际技能强、肢体语言开放和同理心是人际层面披露的促进因素。提供者发起对话、在孩子在场的情况下考虑 FI 披露以及在诊所内使 FI 讨论正常化被描述为鼓励组织层面 FI 披露的方法。在 FI 披露后，照顾者希望提供者提供资源，包括转介到社区资源，而不仅仅是食物。
我们的研究从照顾者的角度确定了在医疗保健环境中进行 FI 筛查的考虑因素，涵盖了社会生态模型。为了成功地进行 FI 筛查和解决问题，多方面的医疗保健干预措施应在多个层面上解决障碍并促进促进因素，并考虑到多种社会需求。
