Department of Epidemiology, Human Genetics and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, United States.
Harris Health System, Houston, TX, United States.
Front Public Health. 2023 Aug 15;11:1167100. doi: 10.3389/fpubh.2023.1167100. eCollection 2023.
Economic and social hardships have worsened food insecurity, particularly among low income and racial-ethnic minority groups. Given the core goal of the 150+ member Houston Health Equity Collective (HEC) to reduce food insecurity by 5% in 2025, we explored member organizations' capacity and challenges faced in screening and responding to food insecurity through care coordination efforts.
A twice-administered Qualtrics XM survey (Provo, Utah) with 76 organizations, followed by five focus groups with 22 of these organizations, explored reach and response efforts to food insecurity. Qualitative assessments lasted between 0.5 to 1.5 h, were audio-recorded, cleaned, coded, and thematically analyzed using NVivo, version 11 (Burlington, Massachusetts). The qualitative study was guided by a general inductive approach. In total, over 6 h of audiovisual recording were extracted, and over 100 pages of text exported to NVivo for data analysis. The research team read and coded transcripts independently using the codebook, and met routinely to discuss and resolve codes -resulting in numerous revisions to the codebook. Coding structure was discussed at multiple meetings and differences were addressed through consensus. Predominant qualitative themes impacting food insecurity screening were "stigma and cultural-related barriers", "clinic capacity and attitudes", "need to focus on upstream influences of food insecurity and SDOH needs", "impact of COVID-19", and "need for HEC system responses". Main recommendations to enhance screening and reach included improving staff culture, enhancing cultural sensitivity across organizational practices, and using shared technology to coordinate care. Respondents stated that the HEC can drive these recommendations through networking opportunities, use of shared resource directory, and placing focus on upstream factors.
Recommendations to target food insecurity must focus on organizational staff responsiveness and sensitivity to patients' needs. Of equal importance is the need for increased attention to the upstream influencers and integration of systems-level interventions to holistically target the barriers impacting food insecurity.
经济和社会困难使粮食不安全状况恶化，尤其是在低收入和少数族裔群体中。鉴于由 150 多个成员组成的休斯顿健康公平联盟（HEC）的核心目标是到 2025 年将粮食不安全减少 5%，我们探讨了成员组织在通过护理协调工作筛查和应对粮食不安全方面的能力和面临的挑战。
对 76 个组织进行了两次问卷调查（犹他州普罗沃），随后对其中 22 个组织进行了五次焦点小组讨论，探讨了对粮食不安全的接触和应对努力。定性评估持续 0.5 至 1.5 小时，使用 NVivo（马萨诸塞州伯灵顿）进行音频记录、清理、编码和主题分析。定性研究采用一般归纳法。总共提取了超过 6 小时的视听记录，超过 100 页的文本导出到 NVivo 进行数据分析。研究小组使用代码本独立阅读和编码转录本，并定期开会讨论和解决代码问题，从而对代码本进行了多次修订。在多次会议上讨论了编码结构，并通过协商解决了差异。影响粮食不安全筛查的主要定性主题包括“耻辱感和与文化相关的障碍”、“诊所能力和态度”、“需要关注粮食不安全和 SDOH 需求的上游影响”、“COVID-19 的影响”以及“需要 HEC 系统响应”。增强筛查和覆盖面的主要建议包括改善员工文化、增强组织实践中的文化敏感性以及使用共享技术协调护理。受访者表示，HEC 可以通过网络机会、使用共享资源目录以及关注上游因素来推动这些建议。
针对粮食不安全问题的建议必须侧重于组织员工对患者需求的响应能力和敏感性。同样重要的是，需要更加关注上游影响因素，并整合系统层面的干预措施，以全面解决影响粮食不安全的障碍。
