Connelley Alexander, Young Abigail, Lee Jennifer T, Miller Markell, Spring Eileen, Hao Wei, Wolfson Julia A, Cohen Alicia J, Patel Minal R, Leung Cindy W
Undergraduate Education in Public Health, School of Public Health, University of Michigan, Ann Arbor, Michigan.
Department of Nutritional Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan.
AJPM Focus. 2025 Feb 7;4(2):100320. doi: 10.1016/j.focus.2025.100320. eCollection 2025 Apr.
Despite the recent expansions of clinical screening for food insecurity, research shows large discrepancies between the number of patients who report food insecurity and those who request assistance. In this qualitative study of patients with food insecurity who declined social assistance, the authors aimed to understand the patients' reasons for not seeking food-related assistance and explore their perspectives on addressing food insecurity with their healthcare provider.
At a large academic medical center in southeast Michigan, the authors conducted semistructured, in-depth interviews with 31 English-speaking adult primary care patients who had screened positive for food insecurity at a previous clinic encounter and subsequently declined assistance from a trained social worker. The interview guide explored patients' reasons for declining social assistance, perspectives on clinical screening for food insecurity and other social risk factors, and the extent to which they discussed their needs with their provider. Interviews were recorded, transcribed, and analyzed using the constant comparative method to reveal emergent themes.
The mean age of the participants was 48.2 years, and 71% were women. The most prominent reasons for patients with food insecurity not seeking social assistance were the belief that the potential resources would be redundant or not helpful and previous negative experiences with receiving food assistance. Several patients also did not remember or know that they had declined assistance. Most patients believed that healthcare providers should be knowledgeable about patients' food insecurity status to better inform care delivery. However, patients expressed discomfort, fear, or embarrassment in revealing this information and emphasized the importance of providers fostering a supportive and empathetic healthcare environment.
Strategies to connect patients with food assistance must target multiple levels, including improving assistance methods, increasing provider knowledge, and prioritizing patient comfort.
尽管近期临床对粮食不安全状况的筛查范围有所扩大，但研究表明，报告粮食不安全的患者数量与请求援助的患者数量之间存在巨大差异。在这项针对拒绝社会援助的粮食不安全患者的定性研究中，作者旨在了解患者不寻求粮食相关援助的原因，并探讨他们对与医疗服务提供者解决粮食不安全问题的看法。
在密歇根州东南部的一家大型学术医疗中心，作者对31名说英语的成年初级保健患者进行了半结构化的深入访谈。这些患者在之前的诊所就诊时粮食不安全筛查呈阳性，随后拒绝了受过培训的社会工作者的援助。访谈指南探讨了患者拒绝社会援助的原因、对粮食不安全和其他社会风险因素临床筛查的看法，以及他们与提供者讨论需求的程度。访谈进行了录音、转录，并使用持续比较法进行分析，以揭示新出现的主题。
参与者的平均年龄为48.2岁，71%为女性。粮食不安全患者不寻求社会援助的最主要原因是认为潜在资源会多余或无用，以及之前接受粮食援助的负面经历。几名患者也不记得或不知道自己拒绝了援助。大多数患者认为医疗服务提供者应该了解患者的粮食不安全状况，以便更好地提供护理。然而，患者在透露这些信息时表示不适、恐惧或尴尬，并强调提供者营造支持性和同理心医疗环境的重要性。
将患者与粮食援助联系起来的策略必须针对多个层面，包括改进援助方法、增加提供者的知识以及优先考虑患者的舒适度。
