An embedded multiple case study: using CFIR to map clinical food security screening constructs for the development of primary care practice guidelines
Abstract Background Food insecurity (FI), the limited access to healthy food to live an active and healthy life, is a social determinant of health linked to poor dietary health and difficulty with disease management in the United States (U.S.). Healthcare experts support the adoption of validated sc...
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| Format: | Article |
| Language: | English |
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BMC
2022-01-01
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| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12889-021-12407-y |
| _version_ | 1818753198507163648 |
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| author | Sabira Taher Naoko Muramatsu Angela Odoms-Young Nadine Peacock C. Fagen Michael K. Suh Courtney |
| author_facet | Sabira Taher Naoko Muramatsu Angela Odoms-Young Nadine Peacock C. Fagen Michael K. Suh Courtney |
| author_sort | Sabira Taher |
| collection | DOAJ |
| description | Abstract Background Food insecurity (FI), the limited access to healthy food to live an active and healthy life, is a social determinant of health linked to poor dietary health and difficulty with disease management in the United States (U.S.). Healthcare experts support the adoption of validated screening tools within primary care practice to identify and connect FI patients to healthy and affordable food resources. Yet, a lack of standard practices limits uptake. The purpose of this study was to understand program processes and outcomes of primary care focused FI screening initiatives that may guide wide-scale program implementation. Methods This was an embedded multiple case study of two primary care-focused initiatives implemented in two diverse health systems in Chicago and Suburban Cook County that routinely screened patients for FI and referred them to onsite food assistance programs. The Consolidated Framework for Implementation Research and an iterative process were used to collect/analyze qualitative data through semi-structured interviews with N = 19 healthcare staff. Intended program activities, outcomes, actors, implementation barriers/facilitators and overarching implementation themes were identified as a part of a cross-case analysis. Results Programs outcomes included: the number of patients screened, identified as FI and that participated in the onsite food assistance program. Study participants reported limited internal resources as implementation barriers for program activities. The implementation climate that leveraged the strength of community collaborations and aligned internal, implementation climate were critical facilitators that contributed to the flexibility of program activities that were tailored to fill gaps in resources and meet patient and clinician needs. Conclusion Highly adaptable programs and the healthcare context enhanced implementation feasibility across settings. These characteristics can support program uptake in other settings, but should be used with caution to preserve program fidelity. A foundational model for the development and testing of standard clinical practice was the product of this study. |
| first_indexed | 2024-12-18T05:03:33Z |
| format | Article |
| id | doaj.art-a80983c9d45f4126b55a3b13511ef19e |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-18T05:03:33Z |
| publishDate | 2022-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-a80983c9d45f4126b55a3b13511ef19e2022-12-21T21:20:05ZengBMCBMC Public Health1471-24582022-01-0122111410.1186/s12889-021-12407-yAn embedded multiple case study: using CFIR to map clinical food security screening constructs for the development of primary care practice guidelinesSabira Taher0Naoko Muramatsu1Angela Odoms-Young2Nadine Peacock3C. Fagen Michael4K. Suh Courtney5Department of Preventive Medicine, Northwestern Feinberg School of MedicineDepartment of Community Health Sciences, School of Public Health, University of Illinois at ChicagoDivision of Nutritional Sciences, College of Human Ecology, Cornell UniversityDepartment of Community Health Sciences, School of Public Health, University of Illinois at ChicagoDepartment of Preventive Medicine, Northwestern Feinberg School of MedicineDepartment of Family Medicine, Loyola Stritch School of MedicineAbstract Background Food insecurity (FI), the limited access to healthy food to live an active and healthy life, is a social determinant of health linked to poor dietary health and difficulty with disease management in the United States (U.S.). Healthcare experts support the adoption of validated screening tools within primary care practice to identify and connect FI patients to healthy and affordable food resources. Yet, a lack of standard practices limits uptake. The purpose of this study was to understand program processes and outcomes of primary care focused FI screening initiatives that may guide wide-scale program implementation. Methods This was an embedded multiple case study of two primary care-focused initiatives implemented in two diverse health systems in Chicago and Suburban Cook County that routinely screened patients for FI and referred them to onsite food assistance programs. The Consolidated Framework for Implementation Research and an iterative process were used to collect/analyze qualitative data through semi-structured interviews with N = 19 healthcare staff. Intended program activities, outcomes, actors, implementation barriers/facilitators and overarching implementation themes were identified as a part of a cross-case analysis. Results Programs outcomes included: the number of patients screened, identified as FI and that participated in the onsite food assistance program. Study participants reported limited internal resources as implementation barriers for program activities. The implementation climate that leveraged the strength of community collaborations and aligned internal, implementation climate were critical facilitators that contributed to the flexibility of program activities that were tailored to fill gaps in resources and meet patient and clinician needs. Conclusion Highly adaptable programs and the healthcare context enhanced implementation feasibility across settings. These characteristics can support program uptake in other settings, but should be used with caution to preserve program fidelity. A foundational model for the development and testing of standard clinical practice was the product of this study.https://doi.org/10.1186/s12889-021-12407-yFood insecurityFood security screeningImplementationDisseminationConsolidated framework for implementation researchPrimary care practice |
| spellingShingle | Sabira Taher Naoko Muramatsu Angela Odoms-Young Nadine Peacock C. Fagen Michael K. Suh Courtney An embedded multiple case study: using CFIR to map clinical food security screening constructs for the development of primary care practice guidelines BMC Public Health Food insecurity Food security screening Implementation Dissemination Consolidated framework for implementation research Primary care practice |
| title | An embedded multiple case study: using CFIR to map clinical food security screening constructs for the development of primary care practice guidelines |
| title_full | An embedded multiple case study: using CFIR to map clinical food security screening constructs for the development of primary care practice guidelines |
| title_fullStr | An embedded multiple case study: using CFIR to map clinical food security screening constructs for the development of primary care practice guidelines |
| title_full_unstemmed | An embedded multiple case study: using CFIR to map clinical food security screening constructs for the development of primary care practice guidelines |
| title_short | An embedded multiple case study: using CFIR to map clinical food security screening constructs for the development of primary care practice guidelines |
| title_sort | embedded multiple case study using cfir to map clinical food security screening constructs for the development of primary care practice guidelines |
| topic | Food insecurity Food security screening Implementation Dissemination Consolidated framework for implementation research Primary care practice |
| url | https://doi.org/10.1186/s12889-021-12407-y |
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