BACKGROUND: Recognizing the connection between food insecurity and health, healthcare institutions in the past decade have begun to provide food assistance to patients. Healthcare-based food assistance programs have previously found positive impacts on food security, overall health, and healthcare spending. However, there is a lack of guidance on creating, staffing, and funding of healthcare-based food assistance programs, which is a significant barrier to the availability, accessibility, and continuation of this important resource for food insecure individuals. To address the evidence-practice gap, this dissertation sought to identify barriers and facilitators to implementation and sustainability of these programs.
METHODS: First, to understand the landscape of healthcare-based food assistance programs in the United States, a scoping review of the peer-reviewed literature was completed and 42 articles regarding 35 healthcare-based food assistance programs were identified. Content analysis was used to extract programmatic information from each article. Program components were then analyzed using the constant comparative method in order create a typology of programs. Second, to investigate an exemplar healthcare based food assistance program, a sequential mixed methods approach, guided by the Practical, Robust Implementation and Sustainability Model (PRISM) framework, was used to evaluate the implementation and uptake of a community health center-based mobile market (MM). Data from semi-structured interviews with MM staff and participants (n=24), direct observations (n=4), and a quantitative dataset containing electronic medical record data with ICD-10 codes and demographic and attendance data collected at the MM (n=3,071 health center patients) were analyzed. Thematic analysis and multiple logistic regression were used to identify barriers and facilitators to MM use.
RESULTS: The scoping review and typology indicate that implementation of healthcare-based food insecurity assistance programs is influenced by program goals, staffing, existence of willing community-based partners, and refrigeration and storage space. Participants reported that facilitators to use of a healthcare-based MM include financial need, simple registration processes, a centralized location, and comfort and familiarity with the health center; barriers to use include impaired mobility and lack of communication regarding MM dates. Analysis of medical record and MM attendance data indicate that cardiometabolic disease (e.g., type 2 diabetes and cardiovascular disease) is not associated with use of the MM.
CONCLUSION: Investment in healthcare-based food assistance programs can provide patients with needed support to improve food insecurity and maintain health. Healthcare institutions should aim to direct as much funding as possible to providing all food insecure patients, not just those with nutrition-related comorbidities, with either food or an increased ability to purchase food (e.g., financial assistance, food vouchers, and federal food assistance program enrollment). To achieve this goal, healthcare institutions should consider: 1) maximizing benefits to patients while minimizing costs to the institution, 2) minimizing barriers to participation, 3) designing programs in line with their unique patient populations’ needs, and 4) planning with sustainability in mind. / 2025-08-03T00:00:00Z
| Identifer | oai:union.ndltd.org:bu.edu/oai:open.bu.edu:2144/46516 |
| Date | 04 August 2023 |
| Creators | Rudel, Rebecca Katherine |
| Contributors | Greece, Jacey A. |
| Source Sets | Boston University |
| Language | en_US |
| Detected Language | English |
| Type | Thesis/Dissertation |
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