Developing and Implementing a Food Insecurity Screening Initiative for Adult Patients Living With Type 2 Diabetes

MacIver

Yuill

2020

Preprint

Background: As more people are living with one or more chronic health conditions, supporting patients to become activated, self-managers of their conditions has become a key health policy focus both in the UK and internationally. There is also growing evidence in the UK that those with long term health conditions have an increased risk of being food insecure. While international evidence indicates that food insecurity adversely affects individual’s health condition management capability, little is known about how those so affected manage their condition(s) in this context. An investigation of lived experience of health condition management was undertaken with food insecure people living in north east Scotland. The study aimed to explore the challenges facing food insecure people in terms of, i. their self-care condition management practices, and ii. disclosing and discussing the experience of managing their condition with a health care professional, and iii. notions of the support they might wish to receive from them. Methods : Twenty in-depth interviews were conducted with individuals attending a food bank and food pantry in north east Scotland. Interview audio recordings were fully transcribed and thematically analysed.Results : Individuals reporting multiple physical and mental health conditions, took part in the study. Four main themes were identified i.e.: 1. food practices, trade-offs and compromises, that relate to economic constraints and lack of choice; 2. illness experiences and food as they relate to physical and mental ill-health; 3. (in)visibility of participants’ economic vulnerability within health care consultations; and 4. perceptions and expectations of the health care system.Conclusions : This study, the first of its kind in the UK, indicated that participants’ health condition management aspirations were undermined by the experience of food insecurity, and that their health care consultations in were, on the whole, devoid of discussions of those challenges. As such, the study indicated practical and ethical implications for health care policy, practice and research associated with the risk of intervention-generated health inequalities that were suggested by this study. Better understanding is needed about the impact of household food insecurity on existing ill health, wellbeing and health care use across the UK.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A qualitative investigation of lived experiences of long-term health condition management with people who are food insecure

MacIver

Yuill

2020

Preprint

“…Data suggest that whatever conversations were taking place around these issues between health care professionals and our participants; they were not grounded in discussions cognisant of the lived social and economic realities of those concerned, and therefore seemed to place those individuals at higher risk of feeling more disempowered than empowered by those conversations. One potential way of overcoming the di culty of raising and discussing nancial di culties in clinical consultations might be through the introduction of a nancial screening question within routine clinical practice, as has been muted in other high-income countries [94][95][96]. This suggestion was raised by health professionals interviewed in a separate study by FD, but it was also pointed out there may be practical di culties and unintended negative consequences that would require careful testing prior to any wholesale adoption in practice [47].…”

Section: Discussionmentioning

confidence: 99%

A qualitative investigation of lived experiences of long-term health condition management with people who are food insecure

MacIver

Yuill

2020

Preprint

Background As more people are living with one or more chronic health conditions, supporting patients to become activated, self-managers of their conditions has become a key health policy focus both in the UK and internationally. There is also growing evidence in the UK that those with long term health conditions have an increased risk of being food insecure. While international evidence indicates that food insecurity adversely affects individual’s health condition management capability, little is known about how those so affected manage their condition(s) in this context. An investigation of lived experience of health condition management was undertaken with food insecure people living in north east Scotland. The study aimed to explore the challenges facing food insecure people in terms of, i. their self-care condition management practices, and ii. disclosing and discussing the experience of managing their condition with a health care professional, and iii. notions of the support they might wish to receive from them. Methods Twenty in-depth interviews were conducted with individuals attending a food bank and food pantry in north east Scotland. Interview audio recordings were fully transcribed and thematically analysed.Results Individuals reporting multiple physical and mental health conditions, took part in the study. Four main themes were identified i.e.: 1. food practices, trade-offs and compromises, that relate to economic constraints and lack of choice; 2. illness experiences and food as they relate to physical and mental ill-health; 3. (in)visibility of participants’ economic vulnerability within health care consultations; and 4. perceptions and expectations of the health care system.Conclusions This study, the first of its kind in the UK, indicated that participants’ health condition management aspirations were undermined by the experience of food insecurity, and that their health care consultations in were, on the whole, devoid of discussions of those challenges. As such, the study indicated practical and ethical implications for health care policy, practice and research associated with the risk of intervention-generated health inequalities that were suggested by this study. Better understanding is needed about the impact of household food insecurity on existing ill health, wellbeing and health care use across the UK.

“…Also, the justification for screening rests on the improvements to clinical management that would follow (Berkowitz & Fabreau, ; Elwell‐Sutton, Marshall, Bobby, & Volmert, ; Silverman et al, ), and these are currently unclear, especially when the salient comparator is clinical management by health professionals who get to know about their patients’ food insecurity via supportive and non‐judgemental conversations. Practical experiences with existing food security screening tools (Gundersen, Engelhard, Crumbaugh, & Seligman, ; Pooler et al, ; Thomas, Fitzpatrick, Sidani, & Gucciardi, ) need careful investigation before any widespread use.…”

Section: Discussionmentioning

confidence: 99%

Health professionals’ experiences and perspectives on food insecurity and long‐term conditions: A qualitative investigation

Health Soc Care Community

Machray

Entwistle

2019

Estimates suggest that over 10% of the UK population are affected by food insecurity. International evidence indicates that food insecurity is a risk factor for many long-term health conditions, and can adversely affect people's ability to manage existing conditions. Food insecurity is thus not only a serious social concern but also a healthcare issue requiring the attention of UK health professionals. An exploratory qualitative study was undertaken to investigate the experiences and views of health professionals in north east Scotland, with a particular focus on support for people with long-term conditions whom they believed were affected by food insecurity. Two focus groups and nine semi-structured interviews were undertaken with a total of 20 health professionals between March and July 2016. Thematic analysis generated three main themes. The health professionals had (a) diverse levels of understanding and experience of food insecurity, but between them identified a range of (b) negative impacts of food insecurity on condition-management, especially for diet dependent conditions or medication regimes, and for mental health. Even for those health professionals more familiar with food insecurity, there were various (c) practical and ethical uncertainties about identifying and working with food insecure patients (it could be difficult to judge, for example, whether and how to raise the issue with people, to tailor dietary advice to reflect food insecurity, and to engage with other agencies working to address food insecurity). This study indicates that health professionals working with food insecure patients have learning and support needs that warrant further investigation. Debates about health professionals' responsibilities, and interventions to guide and support health professionals, including tools that might be used to screen for food insecurity, must also reflect the diverse lived needs and values of people who experience food insecurity. K E Y W O R D Sclinical management, food insecurity, long-term health conditions, self-management support | 405 DOUGLAS et AL.