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

2020

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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. However, while international evidence outside of the UK 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 high-income country context. Methods :A qualitative 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. Interview audio recordings were fully transcribed and thematically analysed.Results : Twenty individuals living with a wide range of self-reported health conditions, and being supported by a local poverty alleviation social enterprise took part. 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: 71%

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

2020

Preprint

Self Cite

“…This is re ective of the ndings of investigations of lived experiences of diabetes management in low income groups in Canada and the US [72,73]. There is also emerging evidence that Scottish health care professionals are encountering patients who are also striving to manage diabetes through diet alone by decreasing their carbohydrate intake and increasing intakes of healthier alternative foods, but failing to sustain those behaviours (and achieving good glycaemic control) due to food costs and the stress of changes to household income [49].…”

Section: Discussionmentioning

confidence: 83%

“…Those include on the patient side, feelings of stigma and powerlessness, and on the health care professional side, professional attitudes, con dence, training, and, available health care contact time [87]. There is also some emerging evidence that health care professionals are not only reluctant to raise the issue of nancial challenges with patients but admit to having trouble recognising if someone was struggling to put food on the table [49,88]. Social distance between health care professionals and patients is also theorised as a barrier to effective and empathetic interaction [89][90][91].…”

Section: Discussionmentioning

confidence: 99%

“…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 [96][97][98]. 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 [49].…”

Section: Discussionmentioning

confidence: 99%

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

2020

Preprint

Self Cite

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.

“…This lack of attention is in contrast to other high-income countries where poverty and food insecurity, and long-term condition prevalence are similarly high [20,22,24,[41][42][43][44][45][46]. A recent study of Scottish-based health care professionals, by the lead author, found that most believed that some of their patients were affected by food insecurity and that it was impacting their ability to manage their health condition(s) [47]. There were particular concerns about medication adherence and side effects, diet dependant conditions and mental health.…”

Section: Introductionmentioning

confidence: 99%

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

2020

Preprint

Self Cite

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.