Interventions Addressing Food Insecurity in Health Care Settings: A Systematic Review

Abstract

Purpose: Based on the recognition that food insecurity (FI) is associated with poor health across the life course, many US health systems are actively exploring ways to help patients access food resources. This review synthesizes findings from studies examining the effects of health care-based interventions designed to reduce FI.

Methods: We conducted a systematic review of peer-reviewed literature published from January 2000 through September 2018 that described health care- based FI interventions. Standardized mean differences (SMD) were calculated and pooled when appropriate. Study quality was rated using Grading Recommendations Assessment Development and Evaluation criteria.

Results: Twenty-three studies met the inclusion criteria and examined a range of FI interventions and outcomes. Based on study design and sample size, 74% were rated low or very low quality. Studies of referral-based interventions reported moderate increases in patient food program referrals (SMD = 0.67, 95% CI, 0.36-0.98; SMD = 1.42, 95% CI, 0.76-2.08) and resource use (pooled SMD = 0.54, 95% CI, 0.31-0.78). Studies describing interventions providing food or vouchers reported mixed results for the actual change in fruit/vegetable intake, averaging to no impact when pooled (-0.03, 95% CI, -0.66 to 0.61). Few studies evaluated health or utilization outcomes; these generally reported small but positive effects.

Conclusions: Although a growing base of literature explores health care-based FI interventions, the low number and low quality of studies limit inferences about their effectiveness. More rigorous evaluation of FI interventions that includes health and utilization outcomes is needed to better understand roles for the health care sector in addressing FI.

Keywords: food insecurity; public health; social determinants of health; systematic review.

Figure 1

Study selection flow diagram. FI = food insecurity.

Figure 2

Forest plots for individual and pooled SMDs by study outcomes using random effects models. CalWORKS = Californial work opportunities and responsibilities to kids program; SMD = standard mean difference; WIC = women, infants, and children supplemental nutrition assistance program. ^aChange in receipt of WIC. ^bChange in receipt of CalWORKS. ^cChange in receipt of food stamps. ^dChange in vegetable consumption. ^eChange in fruit consumption. ^f95% CI and variance not calculable as mean gain for control group was zero. Note: Weights are from random effects analysis.