CommunityRx for Hunger - Resubmission 01

项目摘要/摘要 粮食不安全是健康和健康差距的一个普遍、可改变和被忽视的决定因素 美国的社会经济和种族界限。低收入照顾者(父母、监护祖父母、 需要住院的儿童的法定监护人)特别容易受到食品不安全的影响 医疗保健费用和优先为孩子提供食物。美国医疗保险和医疗补助服务中心 美国儿科学会、美国国家医学学会和其他机构呼吁以医疗保健为基础 筛查和干预以解决粮食不安全问题，支持越来越多关于有害影响的证据 关于健康和医疗保健。大多数护理者和医疗保健提供者都认可这对提供者来说是可以接受的 为了解决粮食不安全和相关需求，医生很少为这些需求进行筛查或转诊。 障碍包括担心造成耻辱和伤害护理人员或患者的满意度 供应商缺乏关于粮食不安全的知识。拟议的混合方法研究将填补 关于如何最好地干预以支持粮食不安全的照顾者的知识。我们将进行双盲法 社区饥饿(CRX-H)干预对照顾者和 超过12个月的儿童健康结果。CRX-H利用医院出院流程准备 照顾患病儿童的照顾者，包括教育和启动自我和家庭管理战略。 将对住院儿童的照顾者进行粮食不安全筛查，并根据粮食安全状况进行分层 随机分为常规护理(UC)或CRX-H。UC包括入院包，其中包含以下信息 医院里的食物资源。除UC外，CRX-H在出院时还包括：简短的教育干预 关于粮食不安全和共同共存需求的信息，关于优质社区粮食资源的信息 和其他支持，以及出院后90天内来自社区资源导航器的短信。这个 本研究的具体目的是：(1)评估CRX-H与UC对食物不安全照顾者的影响 自我效能、照顾者和儿童食品不安全以及成人和儿童健康结果；(2)食品安全 和缺乏安全感的照顾者，评估CRX-H和UC对照顾者对照顾者和耻辱的满意度的影响； (3)定性评估食物不安全的照顾者对以下方面的看法：(A)他们的经历和态度 关于CRX-H干预，(B)耻辱作为自我和家庭管理障碍的作用，(C)如何 医疗保健提供者可以敏感而有效地进行干预，以支持粮食不安全的照顾者。我们的目标 是改善有生病孩子的食物缺乏保障的照顾者的自我和家庭管理。长期目标 通过产生关于公共卫生做法的证据来推动NIMHD的使命 保护照料者及其家人的健康，并减少由于社会经济不利而造成的健康差距。

PROJECT SUMMARY/ABSTRACT Food insecurity is a prevalent, modifiable and overlooked determinant of health and health disparities along socioeconomic and racial lines in the United States. Lower income caregivers (parents, custodial grandparents, legal guardians) of children with illness requiring hospitalization are particularly vulnerable to food insecurity due to healthcare costs and prioritizing food for the child. The U.S. Centers for Medicare & Medicaid Services, the American Academy of Pediatrics, the National Academy of Medicine and others are calling for healthcare-based screening and intervention to address food insecurity, endorsing growing evidence about the deleterious effects on health and healthcare. Most caregivers and healthcare providers endorse that it is acceptable for providers to address food insecurity and related needs, yet physicians rarely screen or make referrals for these needs. Barriers include concerns about compromising caregiver or patient satisfaction by causing feelings of stigma and providers' lack of knowledge about food insecurity. The proposed mixed-methods research will fill a gap in knowledge about how best to intervene to support food insecure caregivers. We will conduct a double-blind randomized controlled trial to test the effect of the CommunityRx-Hunger (CRx-H) intervention on caregiver and child health outcomes over 12 months. CRx-H leverages hospital discharge processes used to prepare caregivers to care for an ill child, including education and activation of self- and family management strategies. Caregivers of hospitalized children will be screened for food insecurity, stratified by food security status, and randomized to either usual care (UC) or CRx-H. UC includes a hospital admission packet with information about food resources in the hospital. In addition to UC, CRx-H includes, at discharge: a brief educational intervention about food insecurity and common co-occurring needs, information about quality community resources for food and other support, and text messages from a community resource navigator over 90 days post-discharge. The specific aims of this research are to: (1) Evaluate the effects of CRx-H versus UC on food insecure caregiver self-efficacy, caregiver and child food insecurity, and adult and child health outcomes; (2) Among food secure and insecure caregivers, evaluate the effects of CRx-H versus UC on caregiver satisfaction with care and stigma; (3) Qualitatively assess food insecure caregivers' perspectives about: (a) their experiences with and attitudes toward the CRx-H intervention, (b) the role of stigma as a barrier to self- and family management, and (c) how healthcare providers can sensitively and effectively intervene to support food insecure caregivers.. Our objective is to improve self- and family management among food insecure caregivers with an ill child. The long-term goal of this work advances the mission of the NIMHD by generating evidence on public health practices to promote the health of caregivers and their families and to reduce health disparities due to socioeconomic disadvantage.