Seeking Food Assistance: Food Insecure Veterans' Experiences Navigating through Systems

寻求粮食援助：粮食不安全退伍军人通过系统导航的经历

• 批准号: 10379076
• 负责人: Nipa P Kamdar
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2022-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10379076
• 关键词: Address; Affect; Age; Area; Assessment tool; COVID-19; COVID-19 impact; COVID-19 pandemic; Calories; Caring; Chronic Disease; Clinic; Collaborations; Communication; Communities; Complex; Consumption; Coupled; Diet; Economics; Elderly; Emotions; Enrollment; Food; Food Access; Food Assistance Programs; Food Services; Foundations; Frustration; Funding; Future; Goals; Grant; Health Food; Health Services Administration; High Prevalence; Improve Access; Individual; Interview; Knowledge; Learning; Low income; Maps; Methodology; Navigation System; Nutrient; Perception; Personal Satisfaction; Phase; Pilot Projects; Policies; Preparation; Prevalence; Primary Care; Printing; Research; Resources; Risk; Services; Site; Stress; System; Texas; Thinking; Veterans; Veterans Health Administration; Visual; Work; aged; arm; community based participatory research; coping; cost; design; expectation; experience; food insecurity; food quality; food security; food shortage; gaps in access; health equity; health inequalities; ideation; improved; innovation; nutrition; poor health outcome; programs; prototype; response; screening; service organization; social health determinants; social stigma; therapy design; tool; visual map; whole health

Background: Food insecurity is defined as limited or uncertain access to adequate food due to a lack of money and is a social determinant of health.6 An estimated 1 in 4 Veterans using VHA services are food insecure.1–3 Working-age Veterans (i.e., those aged 18-59 years) have increased risk for food insecurity compared to elder veterans and non-veterans.1,17 The VHA screens Veterans in primary care for food insecurity. Significance/Impact: However, screening does not equate receiving assistance. Despite having a high prevalence of food insecurity, a smaller percentage of Veterans enroll in the Supplemental Nutrition Assistance Program (SNAP), formally known as food stamps.10,11 We do not know why more Veterans do not use this service. Additionally, as the VHA installs on-site food pantries, we know little about Veterans’ experiences with and perceptions of food pantries. Anecdotal evidence suggest that stigma & concern for quality of food may be barriers to use.12 Innovation: This is the first study to formally take a user-centered approach to learn what Veterans experience as they navigate systems in search of food assistance. Our proposal is set within the design thinking framework which consists of 3 phases: problem identification, solution ideation, & implementation.13,14 Each phase demands stakeholder participation. Our proposal focuses on the first phase. Using journey maps (i.e., visual tools developed through in-depth interviews that document lived experiences), we will identify unmet needs and gaps in service. Specific Aims: 1. Through qualitative, in-depth 1:1 interviews with food insecure Veterans (n=40), we will visually map food insecure Veterans’ experiences with seeking food assistance. 1a) These journey maps will be aggregated and analyzed to identify barriers and facilitators to improve access to food assistance for Veterans living with food insecurity. 1b) Because COVID-19 may have impacted the ability of Veterans to obtain food assistance, we will specifically ask Veterans if and how COVID-19 affected their experience with seeking food assistance. 2. We will strengthen our relationships with community partners and other key stakeholders in preparation for the next two phases of the design thinking framework that require collaboration. We will increase routine communication, host discussion groups, and evaluate responses to the Research Partnership Checklist15,16 which will inform us of partner expectations. Methodology: Using in-depth, 1:1 interviews with 40 Veterans aged 18-59, living in and around southeast Texas, we will construct journey maps to document Veterans’ actions and emotions as they sought food assistance. Aggregated maps will be shared with community partners and other stakeholders. To strengthen relationships, community partners will complete an assessment tool that will help us build working relationships in alignment with their expectations. Implementation/Next Steps: The journey maps will identify areas of difficulty or frustration for Veterans needing food assistance. In collaboration with our community partners and other stakeholders, we will brainstorm and prototype solutions to better meet their needs. Eventually our designed solutions will be trialed and implemented as appropriate.

背景：粮食不安全被定义为由于缺乏足够的粮食而导致获得充足粮食的机会有限或不确定。 金钱，是健康的社会决定因素。6 据估计，使用 VHA 服务的退伍军人中有四分之一是食物 不安全。1-3 工作年龄的退伍军人（即 18-59 岁的人）粮食不安全的风险增加 与老年退伍军人和非退伍军人相比。1,17 VHA 对初级保健中的退伍军人进行食品筛选 不安全感。 意义/影响：然而，筛查并不等于接受援助。尽管拥有很高的 粮食不安全的普遍存在，参加补充营养援助的退伍军人比例较小 计划 (SNAP)，正式名称为食品券。10,11 我们不知道为什么更多退伍军人不使用该计划 服务。此外，由于 VHA 在现场安装了食品储藏室，我们对退伍军人的经历知之甚少。 以及对食品储藏室的看法。轶事证据表明，对食品质量的耻辱和担忧可能会 使用障碍12 创新：这是第一项正式采用以用户为中心的方法来了解退伍军人经历的研究 当他们导航系统寻找粮食援助时。我们的建议是在设计思维中设定的 框架由 3 个阶段组成：问题识别、解决方案构思和实施。13,14 每个阶段 阶段需要利益相关者的参与。我们的建议侧重于第一阶段。使用旅程地图（即 通过深度访谈开发的视觉工具记录生活经历），我们将识别未满足的 服务方面的需求和差距。 具体目标： 1. 通过对粮食不安全的退伍军人 (n=40) 进行定性、深入的 1:1 访谈，我们将直观地绘制粮食图 退伍军人寻求粮食援助的不安全经历。 1a) 这些旅程地图将被汇总并 进行分析，以确定障碍和促进因素，以改善靠食物为生的退伍军人获得粮食援助的机会 不安全感。 1b) 由于 COVID-19 可能影响退伍军人获得粮食援助的能力，我们将 特别询问退伍军人，COVID-19 是否以及如何影响他们寻求粮食援助的经历。 2. 我们将加强与社区合作伙伴和其他主要利益相关者的关系，为 设计思维框架的接下来两个阶段需要协作。我们会增加日常活动 沟通、主持讨论小组并评估对研究合作清单的回应15,16 这将告诉我们合作伙伴的期望。 方法：对居住在东南部及其周边地区的 40 名 18-59 岁退伍军人进行深入的 1:1 访谈 德克萨斯州，我们将构建旅程地图来记录退伍军人在寻找食物时的行为和情绪 协助。汇总的地图将与社区合作伙伴和其他利益相关者共享。加强 关系，社区合作伙伴将完成一个评估工具，帮助我们建立工作关系 符合他们的期望。 实施/后续步骤：旅程地图将确定退伍军人遇到的困难或挫折的领域 需要粮食援助。与我们的社区合作伙伴和其他利益相关者合作，我们将 集思广益并制定原型解决方案，以更好地满足他们的需求。最终我们设计的解决方案将得到试用 并酌情实施。