CommunityRx for Hunger - Resubmission 01

CommunityRx for Hunger - 重新提交 01

• 批准号: 9884800
• 负责人: Stacy Tessler Lindau
• 金额: $ 68.67万
• 依托单位: UNIVERSITY OF CHICAGO
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-03-04 至 2023-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9884800
• 关键词: Academy; Address; Admission activity; Adoption; Adult; Algorithms; American; Attitude; Caregivers; Caring; Child; Child Health; Child Nutrition; Child health care; Chronic; Client satisfaction; Clinical; Communication; Communities; Decision Making; Double-Blind Method; Education; Educational Intervention; Family; Feeling; Food; Goals; Health; Health Care Costs; Health Personnel; Health Promotion; Healthcare; Hospitalization; Hospitalized Child; Hospitals; Household; Hunger; Intervention; Knowledge; Legal Guardians; Link; Low income; Medicine; Methods; Mission; Online Systems; Outcome; Parents; Pathway interactions; Pediatric Hospitals; Pediatrics; Periodicity; Physicians; Process; Provider; Public Health; Public Health Practice; Randomized; Randomized Controlled Trials; Research; Research Methodology; Resources; Role; Science Policy; Secure; Self Care; Self Efficacy; Self Management; Severities; Shame; Social Conditions; Stigmatization; Surveys; Target Populations; Telephone; Testing; Text Messaging; Time; United States; United States Centers for Medicare and Medicaid Services; United States National Institutes of Health; Visit; Work; adult nutrition; base; caregiving; coping; ethnic diversity; evidence base; experience; family management; food insecurity; food resource; food security; grandparent; group intervention; health care service utilization; health disparity; implementation science; improved; injured; low socioeconomic status; primary outcome; programs; racial diversity; satisfaction; screening; secondary outcome; social; social stigma; socioeconomic disadvantage; socioeconomic disparity; socioeconomics; treatment as usual

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.

项目概要/摘要 粮食不安全是健康和健康差距的一个普遍存在的、可改变的和被忽视的决定因素 美国的社会经济和种族界限。低收入看护者（父母、有监护权的祖父母、 患有需要住院治疗的儿童的法定监护人特别容易受到粮食不安全的影响，因为 医疗保健费用并优先考虑儿童的食物。美国医疗保险和医疗补助服务中心 美国儿科学会、美国国家医学院等机构呼吁基于医疗保健的 screening and intervention to address food insecurity, endorsing growing evidence about the deleterious effects 关于健康和医疗保健。大多数护理人员和医疗保健提供者都认可，这对于提供者来说是可以接受的 解决粮食不安全和相关需求，但医生很少筛选或转诊这些需求。 障碍包括担心因引起耻辱感而损害护理人员或患者的满意度 供应商缺乏有关粮食不安全的知识。拟议的混合方法研究将填补以下领域的空白 关于如何最好地进行干预以支持粮食不安全的护理人员的知识。我们将进行双盲 随机对照试验，测试 CommunityRx-Hunger (CRx-H) 干预对照顾者和 12 个月内的儿童健康结果。 CRx-H 利用出院流程来准备 照顾患病儿童的护理人员，包括教育和启动自我和家庭管理策略。 住院儿童的照顾者将接受粮食不安全筛查，按粮食安全状况分层，并 随机接受常规护理 (UC) 或 CRx-H。 UC 包含一个入院包，其中包含以下信息 医院的食物资源。除了 UC 之外，CRx-H 还包括出院时：简短的教育干预 关于粮食不安全和共同发生的需求，有关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 本研究的具体目标是： (1) 评估 CRx-H 与 UC 对粮食不安全的护理人员的影响 自我效能、照顾者和儿童粮食不安全以及成人和儿童健康结果； (2) Among food secure 和不安全的护理人员，评估 CRx-H 与 UC 对护理人员满意度和耻辱感的影响； (3) Qualitatively assess food insecure caregivers' perspectives about: (a) their experiences with and attitudes CRx-H 干预，(b) 耻辱作为自我和家庭管理障碍的作用，以及 (c) 如何 医疗保健提供者可以敏感而有效地进行干预，以支持食品不安全的护理人员。我们的目标 的目标是改善食品不安全且有患病儿童的照顾者的自我和家庭管理。长期目标 这项工作通过提供有关公共卫生实践的证据来推进 NIMHD 的使命，以促进 照顾者及其家人的健康，并减少由于社会经济劣势而造成的健康差距。