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

背景：粮食不安全的定义是，由于缺乏足够的食物，获得适当食物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1/4是食物 1-3处于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 与年长的退伍军人和非退伍军人相比。1，17退伍军人管理局对接受初级护理的退伍军人进行食物筛选 不安全感。 意义/影响：然而，筛查并不等同于接受援助。尽管有很高的 粮食不安全普遍存在，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的退伍军人不使用这个 服务。此外，由于VHA在现场安装食品储藏室，我们对退伍军人在 以及人们对食品储藏室的看法。坊间证据表明，对食物质量的耻辱和担忧可能是 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 因为它们在系统中导航以寻找食物援助。我们的建议是在设计思路内确定的 包括3个阶段的框架：问题识别、解决方案构思和实施。13、14 这一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记录生活体验的可视化工具)，我们将识别未满足的 服务方面的需求和差距。 具体目标： 1.通过对食物缺乏保障的退伍军人(n=40)进行定性的、深入的1：1采访，我们将直观地绘制食物地图 缺乏安全感的退伍军人在寻求食物援助方面的经历。1)这些行程地图将被汇总并 分析以确定障碍和促进者，以改善退伍军人获得食物援助的机会 不安全感。1B)由于新冠肺炎可能影响了退伍军人获得食品援助的能力，我们将 具体询问退伍军人新冠肺炎是否以及如何影响了他们寻求食品援助的经历。 2.我们将加强与社区合作伙伴和其他主要利益攸关方的关系，为 设计思维框架的下两个阶段需要协作。我们将增加例行程序 沟通，主持讨论小组，并评估对研究伙伴关系清单的答复15，16 这将让我们了解合作伙伴的期望。 研究方法：对40名18-59岁、居住在东南及周边地区的退伍军人进行1：1深度访谈 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动和情绪 援助。聚合地图将与社区合作伙伴和其他利益攸关方共享。为了加强 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 与他们的期望保持一致。 实施/下一步：旅程图将确定退伍军人的困难或挫折领域 需要食物援助。通过与我们的社区合作伙伴和其他利益相关者合作，我们将 集思广益和原型解决方案，以更好地满足他们的需求。最终，我们设计的解决方案将进行试验 并在适当的时候实施。

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.