CommunityRx for Hunger - Resubmission 01

CommunityRx for Hunger - 重新提交 01

• 批准号: 10299620
• 负责人: Stacy Tessler Lindau
• 金额: $ 66.27万
• 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/10299620
• 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; National Institute on Minority Health and Health Disparities; Online Systems; Outcome; Parents; Pathway interactions; Pediatric Hospitals; Pediatrics; Periodicity; Persons; Physicians; Process; Provider; Public Health; Public Health Practice; Randomized; Randomized Controlled Trials; Reduce health disparities; 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.

项目总结/文摘