(OR35-05-24) Understanding Motivations Among Patients With Food Insecurity Who Declined Social Assistance at a Large Academic Medical Center

Objectives: In recent years, there have been concerted efforts by health care systems to identify and address food insecurity in patient populations. Research suggests that there is a gap between patients who screen positive for food insecurity and those who request assistance. The primary study objective was to qualitatively understand the motivations of patients with food insecurity who declined assistance. A secondary study objective was to explore their perspectives on addressing their social needs with their health care provider.

Methods: We conducted semi-structured, in-depth, virtual interviews with 31 adult primary care patients at a large, tertiary care academic medical center in Michigan. Eligibility criteria included: 1) English-speaking adults ( >=20 years), 2) a clinic encounter between January 2021 and December 2022, 3) complete social determinants of health (SDH) screening, 4) a positive screen for food insecurity using the Hunger Vital Sign, and 5) declined assistance from a trained social worker for their social need. Interviews were recorded, transcribed, and analyzed using the general inductive approach to reveal emergent themes.

Results: Among the 31 participants, the mean (SD) age was 48.2 (13.0) years, 71% were female, and 52% identified as non-Hispanic White. At the time of the interview, 35% had low food security and 48% had very low food security. Most patients did not remember declining assistance, and some patients would have accepted assistance had more information been provided about available resources. Other patients explicitly chose not to seek assistance due to previous negative experiences with receiving food assistance. Most patients believed that health care providers should be knowledgeable about their patients’ food insecurity status to better inform care delivery. However, not all patients wanted to engage in this discussion with their provider due to discomfort, fear, or embarrassment.

Conclusions: Strategies to facilitate connecting patients to social assistance need to target multiple levels, including improving the methods of offering assistance, increasing provider knowledge, and prioritizing patient comfort.

Funding Sources: This study was supported by Grant Number P30DK092926 (MCDTR) from the National Institute of Diabetes and Digestive and Kidney Diseases.