Understanding caregiver perspectives to improve food security screening in healthcare settings: A focus group study

Healthcare institutions are increasingly engaged in efforts to screen patients for food insecurity and connect households to supportive resources, often in direct collaboration with community develop­ment practitioners and aligned with Food Is Medicine initiatives. Evidence of the effectiveness of these efforts, however, is limited. Drawing on data from six focus groups with a total of 42 partic­ipants, conducted in both English and Spanish, this study explores how low-income parental caregivers experience and understand food security screenings within healthcare settings. From there, it identifies communication barriers and opportunities for improvement. The analysis was guided by commu­nication infrastructure theory (CIT), a framework for understanding how a community’s “storytelling network,” consisting of local residents, organiza­tions, and media, can be harnessed for health pro­motion. Findings revealed a complex mix of trust and skepticism. While some caregivers appreciated efforts to connect families with resources, many expressed concern and fear related to stigma, pri­vacy breaches, and potential intervention by child protective services. Spanish-speaking participants also highlighted linguistic barriers that increased frustration with the process. Participants recom­mended that screening processes prioritize choice and provide follow-through with tangible resource connections, ideally facilitated through trusted community intermediaries. Applying CIT, our anal­ysis suggests that healthcare institutions can strengthen food security outreach by building rela­tionships with familiar individuals and organiza­tions in the community’s storytelling network. Doing so requires fostering trust through transpar­ent, empathetic engagement. Overall, the findings demonstrate an important role for practitioners in food systems and community development to develop community-based communication strate­gies with healthcare institutions. This study both advances theory and offers actionable guidance to make food security screening more equitable, effec­tive, and responsive to caregivers’ lived realities.