Table 4 Overarching study themes and illustrative quotes
Theme | Illustrative quotation |
|---|---|
Limited healthcare resources/EMR | “IT has not been very helpful because they have not been involved with our program so we’re still using paper surveys…we only have one person in charge of screening and she’s overwhelmed…” –Clinician, Program B |
“Screening for food insecurity once a year isn’t enough, but that’s how our EHR works.” Clinician, Program A | |
Limited healthcare resources/EMR | “The food insecurity questions are not embedded in the EHR…the paper system is inefficient for assessing food insecurity needs across the board.” --Clinician, Program B |
Limited healthcare resources/space | “Unfortunately, it’s (screening) not very private. And what I mean by that is that it’s open to more medical assistants that are sitting at that station and potentially another patient getting vitals next to them…So as they’re asking them the questions, there are more people around and it’s not very private. Sometimes we do have that response of no, no, no I’m fine and then they get inside and they tell the doctor maybe something different.” –Clinician, Program A |
“It’s up to the clinic staff to follow through with how they do this because we respect the autonomy of each clinic to take responsibility for the program and how it’s done.” –Program Leader, Program A | |
Leveraging context (clinic-level autonomy) to foster implementation adaptations | “Yeah, so anyone can get a voucher that’s a patient. How we do it is that even after the nurses give them out, we give vouchers to the clerks and other staff that may run into patients. A patient may come up just to pick up some documentation and be like, ‘Oh, I know the Fresh Food Truck has come in. Can I have a voucher?’ Everyone has access to the vouchers so they can give them out at any time on any day.” –Clinician, Program A |
“In general, food insecurity has not been on my radar... As you probably know, a primary care visit is completely overwhelming with—'I have to get your foot exam done, you have to get an influenza shot, I've got to draw your A1C.’ Food insecurity is a serious conversation that takes time…And so that is why it has not been a part of my standard practice.” – Clinician, Program A | |
“We don’t have a way of flagging patients that are food insecure in the EHR to remind doctor’s to talk to patients about resources and sometimes they forget” –Program Leader, Program A | |
Limited healthcare resources/staff capacity | “So we used to have a [phone call] list of the patients who answered yes to the food insecurity questions, but [the phone call reminders] didn't work with us, and was very ineffective because a lot of times patients say no [when asked if they experience food insecurity], but it’s really yes. So their name wouldn't be on the list. So we just wiped out the list altogether and emphasize ‘don't lose your voucher.’” –Clinician, Program A |
Limited healthcare resource/EMR | “When we did it in the summer here at the clinic, space is definitely limited…you can imagine how tight it was… I think our partnership with the park district and their marketing efforts really drew many of the participants. I think that partnership is really, was one of the keys to our success. They shared it on their Facebook page and literally like the next week we had double the amount of participants” –Clinician, Program B |
Leveraging context (clinic-level autonomy) to foster implementation adaptations | |
Limited healthcare resources/space | |
Leveraging context (existing community partnerships and growing model) to foster program reach, acceptability and support | |
Limited healthcare resources/financial | “The food truck visits at each site are not frequent enough because it requires an incredible amount of [food pantry] capacity to staff to run the truck and we don’t have the funds to pay for that. Bad weather, like last year’s polar vortex, can deter participants from coming to the distribution…Patients want more frequent distribution.” –Program Leader, Program A |
Limited healthcare resources/financial | “On that [USDA] grant it’s a total of four [years]…I think we’ve also realized that it’s not a sustainable solution to food insecurity. We’re really trying to think of what else can we do to make this a sustainable food economy here in [neighborhood name].” – Program Leader, Program B |
Leveraging context (existing community partnerships and growing model) to foster program acceptability and support | “We’ve been close partners with [the urban garden collective], and we wrote the USDA grant together for [Program B]. So, the growing concept came from them…One, the hospital alone can’t do it, but when we all came together it was feasible.” –Program Leader, Program B |
Leveraging implementation climate (existing growing model) to foster program acceptability | “I think the strength of having it at the clinic is just the traffic. The traffic of people. So, people walking past the farm stand and seeing the vegetable distribution get naturally brought into the cooking demos… the farmstand is a brilliant move because that farmstand is sitting there just seamlessly with the [prescription produce box] distribution… It becomes a very collective experience. “–Clinician, Program B |