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Zia Ahmed Choudhury MD, MPH

  • Graduate 2020
Scholarly Research Project

Questionnaire-based Screening Ineffective for Identifying Food Insecurity at Obstetric and Pediatric Well Visits

Choudhury Z, Schlar L, Iyengar P.


Food Insecurity (FI) is correlated with adverse maternal-child health outcomes, including pregnancy complications, neural tube defects, low birth weights, and early childhood illness. The USDA estimates 14% of Allegheny County (AC) households experience FI. AAFP, AAP, and ACOG recommend that clinicians screen for FI at well visits. The objectives of this project were to implement a questionnaire-based screen for identifying FI households at obstetric and pediatric well visits and determine whether a questionnaire-based approach was effective.


A protocol was developed wherein patients were given the validated Hagerman FI self-report questionnaire at well visits. Positive screens were to be documented and routed to the SHY FHC Maternal Child Health Coordinator (MCHC) for ongoing follow-up and referral. The screening was limited to pregnant patients and pediatric patients age <5. Intervention results were evaluated for 4 months (January-April 2020). The questionnaire deployment was monitored through a bi-monthly inventory of questionnaire forms. Identification rates were monitored using monthly communication between the MCHC and resident investigator. Documentation rates were to be monitored using smart data elements from the electronic health record, but at the time of analysis, these data were not available due to SARS-CoV-2 pandemic related challenges. 


Seventy-two FI questionnaires were deployed over the intervention period. One FI household was identified from a positive questionnaire. Three FI households were identified from clinician-initiated screening outside of the protocol. Clinician-initiated screening accounted for 75% of FI households identified over the intervention period.


With some limitations (small sample size, limited data for analysis, SARS-CoV-2 pandemic related challenges) questionnaire-based screening was ineffective for identifying FI households. Compared to questionnaire-based screening, clinician-initiated screening was more effective. As the SARS-CoV-2 pandemic exacerbates existing FI within AC and presents new barriers to existing clinical workflows, developing effective, adaptable methods for FI screening and referral should become a priority at the SHY FHC for this patient population.