Draft Research Plan
Food Insecurity: Preventive Services
February 24, 2022
Recommendations made by the USPSTF are independent of the U.S. government. They should not be construed as an official position of the Agency for Healthcare Research and Quality or the U.S. Department of Health and Human Services.
*Intermediate outcomes include behavioral, physiologic, and healthcare utilization outcomes.
- What is the effect of identifying food insecurity in primary care on health outcomes?
- What is the performance of risk assessment or screening tools to identify food insecurity?
- What are the harms or unintended consequences of assessment for food insecurity?
- What is the effect of healthcare-related interventions to address food insecurity on food security, intermediate outcomes (i.e., behavioral, physiologic, and healthcare utilization outcomes), or health outcomes?
- What are the effects of improvements in food security outcomes on intermediate and health outcomes?
- What are the effects of improvements in intermediate outcomes on health outcomes?
- What are the harms or unintended consequences of healthcare-related interventions to address food insecurity?
Contextual questions will not be systematically reviewed and are not shown in the Analytic Framework.
- What risk assessment or screening tools are commonly used in clinical practice to address food insecurity? What are the benefits and limitations of these commonly used tools?
- What factors inform the appropriate reassessment interval for food insecurity?
- What are important moderators that affect the effectiveness or harms of interventions to address food insecurity?
- What is the acceptability of food insecurity assessment and interventions to patients and providers?
- What is the uptake of interventions after food security is identified as a social need?
- What are the patient, provider, and health system barriers to implementing assessment for food insecurity?
- What are the patient, provider, health system, and community barriers to implementing interventions to address food insecurity?
The proposed Research Approach identifies the study characteristics and criteria that the Evidence-based Practice Center will use to search for publications and to determine whether identified studies should be included or excluded from the Evidence Review. Criteria are overarching as well as specific to each of the key questions.
|Condition||KQs 1–5: Food insecurity with or without nutrition insecurity||KQs 1–5:
|Populations*||KQs 1–5: All ages
|Assessment||KQs 1–3: Risk assessment or screening for food with or without nutrition insecurity using tool that addresses food insecurity with other social risk factors or food insecurity alone||KQs 1–3:
|Interventions||KQs 4, 5: Healthcare-related interventions† targeting food with or without nutrition insecurity
||KQs 4, 5: Public health/community-level policies|
|Comparators||KQs 1, 4: Control group (can include active control/comparator)
KQ 2: Any reference standard
KQs 3, 5: No comparator required if explicitly addresses harms
|KQs 1, 4: No control/comparator
KQ 2: No reference standard
|Outcomes||KQs 1, 4:
KQ 2: Test accuracy, predictive validity, and discriminationKQs 3, 5: Any harms or unintended consequences
|KQs 1, 4:
KQs 1–3: Screening conducted in clinical setting or identified through healthcare delivery or payment system (e.g., health plan data)KQs 4, 5: Interventions or programs integrated into, associated with, or referred from healthcare
|Study designs||KQs 1, 4:
KQ 2: Diagnostic test accuracy or risk assessment studiesKQs 3, 5: Randomized or clinically controlled trials, nonrandomized studies, and quasi-experimental studies
|KQs 1, 4: Randomized or clinically controlled trials, nonrandomized studies with less than 12- week followup
KQ 2: Test performance studies without reference standardKQs 3, 5: Case series, case reports, or editorials
|Study quality||Fair to good||Poor|
* For all KQs, populations of interest include persons at higher risk for food insecurity (e.g., by age, race and ethnicity, health status, or other social risk factors).
† Healthcare-related interventions are those in which the patient’s food insecurity was identified through healthcare and/or the intervention itself is provided directly via a healthcare system, based within a healthcare system, or delivered in partnership with a healthcare system.
Abbreviation: KQ=key question.