Understanding-the-Reasons-Why-Patients-With-Food-Insecurity-Decli_2025_AJPM-.pdf

RESEARCH ARTICLE
Understanding the Reasons Why Patients With Food
Insecurity Decline Social Assistance at a Large
Academic Medical Center
Alexander Connelley, BS,1 Abigail Young, BA,1 Jennifer T. Lee2, Markell Miller, MPH,3
Eileen Spring, MA,3 Wei Hao, PhD,4 Julia A. Wolfson, PhD,5,6 Alicia J. Cohen, MD,7,8,9
Minal R. Patel, PhD,10 Cindy W. Leung, ScD11
Introduction: Despite the recent expansions of clinical screening for food insecurity, research
shows large discrepancies between the number of patients who report food insecurity and those
who request assistance. In this qualitative study of patients with food insecurity who declined social
assistance, the authors aimed to understand the patients’ reasons for not seeking food-related assis-
tance and explore their perspectives on addressing food insecurity with their healthcare provider.
Methods: At a large academic medical center in southeast Michigan, the authors conducted semi-
structured, in-depth interviews with 31 English-speaking adult primary care patients who had
screened positive for food insecurity at a previous clinic encounter and subsequently declined assis-
tance from a trained social worker. The interview guide explored patients’ reasons for declining
social assistance, perspectives on clinical screening for food insecurity and other social risk factors,
and the extent to which they discussed their needs with their provider. Interviews were recorded,
transcribed, and analyzed using the constant comparative method to reveal emergent themes.
Results: The mean age of the participants was 48.2 years, and 71% were women. The most promi-
nent reasons for patients with food insecurity not seeking social assistance were the belief that the
potential resources would be redundant or not helpful and previous negative experiences with
receiving food assistance. Several patients also did not remember or know that they had declined
assistance. Most patients believed that healthcare providers should be knowledgeable about patients’
food insecurity status to better inform care delivery. However, patients expressed discomfort, fear,
or embarrassment in revealing this information and emphasized the importance of providers foster-
ing a supportive and empathetic healthcare environment.
From the 1Undergraduate Education in Public Health, School of Public Health, University of Michigan, Ann Arbor, Michigan; 2Department of Nutritional
Sciences, School of Public Health, University of Michigan, Ann Arbor, Michigan; 3Food Gatherers, Ann Arbor, Michigan; 4Department of Biostatistics,
School of Public Health, University of Michigan, Ann Arbor, Michigan; 5Department of International Health, Johns Hopkins Bloomberg School of Public
Health, Baltimore, Maryland; 6Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland;
7Center for Innovation in Long Term Services and Supports, VA Providence Healthcare System, Providence, Rhode Island; 8Department of Family Medi-
cine, Alpert Medical School of Brown University, Providence, Rhode Island; 9Department of Health Services, Policy, and Practice, Brown University School
of Public Health, Providence, Rhode Island; 10Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann
Arbor, Michigan; and 11Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, Massachusetts
Address correspondence to: Cindy W. Leung, ScD, Department of Nutrition, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue,
Building 2, Room 321, Boston MA 02115. E-mail: cindyleung@post.harvard.edu.
2773-0654/$36.00
https://doi.org/10.1016/j.focus.2025.100320
© 2025 The Author(s). Published by Elsevier Inc.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
AJPM Focus 2025;4(2):100320
1
Conclusions: Strategies to connect patients with food assistance must target multiple levels,
including improving assistance methods, increasing provider knowledge, and prioritizing patient
comfort.
AJPM Focus 2025;4(2):100320. © 2025 The Author(s). Published by Elsevier Inc. This is an open access article
under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
INTRODUCTION
Food insecurity is an important social risk factor that
affects 1 in 8 U.S. families.1 Food insecurity is associated
with numerous adverse health outcomes2,3; however, the
experience of food insecurity may not always be obvious.
For this reason, many healthcare systems have adopted
efforts recommended by medical, public health, and
antihunger organizations to universally screen for and
address food insecurity within their patient popula-
tions.4−7 Previous studies have shown that screening for
social risk factors, such as food insecurity, is highly
acceptable and perceived as important by both patients
and providers.8−11 For example, a recent qualitative
study in San Francisco found that adult primary care
patients appreciated the health-related social needs
screening tool as an opportunity to connect patients to
local resources.12 In another study conducted in South-
ern California, 85% of patients agreed that their health
system should ask about social needs, and 88% believed
that their health system should address social needs.13
Although many prior studies have focused broadly on
multiple social risk factors, including housing instability,
transportation barriers, and lack of social support, fewer
studies have focused on food insecurity as the primary
social risk factor.14
Despite the substantial expansion of screening for
food insecurity in clinical practice settings, current
research shows large discrepancies between the number
of patients who report social risk factors (such as food
insecurity) at screening, the number who show interest
in receiving social assistance, and an even smaller num-
ber who eventually engage with community assistance
efforts.15−19 Several of these studies have been con-
ducted
among
parents
or
caregivers
of
pediatric
patients.20−23 For example, in one pediatrics study, 21%
of caregivers reported food insecurity, of whom 75%
expressed interest in food referrals, but only 14% con-
nected with food assistance.19 The number of patients
lost at each step raises concerns, particularly when con-
sidering that effective interventions to address unmet
social needs can lead to measurable improvements in
health and well-being.24,25 Qualitative exploration of
why patients decline social assistance has yielded various
results ranging from the perception that their needs
were not as severe as the needs of others,26 to beliefs that
their social needs could not be alleviated through
the healthcare system,21 and to concern that the
provider−patient
relationship
will
be
harmed.27
Although research continues to fill this gap, several pre-
vious studies have focused on populations with special
needs, including families of pediatric patients28,29 and
patients with chronic diseases,30−32 or have been broadly
inclusive of all unmet social needs.19,33−35
Food insecurity is an important social risk factor that
can be directly targeted by a vast network of community
efforts (e.g., charitable food programs), nutrition assis-
tance programs, and economic policies. Common clini-
cal approaches to addressing food insecurity include
providing referrals to patients to local food pantries,
application assistance for the Supplemental Nutrition
Assistance Program (SNAP), vouchers that can be used
for meals or groceries, medically tailored meals or gro-
ceries, organizing prescription programs, and even
establishing
on-site
food
pantries.7,36
Furthermore,
efforts to identify and target food insecurity in clinical
settings was a main focus at the 2022 White House Con-
ference on Hunger, Nutrition, and Health37 and has
inspired the growing Food is Medicine movement.38
Additional research as to why patients with food insecu-
rity decline social assistance in clinical settings is of great
interest to healthcare providers and public health practi-
tioners to improve patient outcomes and reduce com-
munity food insecurity.
In August 2017, Michigan Medicine implemented
routine screening for food insecurity and other social
risk factors. At new patient visits or annually at health
maintenance examinations, all primary care patients
complete a standardized questionnaire that assesses
food insecurity and other social risk factors as well as
their interest in social assistance.39,40 Authors’ prior
study demonstrated that only 1 in 5 patients with food
insecurity expressed interest in social assistance.41
Through semistructured interviews with patients with
food insecurity, the goals of this study were to (1)
qualitatively understand reasons for not seeking food-
related assistance and (2) explore their perspectives on
addressing
food
insecurity
with
their
healthcare
provider.
2
Connelley et al / AJPM Focus 2025;4(2):100320
www.ajpmfocus.org
Assistance Program (SNAP), vouchers that will be used
Food insecurity is an trivial social risk factor that
METHODS
Study Population
Study participants were recruited from the primary care
patient population at Michigan Medicine, a tertiary care
academic medical center and one of the largest health-
care systems in Michigan. Potential participants were
identified through their electronic health records by the
Michigan Medicine Data Office for Clinical & Transla-
tional Research (DOCTR) on the basis of the following
inclusion criteria: (1) aged ≥20 years, (2) English speak-
ing, (3) completed social risk factor screening at a pri-
mary care clinic encounter between January 2021 and
December 2022, (4) documented a positive screen for
food insecurity using the Hunger Vital Sign,40 and (5)
declined interest in social assistance from a trained social
worker. Declining interest in social assistance was
defined as a response of no to the question, Do you want
to get connected with resources for any of the above
responses? embedded at the end of the standardized
social risk factor questionnaire. The study objective was
described to participants as “to better understand food-
related needs among Michigan Medicine patients.” Eligi-
ble participants were sent a recruitment flier by the
DOCTR and invited to contact the study coordinator if
interested. Those who expressed interest were then con-
tacted by the study coordinator with an online preinter-
view survey and the online written informed consent
form. Once completed, the project coordinator sched-
uled the participant for an online (Zoom) or phone
interview. The recruitment protocol was designed with
staff from the Michigan Medicine DOCTR to adhere to
institutional privacy regulations. The study’s methodol-
ogy was approved by the University of Michigan Medical
School IRB.
Measures
The preinterview survey assessed the participants’ socio-
demographic characteristics and food security status
using the 6-Item Short Form Food Security Survey Mod-
ule.42 Affirmative responses were summed, and the fol-
lowing
categories
were
created
according
to
U.S.
Department of Agriculture guidelines: high or marginal
food security (Scores 0−1), no or few reported indica-
tions of problems with food access; low food security
(Scores 2−4), some disruptions to eating patterns,
reduced diet quality; and very low food security (Scores
5−6), many disruptions to eating patterns, reduced diet
quality and intake. An open-ended interview question
guide was developed by the project team, adapted on the
basis of previous literature.20,43−46 The final interview
guide consisted of 11 questions that explored partici-
pants’
current
experiences
with
food
insecurity,
perspectives on social risk factor screening for their
recent healthcare encounter, and reasons for declining
social assistance at Michigan Medicine (Appendix Table
1, available online).
In total, 54 individuals initially reached out with
interest, 23 individuals did not return contact or
declined to participate, and 31 individuals completed
the study. Participant recruitment was stopped when
data saturation was reached, that is, when the content
from new interviews began to sound repetitive, and the
emergent themes overlapped with those raised in prior
interviews.47 All interviews were conducted between
May and August of 2023 by 2 research assistants
(undergraduate students studying public health) who
completed training in qualitative research methods. The
interviews lasted, on average, 20−25 minutes. Upon
interview completion, participants were compensated
for their time with a $30 gift card to a grocery store of
their choosing.
Statistical Analysis
Interviews were professionally transcribed verbatim
from audio recordings and checked for accuracy by the
study team. Transcriptions of the interviews were ana-
lyzed for thematic content using the constant compara-
tive method.48 Two researchers (AC and AY) reviewed
the transcripts line by line to generate codes from the
data. The senior author (CWL) compiled and reviewed
all codes, refined the wording (if necessary), and orga-
nized the codes by domains of the interview guide.
Researchers agreed upon the final codebook before inde-
pendently reviewing each transcript again and applying
the relevant codes to the text. Researchers met regularly
to resolve discrepancies and achieve consensus. After all
transcripts were systematically coded, the researchers
used the codes to identify emergent themes and repre-
sentative quotes from the data, in accordance with the
goals of the study. The iterative nature of the analysis,
peer debriefing process, examination of researcher posi-
tionality, and consultation with the entire project team
(clinicians, academic researchers, and local antihunger
advocates) on the emergent themes were used to help
ensure rigor and trustworthiness of this study. Analyses
were conducted in 2023−2024.
RESULTS
Among the 31 participants, the mean (SD) age was 48.3
(2.3) years, 71% were female, and 52% identified as non-
Hispanic White (Table 1). The majority of participants
(74.2%) were not married or partnered, and 77.4% did
not have any children in their home. At the time of the
Connelley et al / AJPM Focus 2025;4(2):100320
3
April 2025
interview, 36% had low food security, and 48% had very
low food security.
Thirteen patients with food insecurity explicitly dis-
cussed reasons for not seeking social assistance. Two com-
mon reasons for patients not seeking social assistance
were believing that the potential food-related resources
would be redundant or not helpful and having previous
negative experiences with receiving food assistance.
One reason patients gave was that potential resources
would be repetitive or not helpful. Several patients
described being previously referred to the same resour-
ces, which led them feeling frustrated. For example, one
patient previously connected with a social worker and
received the same list of resources at different times.
They said, “I had gotten the same information twice
before, like the same information packet with the same
resources and food banks, blah blah blah. I had gotten
that twice before, so that’s why I declined [assistance]
the last time because I already have it.” This patient sug-
gested updating the list of pantries periodically to alert
existing patients of new resources: “Let’s say a new food
bank came up on [the hospital’s] radar. Have a list of
people that [the hospital] is currently helping and send
those letters out to those people. Let them know that
there’s an update on the packet I sent to you. . .. I just
think that would be very helpful because then you’re not
giving the same information out to the same people.”
Similar to the first patient, other patients were already
familiar with their local food pantries and/or receiving
assistance from SNAP. One patient said that the last
time they sought food assistance, they were referred to a
food pantry in a neighboring town but decided that it
was not worth “the money in gas to travel somewhere to
try to access healthier food.” Another patient also
described the inconvenience of navigating food pantry
referrals that were not near her home. When asked
whether this was why she declined assistance, she
remarked, “After a while, you just get tired of the same
stuff, and nobody really showing you how they can help
you or telling you what programs are available.”
Some patients declined assistance owing to having
prior negative experiences with seeking food assistance,
including local pantries having poor quality food, being
denied SNAP benefits despite having low incomes, and
not being able to use food vouchers. One patient
described the quality of the food at a local pantry as
being so poor that “I think I’d do better not eating.”
Another patient previously connected with a social
worker who provided them with farmer’s market vouch-
ers but found difficulty in redeeming them: “They were
coupons on a piece of paper that they called tokens for
the farmer’s market. We went to quite a few of the farm-
er’s markets. Them people know it was very hard to use
them. They don’t take that. I was never able to use them.
Never.” The challenges of seeking food assistance were
further complicated by patients’ existing medical condi-
tions (e.g., diabetes, cancer, mobility limitations) or spe-
cial dietary needs (e.g., food allergies, veganism, gluten
intolerance). Several patients expressed not being able to
find the foods they needed at local pantries.
Ten patients in the study remembered completing the
social risk factor questionnaire but did not remember or
know that they declined assistance. When researchers
explained the team of trained social workers at the
healthcare system who could contact them with local
resources, several patients said that they would have
opted to accept assistance had they had more informa-
tion about what the question was asking or what resour-
ces
were
available.
One
patient
emphasized
the
importance of communicating clearly to the patient: “If
we fill out the survey and somebody reaches out, maybe
just give a little bit more detail, or expand more on it so
we can know exactly what it’s about. . .It’s like somebody
trying to sell you something. You’re like, ‘I don’t need it.’
But, if you explain it more in a way of why the patient
could benefit from it, they might be more willing to
want to learn about it.” Another patient, who lived in a
rural area, also expressed interest in receiving local refer-
rals and more information: “I think that would have
Table 1. Participant Characteristics
Characteristic
Mean
SD
Age, year
48.3
2.3
Sex, n (%)
Male
9
29.0
Female
22
71.0
Race/ethnicity, n (%)
Non-Hispanic Asian
2
6.5
Non-Hispanic Black
10
32.3
Non-Hispanic White
16
51.6
Other (non-Hispanic)
3
9.7
Educational attainment, n (%)
High school graduate or fewer years
10
32.3
Any college
13
41.9
College graduate
8
25.8
Marital status, n (%)
Not married or partnered
23
74.2
Married or living with partner
8
25.8
Household composition, n (%)
No children
24
77.4
Has children
7
22.6
Food security status, n (%)
High/marginal food security
5
16.1
Low food security
11
35.5
Very low food security
15
48.4
4
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been very helpful to be provided with resources that are
tailored to my area—local resources as well as state and
federally regulated assisted programs and how to get
started with those and qualifications and stuff like
that. . . I know that would be nice to get resources tai-
lored towards people who are living in a more rural area
or more food scarce where there are less apparent
resources.” Eight additional patients did not remember
completing the social risk factor questionnaire, nor did
they remember declining assistance.
Most patients believed that healthcare providers
should be knowledgeable about their patients’ food inse-
curity status to better inform care delivery. Patients
expressed the views that knowing their food insecurity
status would lead healthcare providers to better tailor
treatment approaches, interventions, and recommenda-
tions to address not only their medical needs but also
their
socioeconomic
circumstances
and
nutritional
requirements. One patient said, “Well, if I can’t eat, I
can’t be healthy. If I don’t have access to healthy foods,
then I can’t be healthy. It will lead to other health issues.
They should be concerned.”
Despite the overwhelming belief that healthcare pro-
viders should be aware of patients’ food-related needs,
patients acknowledged that this may not be an easy con-
versation to have with their healthcare provider. Some
patients mentioned not wanting to have the conversa-
tion with their provider owing to discomfort and embar-
rassment. One patient said, “It’s embarrassing because
we’ve always worked and we’ve never been in a situation
like this before our whole lives. It was a really tough situ-
ation. Our doctor continually asked us about it. The
whole thing is embarrassing.” Another patient described
the situation as uncomfortable despite having a good
relationship with their provider: “It was just embarrass-
ing but she was a wonderful doctor. She was good about
talking to us about it and she kept saying, ‘There’s no
shame in that. You can’t help what happened.’ I mean,
she was great, but it still is a tough situation to be in.”
Furthermore, some patients expressed concern about
the consequences of having food insecurity documented
in their medical chart. For example, one patient said,
“Well, if I write this down, what are they going to think
of me? Is this going to count negatively towards me?”
Another patient echoed, “Anything they put in that
chart can be used against you. So, you’re careful on what
you want to have put in your chart.”
In general, patients preferred that providers initiate
conversations about their experiences with food insecu-
rity. One patient said, “Some patients will feel shy talking
about this issue. If [doctors] are able to give you this
time, many patients will talk about [their food-related
needs],
especially
low-income
patients. . .it
will
be
helpful for many patients.” Other patients described past
experiences of being dismissed or invalidated when
attempting to discuss food insecurity or other social
needs, which closed the window to further conversations
with their provider. As one patient said, “I’ve been in
contact with [doctors] regarding this, it seems like they
just wanted to treat me for what I was there for. ‘Don’t
ask any more questions that’s not related to that and get
to stepping.’” Another patient described a previous
encounter where they reached out to her provider for
assistance but never received any information about
resources or follow-up. They said, “When I had my visit
to Michigan Medicine, my primary doctor asked me if I
need support with anything. I said, ‘Okay, I need sup-
port.’ But they didn’t get back to me. . . If they reach out
to me, they email me at any time, I will just reply to
them. But they didn’t reach out to me. They didn’t con-
tact me.” Overall, patients emphasized the importance
of fostering a supportive and empathetic healthcare
environment where discussions about food insecurity
are welcomed, destigmatized, and seamlessly integrated
into routine care practices.
DISCUSSION
This study aimed to qualitatively understand the reasons
why clinical primary care patients with food insecurity
chose not to seek food-related assistance and further
explore their perspectives on addressing social needs
with their healthcare provider. Several key findings
emerged from this research. The primary reasons why
patients with food insecurity declined assistance were
the belief that the potential resources would be redun-
dant or not helpful or they had prior negative experien-
ces with receiving food assistance. These findings are
consistent with previous qualitative and mixed-methods
studies that identified discomfort, fear, or embarrass-
ment as prominent reasons why patients with unmet
social needs chose not to engage in assistance from their
healthcare provider.15,27,31,34,35 This study builds upon
this important research by focusing specifically on
patients with food insecurity and how healthcare
systems can better address their food-related needs.
Another reason for patients declining assistance was
not understanding or remembering that they had explic-
itly declined assistance on the social risk factor question-
naire. Notably, several patients indicated that they
would have accepted assistance had they been better
informed about the resources that the healthcare system
could provide. These findings add important context to
the authors’ prior study showing that only 1 in 5 adult
primary care patients with food insecurity at Michigan
Medicine had requested assistance.41 Results from this
Connelley et al / AJPM Focus 2025;4(2):100320
5
April 2025
In general, patients preferred that providers initiate would have accepted assistance had they been worse
study suggest improvements to the processes through
which patients are screened for social risk factors, and
the information communicated to patients before and
during this process may influence their willingness to
seek assistance. Higher-intensity models could be bor-
rowed from other clinics that improve the process of
screening and referrals. For example, this could include
directed referrals to food assistance, support for com-
pleting applications for SNAP or other programs, navi-
gation
support
services,
and
extended
navigation
support with additional follow-up to encourage patients
to follow through with services.49 Furthermore, clarity
from clinics on how the documentation of food or other
basic needs insecurities within electronic health records
will be used to inform a patient’s care management and
who will have access to their social risk factor data may
help encourage honest responses and allay concerns
about how the information might be used.
Along these lines, most patients believed that health-
care providers should be knowledgeable about their food
insecurity status to inform more effective care delivery.
This perspective highlights patients’ awareness that food
insecurity can negatively influence their diet and health
behaviors, ability to manage chronic conditions, adher-
ence to treatment plans, and overall health maintenance,
consistent
with
the
research
and
provider
perspectives.9,50,51 However, not all patients were willing
to engage in discussions on this topic, citing discomfort
or embarrassment as salient barriers. It is important for
providers to acknowledge that food insecurity is not
only an important social risk factor but one that is also
inherently stressful and stigmatizing.45,52 One prior
qualitative study that specifically focused on improving
patient−provider communication around food insecu-
rity identified empathy, trust, cultural sensitivity, and
showing interest in the whole patient as key factors
among providers that allowed patients to share their
experiences of food insecurity with their provider.53
Recent strategies to leverage partnerships between clinics
and community food banks could also serve to improve
providers’ motivation to discuss food-related needs with
their patients, which can help with normalizing these
conversations and destigmatizing food insecurity. These
partnerships can also facilitate the development of
updated resources for local food pantries and SNAP
application assistance. An extension of this is the role of
clinical teams to better address patients’ complex health
and social needs, including multiple primary care clini-
cians, mental health providers, community health work-
ers, social workers, patient navigators, dietitians, and/or
other healthcare staff. The team-based model has been
valued by multiple healthcare staff as having the poten-
tial to improve patients’ health.54−56
Limitations
This study has limitations. First, the generalizability of
the results may be limited given that all English-speak-
ing adult patients were recruited from 1 large academic
medical center in Southeast Michigan. The authors
chose English-speaking adults who were aged ≥20 years
to identify individuals who may exert control over their
household food budget and could describe their house-
hold’s food security experiences to the study team.
Recruitment was conducted through email, necessitat-
ing potential participants to have regular email access.
Future studies may want to consider conducting similar
research in languages other than English to better cap-
ture experiences for non-English speakers and to recruit
participants using varied methods (e.g., in person,
phone). In addition, patients were recruited from the
larger pool of prospective participants who had encoun-
ters dating back to January 2021. Some patients may
have had more difficulties recalling completing the
social risk factor questionnaire or engaging in discus-
sions about food-related needs with their healthcare
provider, particularly because the encounter window
overlapped with the coronavirus disease 2019 (COVID-
19) pandemic. However, most patients were able to
remember completing the social risk factor question-
naire even if they did not remember declining social
assistance. In this study, only 8 patients could not recall
completing the social risk factor questionnaire or
declining assistance. The pandemic may have also
affected the nature of the encounter between the patient
and provider, the manner in which the patient com-
pleted the standardized social risk factor questionnaire,
and the extent to which providers were able to prioritize
discussing resources for food insecurity. The authors
did not systematically capture the reasons why individ-
uals declined to participate in this study. This informa-
tion would have been helpful in understanding whether
the results from this study might be generalizable to
other Michigan Medicine patients. Finally, patients
were recruited by a central office that aims to connect
researchers with patients and their medical data. Inter-
ested patients were encouraged to reach out to the study
coordinator
for
further
information.
This
passive
recruitment process may have affected who decided to
participate in this study, and the themes from the study
may have been different had the authors used a more
direct recruitment method.
CONCLUSIONS
Existing efforts to screen for and address food insecurity
in healthcare settings have varied in efficacy in connect-
ing patients with social needs to community resources.
6
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Results from this qualitative study suggest that improved
coordination between healthcare providers, social work-
ers, and the antihunger community could lead to better
navigation of community resources for patients, particu-
larly those who already have existing experiences with
food assistance. Furthermore, although the majority of
patients emphasized the importance of discussing food
insecurity with their providers, others emphasized dis-
comfort, fear, and embarrassment as barriers to engag-
ing in this discussion. Interventions to address these
concerns may include better tailoring and updating food
assistance resources for patients in surrounding commu-
nities; prioritizing new food pantries based on the
patient’s location that also account for patients’ trans-
portation options and hours of availability; and leverag-
ing the roles of the primary care provider, patient
navigators, and community health workers to facilitate a
warm handoff.
Overall, this study shows that strategies to facilitate
connecting patients to social assistance need to target
multiple levels, including improving the modalities of
offering assistance, increasing provider knowledge and
empathy, and prioritizing patient comfort.
ACKNOWLEDGMENTS
The authors thank all the study participants for sharing their
experiences and perspectives.
Disclaimers: The funders had no role in the study design;
data collection, analysis, and interpretation; or writing of the
report.
Funding: This study was supported by Grant Number
P30DK092926 (Michigan Center for Diabetes Translational
Research) from the National Institute of Diabetes and Digestive
and Kidney Diseases. AJC was additionally supported by Grant
CDA 20-037 from the Department of Veterans Affairs Health
Services Research & Development Service.
Declaration of interest: None.
CREDIT AUTHOR STATEMENT
Alexander Connelley: Methodology, Data curation, Formal analy-
sis, Writing-original draft. Abigail Young: Methodology, Data
curation, Formal analysis, Writing-original draft. Jennifer Lee:
Methodology, Data curation, Writing-review and editing, Project
administration. Markell Miller: Conceptualization, Methodology,
Writing-review and editing. Eileen Spring: Conceptualization,
Methodology, Writing-review and editing. Wei Hao: Project
administration, Writing-review and editing. Julia A. Wolfson:
Writing-review and editing. Alicia J. Cohen: Writing-review and
editing. Minal Patel: Writing-review and editing. Cindy W. Leung:
Conceptualization, Methodology, Formal analysis, Supervision,
Project administration, Funding acquisition.
SUPPLEMENTARY MATERIALS
Supplementary material associated with this article can
be found in the online version at doi:10.1016/j.focus.2025.
100320.
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