CIC 2023: Enhancing Referrals to the Supplemental Nutrition Assistance Program (SNAP) through Clinical Integration of a Standards-Based Decision Support System.

BACKGROUND: The Supplemental Nutrition Assistance Program (SNAP) is one of the most successful national programs to reduce poverty and improve health outcomes, but millions of Americans who qualify still do not have access to SNAP, and limited data is available to determine how referrals to the program can be completed successfully. OBJECTIVES: We aimed to design and develop a standards-based digital care coordination platform to support closed-loop social services referrals between patients and social and health care providers; and demonstrate the feasibility to screen, diagnose, plan, and complete interventions with selected patients in real-settings. METHODS: We partnered with community members to design the platform through Community Engagement Studios and with a Federally Qualified Health Center, Local Mental Health Authority, and Food Bank to determine the features and workflow requirements of the platform design. We customized currently available systems to use Fast Healthcare Interoperability Resources (FHIR) Application Programming Interfaces (APIs) that could exchange information in real-time across providers and participants. RESULTS: The platform was successfully demonstrated through a pilot where patients were recruited in clinical settings and referred to a Food Bank that provided SNAP application assistance to study participants. We translated the requirements of the platform to national standards and required workflows of providers and patients. Study participants were notified electronically of the specific steps to follow to complete their SNAP applications while receiving support from specialists from the Food Bank. CONCLUSION: The pilot demonstrated the feasibility of collecting granular social service referral information that can be used to better address gaps in social care. The pilot also highlighted the importance of further coordination on the usage and harmonization of needs assessment nationally and that current digital systems are still not ready to fully utilize national Social Determinants of Health (SDOH) data standards.

Psychosocial Determinants of Food Acquisition and Preparation in Low-Income, Urban African American Households.

BACKGROUND: Psychosocial factors are important determinants of health behaviors and diet-related outcomes, yet relatively little work has explored their relation to food-purchasing and preparation behaviors in low-income populations. AIM: To evaluate the psychosocial factors associated with food-related behaviors. METHODS: Cross-sectional data collected from 465 low-income African American adult caregivers in the baseline evaluation of the B'more Healthy Communities for Kids obesity prevention trial. Questionnaires were used to assess household sociodemographic characteristics, food sources frequently used, and food preparation and food acquisition behaviors. Multiple linear regression models explored the associations between caregiver psychosocial variables and food-related behaviors, controlling for caregivers' age, sex, household income, household size, and food assistance participation. RESULTS: Caregivers purchased prepared food at carry-outs on average 3.8 times (standard deviation [ SD] = 4.6) within 30 days. Less healthy foods were acquired 2 times more frequently than healthier foods ( p < .001). Higher food-related behavioral intention and self-efficacy scores were positively associated with healthier food acquisition (ß = 0.7; 95% confidence interval [CI] [0.09, 1.4]; ß = 0.04; 95% CI [0.02, 0.06]) and negatively associated with frequency of purchasing at prepared food sources (ß = -0.4; 95% CI [-0.6, -0.2]; ß = -0.5; 95% CI [-0.7, -0.3]), respectively. Higher nutrition knowledge was associated with lower frequency of purchasing food at prepared food venues (ß = -0.7; 95% CI: [-1.2, -0.2]). DISCUSSION: Our findings indicate a positive association between psychosocial determinants and healthier food acquisition and food preparation behaviors. CONCLUSION: Interventions that affect psychosocial factors (i.e., food-related behavioral intentions and self-efficacy) may have the potential to increase healthier food preparation and food-purchasing practices among low-income African American families.

Adherence with physical activity monitoring wearable devices in a community-based population: observations from the Washington, D.C., Cardiovascular Health and Needs Assessment.

Wearable mobile health (mHealth) technologies offer approaches for targeting physical activity (PA) in resource-limited, community-based interventions. We sought to explore user characteristics of PA tracking, wearable technology among a community-based population within a health and needs assessment. In 2014-2015, we conducted the Washington, D.C., Cardiovascular Health and Needs Assessment in predominantly African-American churches among communities with higher obesity rates and lower household incomes. Participants received a mHealth PA monitor and wirelessly uploaded PA data weekly to church data collection hubs. Participants (n = 99) were 59 ± 12 years, 79% female, and 99% African-American, with a mean body mass index of 33 ± 7 kg/m2. Eighty-one percent of participants uploaded PA data to the hub and were termed "PA device users." Though PA device users were more likely to report lower household incomes, no differences existed between device users and non-users for device ownership or technology fluency. Findings suggest that mHealth systems with a wearable device and data collection hub may feasibly target PA in resource-limited communities.