Screening for food insecurity

Eighteen^{(Reference Gany, Pan, Ramirez and Paolantonio12,Reference Ferrer, Neira, De Leon Garcia, Cuellar and Rodriguez15,Reference Sastre, Wynn, Roupe and Jacobs18,Reference Berkowitz, Terranova, Randall, Cranston, Waters and Hsu19,Reference Newman and Lee23,Reference Aiyer, Raber and Bello34,Reference Beck, Henize, Kahn, Reiber, Young and Klein35,Reference Blitstein, Lazar and Gregory38,Reference Cook, Ward and Newman43,Reference Ghouse, Gunther and Sebastian45,Reference Hager, De Kesel Lofthus, Balan and Cutts47,Reference Knowles, Khan and Palakshappa50,Reference Mirsky, Zack, Berkowitz and Fiechtner53,Reference Paolantonio, Kim and Ramirez55,Reference Schlosser, Joshi, Smith, Thornton, Bolen and Trapl58,Reference Schlosser, Smith, Joshi, Thornton, Trapl and Bolen59,Reference Joshi, Smith, Bolen, Osborne, Benko and Trapl60,Reference Smith, Malinak and Chang62,Reference Wynn, Staffileno, Grenier and Phillips63,Reference Walker, DePuccio and Hefner66,Reference Stenmark, Steiner, Marpadga, DeBor, Underhill and Seligman69)} of the thirty-five programmes discussed screening for food insecurity. Of these, six programmes^{(Reference Newman and Lee23,Reference Blitstein, Lazar and Gregory38,Reference Cook, Ward and Newman43,Reference Ghouse, Gunther and Sebastian45,Reference Paolantonio, Kim and Ramirez55,Reference Smith, Malinak and Chang62,Reference Gany70)} used the USDA Household Food Security Survey, with number of items ranging from two to eighteen. Thirteen programmes^{(Reference Ferrer, Neira, De Leon Garcia, Cuellar and Rodriguez15,Reference Sastre, Wynn, Roupe and Jacobs18,Reference Aiyer, Raber and Bello34,Reference Beck, Henize, Kahn, Reiber, Young and Klein35–Reference Xie, Price, Curran and Østbye37,Reference Hager, De Kesel Lofthus, Balan and Cutts47,Reference Jones, VanWassenhove-Paetzold and Thomas49,Reference Knowles, Khan and Palakshappa50,Reference Mirsky, Zack, Berkowitz and Fiechtner53,Reference Schlosser, Joshi, Smith, Thornton, Bolen and Trapl58–Reference Joshi, Smith, Bolen, Osborne, Benko and Trapl60,Reference Wynn, Staffileno, Grenier and Phillips63,Reference Walker, DePuccio and Hefner66,Reference Stenmark, Steiner, Marpadga, DeBor, Underhill and Seligman69)} screened for food insecurity using the Hunger Vital Sign.,^{(Reference Hager, Quigg and Black71–Reference Cutts and Cook73)} two programmes^{(Reference Cohen, Richardson and Heisler41,Reference Cohen, Oatmen and Heisler42,Reference Kulie, Steinmetz, Johnson and McCarthy51)} used unique screeners, and one used a ‘standardised assessment form’.^{(Reference Morales, Epstein, Marable, Oo and Berkowitz54)} programmes that did not screen for food insecurity were either open to anyone regardless of food insecurity status,^{(Reference Adams32,Reference Dunn, Vercammen and Bleich33,Reference Milliron, Vitolins, Gamble, Jones, Chenault and Tooze52)} open to patients of clinics that serve primarily low-income populations, or used medical records to identify patients with ‘poor nutrition’.^{(Reference Esquivel, Higa, Hitchens, Shelton and Okihiro44)} One programme used the clinical expertise of an on-site nutritionist to identify eligible patients.^{(Reference Cavanagh, Jurkowski, Bozlak, Hastings and Klein40)}

Defining eligibility criteria

Sixteen^{(Reference Ferrer, Neira, De Leon Garcia, Cuellar and Rodriguez15,Reference Newman and Lee23,Reference Berkowitz, Curran, Hoeffler, Henderson, Price and Ng36–Reference Cavanagh, Jurkowski, Bozlak, Hastings and Klein40,Reference Cook, Ward and Newman43,Reference Esquivel, Higa, Hitchens, Shelton and Okihiro44,Reference Ghouse, Gunther and Sebastian45,Reference Mirsky, Zack, Berkowitz and Fiechtner53,Reference Paolantonio, Kim and Ramirez55,Reference Schlosser, Joshi, Smith, Thornton, Bolen and Trapl58,Reference Schlosser, Smith, Joshi, Thornton, Trapl and Bolen59,Reference Joshi, Smith, Bolen, Osborne, Benko and Trapl60,Reference Slagel, Newman and Sanville61,Reference Stotz, Thompson, Bhargava, Scarrow, Capitano and Lee64–Reference Weinstein, Galindo, Fried, Rucker and Davis67)} of the thirty-five programmes included a cardiometabolic diagnosis (e.g. overweight, obesity, pre-diabetes, diabetes mellitus, hypertension, or hyperlipidaemia) as part of their eligibility criteria. One programme^{(Reference Morales, Epstein, Marable, Oo and Berkowitz54)} was created explicitly for pregnant women, four^{(Reference Beck, Henize, Kahn, Reiber, Young and Klein35,Reference Esquivel, Higa, Hitchens, Shelton and Okihiro44,Reference Knowles, Khan and Palakshappa50,Reference Saxe-Custack, LaChance, Hanna-Attisha and Ceja57)} for children, and one^{(Reference Jones, VanWassenhove-Paetzold and Thomas49)} for families with either pregnant women or children under age seven. Fourteen^{(Reference Gany, Pan, Ramirez and Paolantonio12,Reference Ferrer, Neira, De Leon Garcia, Cuellar and Rodriguez15,Reference Sastre, Wynn, Roupe and Jacobs18,Reference Aiyer, Raber and Bello34,Reference Beck, Henize, Kahn, Reiber, Young and Klein35,Reference Ghouse, Gunther and Sebastian45–Reference Hager, De Kesel Lofthus, Balan and Cutts47,Reference Knowles, Khan and Palakshappa50,Reference Mirsky, Zack, Berkowitz and Fiechtner53,Reference Paolantonio, Kim and Ramirez55,Reference Schlosser, Joshi, Smith, Thornton, Bolen and Trapl58–Reference Joshi, Smith, Bolen, Osborne, Benko and Trapl60,Reference Wynn, Staffileno, Grenier and Phillips63,Reference Stenmark, Steiner, Marpadga, DeBor, Underhill and Seligman69)} programmes required patients to screen positive for food insecurity in order to be enrolled. One programme^{(Reference Newman and Lee23,Reference Cook, Ward and Newman43)} required patients to be eligible for the Supplemental Nutrition Assistance Programme (SNAP) or to screen positive for food insecurity.

Direct provision of food

Fourteen programmes^{(Reference Ferrer, Neira, De Leon Garcia, Cuellar and Rodriguez15,Reference Sastre, Wynn, Roupe and Jacobs18,Reference Adams32,Reference Dunn, Vercammen and Bleich33,Reference Beck, Henize, Kahn, Reiber, Young and Klein35,Reference Ghouse, Gunther and Sebastian45,Reference Greenthal, Jia, Poblacion and James46,Reference Izumi, Martin and Garvin48,Reference Milliron, Vitolins, Gamble, Jones, Chenault and Tooze52,Reference Mirsky, Zack, Berkowitz and Fiechtner53,Reference Paolantonio, Kim and Ramirez55,Reference Smith, Malinak and Chang62–Reference Stotz, Thompson, Bhargava, Scarrow, Capitano and Lee64,Reference Wetherill, Chancellor McIntosh, Beachy and Shadid68)} provided food directly to patients. Of these, eight^{(Reference Gany, Pan, Ramirez and Paolantonio12,Reference Ferrer, Neira, De Leon Garcia, Cuellar and Rodriguez15,Reference Sastre, Wynn, Roupe and Jacobs18,Reference Ghouse, Gunther and Sebastian45,Reference Greenthal, Jia, Poblacion and James46,Reference Izumi, Martin and Garvin48,Reference Mirsky, Zack, Berkowitz and Fiechtner53,Reference Wetherill, Chancellor McIntosh, Beachy and Shadid68)} provided both produce and non-perishable foods, three^{(Reference Adams32,Reference Dunn, Vercammen and Bleich33,Reference Milliron, Vitolins, Gamble, Jones, Chenault and Tooze52,Reference Stotz, Thompson, Bhargava, Scarrow, Capitano and Lee64)} provided only produce, one [40] provided only non-perishable foods, and one^{(Reference Beck, Henize, Kahn, Reiber, Young and Klein35)} provided baby formula. Refrigerated storage capacity was noted as a barrier to providing produce directly to patients.^{(Reference Gany, Pan, Ramirez and Paolantonio12,Reference Mirsky, Zack, Berkowitz and Fiechtner53)} programmes circumvented this issue by partnering with community-based organisations (CBOs) to provide same-day delivery and distribution of produce,^{(Reference Gany, Pan, Ramirez and Paolantonio12,Reference Adams32,Reference Dunn, Vercammen and Bleich33,Reference Izumi, Martin and Garvin48,Reference Stotz, Thompson, Bhargava, Scarrow, Capitano and Lee64)} while others obtained dedicated refrigeration space.^{(Reference Greenthal, Jia, Poblacion and James46,Reference Mirsky, Zack, Berkowitz and Fiechtner53)} One programme^{(Reference Milliron, Vitolins, Gamble, Jones, Chenault and Tooze52)} utilised an on-site community garden. Two programmes ^{(Reference Gany, Pan, Ramirez and Paolantonio12,Reference Greenthal, Jia, Poblacion and James46)} that provided food directly to patients offered a choice of food, while ten programmes^{(Reference Ferrer, Neira, De Leon Garcia, Cuellar and Rodriguez15,Reference Sastre, Wynn, Roupe and Jacobs18,Reference Adams32,Reference Dunn, Vercammen and Bleich33,Reference Ghouse, Gunther and Sebastian45,Reference Izumi, Martin and Garvin48,Reference Milliron, Vitolins, Gamble, Jones, Chenault and Tooze52,Reference Mirsky, Zack, Berkowitz and Fiechtner53,Reference Wynn, Staffileno, Grenier and Phillips63,Reference Stotz, Thompson, Bhargava, Scarrow, Capitano and Lee64,Reference Wetherill, Chancellor McIntosh, Beachy and Shadid68)} provided participants with a pre-packed bag. Three programmes ^{(Reference Gany, Pan, Ramirez and Paolantonio12,Reference Sastre, Wynn, Roupe and Jacobs18,Reference Greenthal, Jia, Poblacion and James46)} provided medically-tailored foods, that is, foods that met the nutritional requirements of the patient based on their medical status, as designated by their physician or registered dietitian. These three medically-tailored programmes operated as on-site food pantries.

Provision of vouchers

Fourteen programmes ^{(Reference Newman and Lee23,Reference Aiyer, Raber and Bello34,Reference Berkowitz, Curran, Hoeffler, Henderson, Price and Ng36,Reference Xie, Price, Curran and Østbye37,Reference Bryce, Guajardo and Ilarraza39,Reference Cavanagh, Jurkowski, Bozlak, Hastings and Klein40–Reference Esquivel, Higa, Hitchens, Shelton and Okihiro44,Reference Jones, VanWassenhove-Paetzold and Thomas49,Reference Paolantonio, Kim and Ramirez55–Reference Smith, Malinak and Chang62,Reference Veldheer, Scartozzi and Bordner65–Reference Weinstein, Galindo, Fried, Rucker and Davis67)} provided vouchers or other cash incentives that allowed participants to increase their purchasing power for food. By virtue of providing cash assistance to purchase foods, all fourteen programmes provided the participant with some form of choice in the foods they received. None of these programmes provided medically-tailored foods.

The amount of money provided to participants in voucher programmes ranged from a minimum of $6 for the entire programme in 2011 dollars^{(Reference Weinstein, Galindo, Fried, Rucker and Davis67)} to a maximum of $230 per month for six months in 2021 dollars.^{(Reference Paolantonio, Kim and Ramirez55)} Four programmes ^{(Reference Newman and Lee23,Reference Cook, Ward and Newman43,Reference Jones, VanWassenhove-Paetzold and Thomas49,Reference Slagel, Newman and Sanville61)} provided $1 (between 2015 and 2018) per household member per day.

Ten programmes^{(Reference Newman and Lee23,Reference Bryce, Guajardo and Ilarraza39,Reference Cavanagh, Jurkowski, Bozlak, Hastings and Klein40–Reference Esquivel, Higa, Hitchens, Shelton and Okihiro44,Reference Saxe-Custack, Lofton and Hanna-Attisha56–Reference Slagel, Newman and Sanville61,Reference Veldheer, Scartozzi and Bordner65,Reference Weinstein, Galindo, Fried, Rucker and Davis67)} allowed the vouchers to be utilised only for fresh fruits and vegetables, and three programmes^{(Reference Aiyer, Raber and Bello34,Reference Berkowitz, Curran, Hoeffler, Henderson, Price and Ng36,Reference Xie, Price, Curran and Østbye37,Reference Jones, VanWassenhove-Paetzold and Thomas49)} allowed voucher use for both fresh and non-perishable healthful (e.g. fruits, vegetables, or whole grains, etc.) foods. One programme allowed participants to use the voucher for any food purchases, though they were reminded to choose healthful foods.^{(Reference Paolantonio, Kim and Ramirez55)} Ten programmes^{(Reference Newman and Lee23,Reference Bryce, Guajardo and Ilarraza39,Reference Cohen, Richardson and Heisler41–Reference Esquivel, Higa, Hitchens, Shelton and Okihiro44,Reference Jones, VanWassenhove-Paetzold and Thomas49,Reference Saxe-Custack, Lofton and Hanna-Attisha56,Reference Saxe-Custack, LaChance, Hanna-Attisha and Ceja57–Reference Slagel, Newman and Sanville61,Reference Veldheer, Scartozzi and Bordner65,Reference Weinstein, Galindo, Fried, Rucker and Davis67)} partnered with farmer's markets to accept the vouchers, two^{(Reference Bryce, Guajardo and Ilarraza39,Reference Esquivel, Higa, Hitchens, Shelton and Okihiro44)} of which were markets located on-site at the healthcare center where the programme was implemented. One programme^{(Reference Aiyer, Raber and Bello34)} provided vouchers for a food pantry, and one programme^{(Reference Cavanagh, Jurkowski, Bozlak, Hastings and Klein40)} provided a voucher to be used at a mobile produce truck that parked at the health center where the intervention was implemented once weekly. Three programmes^{(Reference Berkowitz, Curran, Hoeffler, Henderson, Price and Ng36,Reference Xie, Price, Curran and Østbye37,Reference Jones, VanWassenhove-Paetzold and Thomas49,Reference Paolantonio, Kim and Ramirez55)} allowed participants to utilize the programme at participating partner supermarkets, and one^{(Reference Jones, VanWassenhove-Paetzold and Thomas49)} at convenience stores. Three^{(Reference Bryce, Guajardo and Ilarraza39,Reference Jones, VanWassenhove-Paetzold and Thomas49,Reference Paolantonio, Kim and Ramirez55)} used debit cards and one programme^{(Reference Berkowitz, Curran, Hoeffler, Henderson, Price and Ng36,Reference Xie, Price, Curran and Østbye37)} loaded additional funds onto EBT cards. Others used printed vouchers or tokens.

Nine programmes^{(Reference Newman and Lee23,Reference Aiyer, Raber and Bello34,Reference Bryce, Guajardo and Ilarraza39,Reference Cook, Ward and Newman43,Reference Esquivel, Higa, Hitchens, Shelton and Okihiro44,Reference Jones, VanWassenhove-Paetzold and Thomas49,Reference Saxe-Custack, Lofton and Hanna-Attisha56–Reference Schlosser, Joshi, Smith, Thornton, Bolen and Trapl58,Reference Joshi, Smith, Bolen, Osborne, Benko and Trapl60,Reference Slagel, Newman and Sanville61,Reference Veldheer, Scartozzi and Bordner65)} were fruit and vegetable prescription (FVRx) programmes, in which clinicians wrote ‘prescriptions’ that patients could take to farmer's markets to purchase a certain number of fruits and vegetables.

Provision of referrals

Thirteen programmes^{(Reference Gany, Pan, Ramirez and Paolantonio12,Reference Sastre, Wynn, Roupe and Jacobs18,Reference Beck, Henize, Kahn, Reiber, Young and Klein35,Reference Blitstein, Lazar and Gregory38,Reference Ghouse, Gunther and Sebastian45,Reference Knowles, Khan and Palakshappa50,Reference Kulie, Steinmetz, Johnson and McCarthy51,Reference Morales, Epstein, Marable, Oo and Berkowitz54,Reference Smith, Malinak and Chang62,Reference Wynn, Staffileno, Grenier and Phillips63,Reference Walker, DePuccio and Hefner66,Reference Stenmark, Steiner, Marpadga, DeBor, Underhill and Seligman69,Reference Hager, Quigg and Black71)} provided referrals to local or national food programmes, such as local food pantries, SNAP, or the Special Supplemental Nutrition programme for Women, Infants, and Children, commonly referred to as WIC. Of these, twelve^{(Reference Sastre, Wynn, Roupe and Jacobs18,Reference Beck, Henize, Kahn, Reiber, Young and Klein35,Reference Blitstein, Lazar and Gregory38,Reference Ghouse, Gunther and Sebastian45,Reference Knowles, Khan and Palakshappa50,Reference Kulie, Steinmetz, Johnson and McCarthy51,Reference Morales, Epstein, Marable, Oo and Berkowitz54,Reference Smith, Malinak and Chang62,Reference Wynn, Staffileno, Grenier and Phillips63,Reference Walker, DePuccio and Hefner66,Reference Stenmark, Steiner, Marpadga, DeBor, Underhill and Seligman69,Reference Hager, Quigg and Black71)} of these programmes referred to local CBOs, such as food pantries, and eight^{(Reference Gany, Pan, Ramirez and Paolantonio12,Reference Beck, Henize, Kahn, Reiber, Young and Klein35,Reference Blitstein, Lazar and Gregory38,Reference Knowles, Khan and Palakshappa50,Reference Morales, Epstein, Marable, Oo and Berkowitz54,Reference Smith, Malinak and Chang62,Reference Stenmark, Steiner, Marpadga, DeBor, Underhill and Seligman69,Reference Hager, Quigg and Black71)} assisted with enrollment in SNAP and WIC. Seven programmes^{(Reference Gany, Pan, Ramirez and Paolantonio12,Reference Beck, Henize, Kahn, Reiber, Young and Klein35,Reference Blitstein, Lazar and Gregory38,Reference Knowles, Khan and Palakshappa50,Reference Morales, Epstein, Marable, Oo and Berkowitz54,Reference Smith, Malinak and Chang62,Reference Stenmark, Steiner, Marpadga, DeBor, Underhill and Seligman69,Reference Hager, Quigg and Black71)} provided both. Six programmes^{(Reference Sastre, Wynn, Roupe and Jacobs18,Reference Blitstein, Lazar and Gregory38,Reference Kulie, Steinmetz, Johnson and McCarthy51,Reference Morales, Epstein, Marable, Oo and Berkowitz54,Reference Smith, Malinak and Chang62,Reference Walker, DePuccio and Hefner66)} utilised on-site benefits specialists to assist with referrals, while five^{(Reference Beck, Henize, Kahn, Reiber, Young and Klein35,Reference Knowles, Khan and Palakshappa50,Reference Wynn, Staffileno, Grenier and Phillips63,Reference Stenmark, Steiner, Marpadga, DeBor, Underhill and Seligman69,Reference Hager, Quigg and Black71)} used electronic referrals to alternative CBOs (e.g. food bank,^{(Reference Walker, DePuccio and Hefner66)} NowPow,^{(Reference Wynn, Staffileno, Grenier and Phillips63)} Benefits Data Trust,^{(Reference Knowles, Khan and Palakshappa50)} medical–legal partnership,^{(Reference Beck, Henize, Kahn, Reiber, Young and Klein35)} or Hunger Free Colorado^{(Reference Stenmark, Steiner, Marpadga, DeBor, Underhill and Seligman69)}), who then followed up with the patient.

Offering patient education

Nineteen programmes ^{(Reference Ferrer, Neira, De Leon Garcia, Cuellar and Rodriguez15,Reference Sastre, Wynn, Roupe and Jacobs18,Reference Newman and Lee23,Reference Aiyer, Raber and Bello34,Reference Beck, Henize, Kahn, Reiber, Young and Klein35,Reference Blitstein, Lazar and Gregory38,Reference Bryce, Guajardo and Ilarraza39,Reference Cook, Ward and Newman43,Reference Ghouse, Gunther and Sebastian45,Reference Greenthal, Jia, Poblacion and James46,Reference Izumi, Martin and Garvin48,Reference Jones, VanWassenhove-Paetzold and Thomas49,Reference Milliron, Vitolins, Gamble, Jones, Chenault and Tooze52,Reference Mirsky, Zack, Berkowitz and Fiechtner53,Reference Schlosser, Joshi, Smith, Thornton, Bolen and Trapl58–Reference Slagel, Newman and Sanville61,Reference Stotz, Thompson, Bhargava, Scarrow, Capitano and Lee64,Reference Veldheer, Scartozzi and Bordner65,Reference Weinstein, Galindo, Fried, Rucker and Davis67,Reference Wetherill, Chancellor McIntosh, Beachy and Shadid68)} provided education to patients, which included nationally-available courses such as Cooking Matters^{(Reference Ghouse, Gunther and Sebastian45,74)} and ‘Eat Right When Money's Tight’,^{(Reference Blitstein, Lazar and Gregory38)} as well as education produced by the intervention healthcare institution. Of the 19, sixteen programmes ^{(Reference Ferrer, Neira, De Leon Garcia, Cuellar and Rodriguez15,Reference Sastre, Wynn, Roupe and Jacobs18,Reference Newman and Lee23,Reference Aiyer, Raber and Bello34,Reference Beck, Henize, Kahn, Reiber, Young and Klein35,Reference Blitstein, Lazar and Gregory38,Reference Cook, Ward and Newman43,Reference Ghouse, Gunther and Sebastian45,Reference Jones, VanWassenhove-Paetzold and Thomas49,Reference Milliron, Vitolins, Gamble, Jones, Chenault and Tooze52,Reference Mirsky, Zack, Berkowitz and Fiechtner53,Reference Schlosser, Joshi, Smith, Thornton, Bolen and Trapl58–Reference Slagel, Newman and Sanville61,Reference Stotz, Thompson, Bhargava, Scarrow, Capitano and Lee64,Reference Veldheer, Scartozzi and Bordner65,Reference Weinstein, Galindo, Fried, Rucker and Davis67,Reference Wetherill, Chancellor McIntosh, Beachy and Shadid68)} provided nutrition education, while eight^{(Reference Newman and Lee23,Reference Bryce, Guajardo and Ilarraza39,Reference Cook, Ward and Newman43,Reference Ghouse, Gunther and Sebastian45,Reference Greenthal, Jia, Poblacion and James46,Reference Izumi, Martin and Garvin48,Reference Jones, VanWassenhove-Paetzold and Thomas49,Reference Slagel, Newman and Sanville61,Reference Stotz, Thompson, Bhargava, Scarrow, Capitano and Lee64)} provided cooking demonstrations or education. Five programmes^{(Reference Newman and Lee23,Reference Cook, Ward and Newman43,Reference Ghouse, Gunther and Sebastian45,Reference Jones, VanWassenhove-Paetzold and Thomas49,Reference Slagel, Newman and Sanville61,Reference Stotz, Thompson, Bhargava, Scarrow, Capitano and Lee64)} provided both. Seven of the nineteen programmes^{(Reference Ferrer, Neira, De Leon Garcia, Cuellar and Rodriguez15,Reference Newman and Lee23,Reference Beck, Henize, Kahn, Reiber, Young and Klein35,Reference Blitstein, Lazar and Gregory38,Reference Cook, Ward and Newman43,Reference Schlosser, Joshi, Smith, Thornton, Bolen and Trapl58,Reference Schlosser, Smith, Joshi, Thornton, Trapl and Bolen59,Reference Joshi, Smith, Bolen, Osborne, Benko and Trapl60,Reference Stotz, Thompson, Bhargava, Scarrow, Capitano and Lee64,Reference Wetherill, Chancellor McIntosh, Beachy and Shadid68)} provided education on cooking on a budget or food resource management. Six programmes^{(Reference Aiyer, Raber and Bello34,Reference Beck, Henize, Kahn, Reiber, Young and Klein35,Reference Blitstein, Lazar and Gregory38,Reference Schlosser, Joshi, Smith, Thornton, Bolen and Trapl58,Reference Schlosser, Smith, Joshi, Thornton, Trapl and Bolen59,Reference Stotz, Thompson, Bhargava, Scarrow, Capitano and Lee64,Reference Wetherill, Chancellor McIntosh, Beachy and Shadid68)} used passive nutrition education, such as with printed materials or online videos, while nine^{(Reference Ferrer, Neira, De Leon Garcia, Cuellar and Rodriguez15,Reference Newman and Lee23,Reference Bryce, Guajardo and Ilarraza39,Reference Cook, Ward and Newman43,Reference Ghouse, Gunther and Sebastian45,Reference Greenthal, Jia, Poblacion and James46,Reference Milliron, Vitolins, Gamble, Jones, Chenault and Tooze52,Reference Mirsky, Zack, Berkowitz and Fiechtner53,Reference Slagel, Newman and Sanville61,Reference Veldheer, Scartozzi and Bordner65)} provided in-person education or cooking demonstrations. Two programmes^{(Reference Izumi, Martin and Garvin48,Reference Jones, VanWassenhove-Paetzold and Thomas49)} provided both printed materials and in-person cooking demonstrations. Four programmes^{(Reference Bryce, Guajardo and Ilarraza39,Reference Izumi, Martin and Garvin48,Reference Milliron, Vitolins, Gamble, Jones, Chenault and Tooze52,Reference Mirsky, Zack, Berkowitz and Fiechtner53)} provided education informally, such as during other healthcare visits,^{(Reference Milliron, Vitolins, Gamble, Jones, Chenault and Tooze52)} in passing and without billing,^{(Reference Mirsky, Zack, Berkowitz and Fiechtner53)} or during a farmer's market.^{(Reference Bryce, Guajardo and Ilarraza39,Reference Izumi, Martin and Garvin48)}

Programmes that provide food directly

programmes that provide food directly to patients provide both produce and non-perishable foods and tend not to offer patients a choice of food, instead, providing a standardised pre-packed bag or box. These programmes frequently include nutrition education, and sometimes cooking demonstrations, and tend to be permanent and on-site. Examples include food pantries, community gardens, and on-site food delivery and distribution in partnership with a local food bank. Often, institutions and programmes partner with CBOs for obtaining the food to be provided.

Patients can be referred to these programmes by their healthcare providers (e.g. physicians or dietitians) and utilize the programme at any time at any time in their care, as they are static programmes. These programmes vary in size: some provide assistance to a limited number of patients, while others provide food to any patient who would benefit. Often these programmes are only developed for and provided to patients with certain diagnoses, most often nutrition-related cardiometabolic diagnoses, such as diabetes, obesity, and cardiovascular disease. However, it is not uncommon that these programmes also provide foods for all patients with food insecurity, regardless of cardiometabolic diagnosis.

Programmes that refer patients to resources that provide food assistance

Programmes that refer to resources that provide food assistance are typically available for all patients that screen positive for food insecurity, either on the Hunger Vital Sign^{(Reference Hager, Quigg and Black71,Reference Gundersen, Engelhard, Crumbaugh and Seligman72,Reference Cutts and Cook73)} or another screening tool.⁽⁷⁵⁾ These programmes can be time-limited or permanent at the healthcare institution, but each participant's interaction with the programme happens only once, when they are referred to resources.

Referrals can be to local CBOs such as food pantries, regional resources such as a Feeding America site, or enrollment assistance with federal food assistance programmes such as SNAP and WIC. Enrollment assistance happens both on-site or via referral to a CBO to assist.

Referral programmes are more limited in scope than other food assistance programmes. Because the programme consists of a referral to an outside entity, the healthcare institution has no control over the type of food provided; patients instead receive food assistance from the CBO or federal programme. Nutrition education is rarely provided by the healthcare institution in tandem with the referral programme. Reach for these programmes is significant; many patients are able to be referred. The referral programmes we identified used research staff to complete the patient identification and referral process. Use of temporary research staff, rather than permanent healthcare staff, highlights the uncertainty of programme funding and sustainability.

Programmes that provide vouchers to purchase food

Programmes that provide vouchers to purchase food are time-bound, providing patients with vouchers for an average of three to six months. They are typically available for patients with both food insecurity and a health status associated with nutritional risk (e.g. pregnancy obesity, underweight) or cardiometabolic disease. Produce prescription programmes, which are a type of voucher program, are frequently funded by the USDA National Institute of Food and Agriculture Gus Schumacher Nutrition Incentive programme (GusNIP), which requires that they reach low-income populations with diet-related health conditions.⁽²⁹⁾

Voucher programmes prioritize the procurement of fruits and vegetables over non-perishable foods and provide a choice of foods within this limitation (i.e. patients can choose which fruits or vegetables they would like to purchase with their voucher). Nutrition education and cooking demonstrations are frequently paired with these programmes. Partnerships with food purveyors, such as farmers, farmer's markets, supermarkets, and convenience stores, are necessary for providing a venue in which the vouchers are accepted.^{(29,Reference Caceres76)} These programmes are often limited in reach, helping fewer patients than other types of programmes, likely due to the cost of providing financial assistance. These programmes often require a physician to refer the patient to the program; they are rarely open to all patients; only those with a prescription can participate.