Development of User-Centered Design for Screening, Referral, and Enrollment of Medicaid Adults with Hypertension in a Health Care by FoodTM Pilot Study

Top Things to Know

Screening and referral workflows should be designed with the patient experience in mind, as stigma, embarrassment, and uncertainty about program offerings can reduce participation even among individuals experiencing food insecurity.

Trusting relationships with health care providers appear to be an important facilitator of Food Is Medicine enrollment, suggesting that provider communication and patient engagement strategies may influence program reach.

Clear information about food benefits, simplified enrollment procedures, multiple screening modalities, and reduced administrative burden may help improve uptake of Food Is Medicine programs.

Summary of Conclusion/Findings

This study evaluated a user-centered design (UCD) approach to screening, referral, and enrollment for a Health Care by Food™ pilot serving Medicaid-insured adults with hypertension in Kentucky. Across two health systems, 9,587 patients were screened for food insecurity, 673 screened positive and met at least some eligibility criteria, 230 expressed interest in referral, and 159 ultimately enrolled in the Food Is Medicine program, representing a 73% enrollment rate among eligible and interested patients. The mixed-methods evaluation found that health care providers viewed screening and referral processes as easy to implement, while enrolled participants generally reported that enrollment was straightforward and acceptable. However, participants who declined referral or enrollment frequently cited embarrassment, stigma, discomfort sharing personal information, uncertainty about the foods offered, and concerns about taking resources away from others as barriers to participation. Qualitative findings highlighted the importance of trust between patients and health care providers, clear communication about program benefits, minimal paperwork burden, and multiple screening modalities (face-to-face and automated) to support engagement. The authors concluded that incorporating user-centered design principles into Food Is Medicine screening and enrollment workflows may improve program acceptability and participation while identifying practical opportunities to reduce stigma and increase uptake.