The proposed project promotes public health goals because it advances understanding of the impact of food insecurity on the health care of the increasing numbers of diverse older adult patients with multiple chronic conditions in geriatric primary care. Photovoice holds promise to be a communication and assessment tool that elicits critical components of a geriatric assessment from the patients' perspective. Exploring the feasibility, acceptability and potential impact of Photovoice in the geriatric primary care setting through the lens of food insecurity is an important first step in assessing the utility of incorporating Photovoice in an ambulatory clinical encounter.
Food insecurity, defined as uncertain or limited access to nutritionally adequate and safe foods, has important implications in the geriatric primary care of growing numbers of older adult patients with multiple chronic conditions (MCC). An estimated 60-75% of older adults have MCC, many of which are nutrition sensitive conditions (e.g. diabetes, hypertension), and about one out of 11 older adults are food insecure. Food insecurity leads to malnutrition and unhealthy weight through reduced food intake, missed meals and alterations of food eaten including more energy-dense foods which are often high in added sugar and fat. Food insecurity also contributes to the development or exacerbation of chronic diseases such as diabetes and hypertension. Yet, the potential impact of food insecurity in older adult patients with MCC has been under- recognized in primary care. Limited English proficiency (LEP) and social stigma and cultural sensitivity attached to food insecurity and enrollment in the Supplemental Nutrition Assistance Program (SNAP) to alleviate food insecurity may contribute as barriers to communicate about food insecurity in the primary care setting. A geriatric approach to the clinical assessment and communication of food insecurity among older adult patients with MCC may be enhanced by incorporating Photovoice in the primary care setting to overcome communication barriers. Photovoice is a qualitative methodology which involves a) photo taking by participants to show their experiences relevant to the health issue and b) dialogue, reflection and action of the issue through sharing of photos. Photovoice has been used for participants to identify, represent and share experiences that may be otherwise difficult or sensitive to communicate by those from vulnerable or LEP populations. The aims of this proposal are to 1) describe the prevalence and associated clinical characteristics of food insecurity in a sample of diverse older adult patients with MCC using the electronic health record in a primary care practice with a diverse geriatric patient population; 2) assess the utilit of Photovoice for eliciting patient attitudes and behaviors regarding their food insecurity and 3) assess the feasibility, acceptability and potential impact of incorporating Photovoice as a communication and assessment tool for food insecurity in the geriatric primary care setting. The proposed study will help advance understanding of the impact of food insecurity as a determinant of health among diverse older adult patients with MCC who are vulnerable to adverse health outcomes. Pilot data from this study will also provide a foundation for the development of a geriatric primary care based intervention incorporating Photovoice to address diet-related chronic diseases to be proposed in future applications. Photovoice could have important applications in facilitating patient-provider communication around sensitive topics such as food insecurity and may be a useful patient-centered approach for providers to more fully assess the environmental and socio-cultural contexts that affect the health of vulnerable geriatric patients.