Household food insecurity has significant negative implications across the lifespan. While routine screening is recommended, particularly in healthcare, guidelines are lacking on selection of screening tools and best-practice implementation across different contexts in non-stigmatizing ways. The objective of this scoping review was to synthesize evidence on household food insecurity screening tools, including psychometrics, implementation in a range of settings, and experiences of carrying out screening or being screened. Four electronic databases were searched for studies in English published from 1990 until June 2023. A total of 58 papers were included, 21 of which focused on tool development and validation, and 37 papers described implementation and perceptions of screening. Most papers were from the USA and described screening in healthcare settings. There was a lack of evidence regarding screening in settings utilized by Indigenous people. The two-item Hunger Vital Sign emerged as the most used and most valid tool across settings. While there is minimal discomfort associated with screening, screening rates in practice are still low. Barriers and facilitators of screening were identified at the setting, system, provider, and recipient level and were mapped onto the COM-B model of behavior change. This review identifies practical strategies to optimize screening and disclosure.

Arohanui Hospice is a 12-bed specialist palliative care service based in Palmerston North, New Zealand. It serves a population of 180 000 people spread over a wide geographical area, both urban and rural. The Liverpool Care Pathway (LCP) was initially implemented at the hospice inpatient unit in January 2005. Following this, the ‘LCP Pilot Project’ was developed. This project involved the implementation of the LCP within three aged residential care facilities and two wards within the regional hospital. Included in the project was a research component to enable evaluation of the effectiveness of the LCP in each setting. This article will consider and demonstrate the use of process mapping (Buckman, 2003) as a quality improvement tool to enhance the effective implementation and sustained use of the LCP for the dying patient within aged residential care. Measures are considered that support the implementation of the LCP at an organisational level rather than at a purely clinical level. While this work has been completed within the New Zealand context, it is believed that the principles are transferable to similar settings internationally.

Food insecurity is a significant social and health issue for children in high-income countries and contributes to sub-optimal child outcomes. This scoping review examines how food insecurity intersects with the moral experiences of those involved in providing and receiving paediatric health care. Multiple databases were searched using a priori inclusion criteria, papers were screened by multiple reviewers. Searches yielded nine papers. Descriptive data was summarised and qualitative results extracted from included papers were analysed using inductive and deductive thematic analysis. Four main themes emerged: Food insecurity threatens caregiver and healthcare provider identity; is food insecurity the business of health? is screening for food insecurity surveillance or facilitating assistance? and the lived experience of navigating the tension of managing food insecurity and a child’s health condition. The moral experiences lens has magnified the countless everyday encounters in which values and beliefs about what is ‘right’ or ‘just’ can be realised or thwarted in the context of the intersection between healthcare and food insecurity. Review findings have implications relating to the inclusion of children’s voices in healthcare settings, healthcare practice and policy design, and the development and use of FI screening tools.

Experiences of household food insecurity are associated with a wide range of deleterious nutritional, developmental, psychological and social consequences for children. Children's distinct experiences of food insecurity, compared to adults, have been identified in diverse economic and cultural contexts. Yet historically, measurement of food insecurity in children has been predominantly reported by adult respondents on behalf of children, potentially underestimating prevalence and neglecting their unique perspectives. In response to this, child-report measures have been developed to assess food security status at both the individual and household level. To identify and characterise child self-report food insecurity assessment tools used globally, with particular interest in how children's perspectives have been included in measure development processes. A scoping systematic literature review was conducted using PRISMA-ScR. Searches were conducted in four databases in January 2024 using keywords and MeSH terms. Data were extracted and synthesised relating to population and measure characteristics, validity and reliability metrics, and child involvement in measure development. A total of 169 papers employing child-report measures were included after screening. Most papers originated in North America, used a single-item and included children aged >12 years. Of the child-report measures identified (n = 33), most were not specifically validated in the population of use. Only a small number of included papers (n = 13) had the aim to specifically evaluate measure validity. The Child Food Insecurity Experiences Scale and Child Food Assessment Scale emerged as child-centred measures with comprehensive validity evidence. Further child-centred validity testing, particularly with younger children (<12 years) is necessary to ensure validity of measures across age-groups and contexts. Ethical considerations when employing child-report measures, including how to best use tools across different child settings also warrant further exploration.

Background/Objectives: Household food insecurity (FI) impacts child health and development. Children have distinct and unique experiences of FI, and child self-report measures are increasingly used. However, there is limited reporting of children’s comprehension and engagement with these measures within local settings. The Child Food Insecurity Experiences Scale (CFIES) is a 10-item child self-report tool that is widely used, despite limited validity evidence. This study aimed to explore the face and content validity of the CFIES in an Australian context. Methods: We used cognitive interviews with 25 children aged 8–12 years to document CFIES comprehension. Data were analyzed using inductive and deductive approaches. Results: Children demonstrated awareness of FI (even when food secure themselves) and displayed sophisticated understanding of its social ramifications. While the overall perception of the tool was generally positive, we uncovered that not all key terms or emotion words were universally understood, potentially impacting validity. Similarly, conditional clauses or question modifiers were sometimes overlooked. In addition, the 12-month response timeframe and the answering categories (“many times”, “one or two times” or “never”) proved challenging for some children. In addition to the item-specific impressions, children provided nuanced ideation across four broader themes, which may impact item interpretation and willingness to answer: perceptions of hunger; micro and macroeconomics affecting households; social identity and comparison; and caregiver protection dynamics. Children indicated the need to consider survey modality and ensure privacy. Conclusions: A global tool that reflects children’s cross-cultural conceptualization of FI represents a pragmatic and feasible way to monitor change in FI across regions and may aid advocacy efforts. However, this study suggests the need for further modifications to the CFIES and the necessity to build rapport with communities and organizations that allow for the interpretation of the data within the contextual considerations.