The purpose of this study was to better understand the relationship between elements of patient-centered care and patient/provider comfort with conversing about food insecurity and related social determinants of health. A mixed methods study was conducted. Patients and healthcare providers were surveyed on their experiences with patient-centered care and comfort discussing food insecurity and related social concerns. Telephone interviews were conducted to gain a richer understanding of the concepts under investigation. In the survey and telephone interviews, both samples were also asked about changes in communication during COVID-19 times. Quantitative findings show that patient involvement in care and cultural sensitivity are two important patient-centered variables that positively impact patient comfort being screened for food insecurity. Qualitative findings support this inference, and also denote the importance of other patient-centered care elements, such as empathy, trust, and effective communication. For healthcare providers, process-oriented variables, such as having food insecurity screenings built into the patient history assessment and sufficient training administering screenings were important factors that facilitated comfort screening patients for food insecurity and related concerns. Both populations stated several changes in communication resulting from COVID-19. For example, both samples noted an increase in communication through various channels. However, this increased communication did not necessarily reflect an increase in quality of communication. Patients described quicker and less personal interactions with healthcare providers. Providers observed increased difficulty in conveying empathy and support through nonverbal cues because of wearing masks and communicating through computer screens. The findings of this study provide important implications for healthcare practitioners and community organizations that aim to increase screenings for food insecurity in outpatient medical settings and highlight additional challenges that may be faced resulting from COVID-19.


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Graduation Date





Hou, Su-I


Doctor of Philosophy (Ph.D.)


College of Community Innovation and Education


School of Public Administration

Degree Program

Public Affairs; Health Services Management and Research







Release Date

May 2021

Length of Campus-only Access


Access Status

Doctoral Dissertation (Open Access)