Date of Conferral

8-13-2026

Date of Award

August 2026

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Tracy Andrews

Abstract

Rural America, including Arkansans, face a number of social determinants of health (SDOH) including food insecurities (FIs) and the inability to access nutritious food. FIs contribute to poor outcomes and increases healthcare utilization. Inconsistent screenings for FIs in adults living in the rural health clinic (RHC) setting, lack of standardized workflows, and failure to provide community resources when FI is identified represents a significant gap in practice. Purpose: The purpose of this Doctor of Nursing Practice (DNP) staff education project was to increase utilization of screening tools for FI, implement a standardized workflow, and provide patients with resources to improve health outcomes among adults in the RHC. Project Question: Among the adult population in the RHC, what are best practice strategies for FI risk assessment screening and utilization to improve outcomes? Methods: A systematic search of databases such as Google Scholar, PubMed, CINAHL and MEDLINE published between 2021 and 2026 was conducted, with current evidence gathered to support the need to screen patients for FI and offer community resources to improve outcomes. An educational in-service was conducted at select RHC’s in Arkansas. The intervention included training on the importance of FI screenings, integration of a strategic workflow process, and distribution of a newly developed community resource page. Pre- and post-implementation data were extracted from the electronic health record (EHR) using the Slicer Dicer Report for utilization review over a four-week period. Organizational readiness, stakeholder analysis, and evidence-based practice tools guided the project development. Results: Post-implementation screening rates increased to 23.72% (95% confidence interval ±0.949%, z-score 1.96, standard error 0.484), demonstrating improved utilization of FI screenings after staff educational in-service. Conclusions and Implications: This quality improvement (QI) project successfully enhanced FI screening practices and has potential based on other current EBR to promote positive patient outcomes related to FI, cost savings for both the organization and patients, and reduce healthcare utilization. Limitations include the short project duration, delayed integration of the resource page into the EHR, boundaries of the community resources, and evaluation of the impact on chronic disease. Recommendations include workflow optimization, longitudinal outcome tracking, and expansion across RHCs in Arkansas. Further recommendations include referrals and processes moving forward for a Food RX program. Further research is needed on the outcomes related to chronic conditions as evidence by improved lipid panels and hemoglobin A1C levels. The project advances health equity by systematically identifying at-risk patients regardless of background and connecting patients to resources within the community, thereby supporting diversity, equity, and inclusion.

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