Asking About Food Before Asking About A1c: Problem, Organizational Need, Feasibility, and PICOT for a DNP Project on Food Insecurity Screening in Diabetes Care
Student Name
Doctor of Nursing Practice Program, Aspen University
DNP880: DNP Project
Instructor Name
Month Day, Year
Asking About Food Before Asking About A1c: Problem, Organizational Need, Feasibility, and PICOT for a DNP Project on Food Insecurity Screening in Diabetes Care
A DNP project begins with a practice problem that matters to patients, an organization that wants it solved, and a scope one doctoral student can complete. This section of the project proposal defines the problem of unaddressed food insecurity among adults with type 2 diabetes at a composite community health center, documents the organizational need and support, assesses feasibility and scope, and states the PICOT question that will guide the evidence review.
The Practice Problem
Food insecurity, limited or uncertain access to adequate food, makes diabetes harder to manage. Patients may skip meals and then overeat, rely on inexpensive, high-carbohydrate foods, and choose between food and medications at the end of the month. Gundersen and Ziliak (2015) reviewed the evidence linking food insecurity to health and found associations with a range of poor outcomes among adults, including diabetes and other chronic conditions. In a study of 411 adults with diabetes drawn from an academic primary care clinic, two community health centers, and a specialty diabetes center, 19.1 percent reported food insecurity, and food insecurity was associated with poor diabetes control in multivariable models (Berkowitz et al., 2015).
At Maple Street Community Health Center, a composite federally qualified health center with 1,420 adults with type 2 diabetes, 41 percent had a most recent A1c above 8 percent last year. Food insecurity is not systematically assessed. A chart review of 100 randomly selected diabetes visits found food access documented in 6. Clinicians were adjusting insulin doses for patients whose real problem was an empty refrigerator in the last week of the month, and the record had no way to show it.
Organizational Need and Support
The health center's strategic plan names social determinants of health as a priority, and its Medicaid managed care contracts now reward documented screening for social needs. The medical director and the director of nursing have agreed to sponsor the project and have signed a letter of support. The center employs two community health workers who already help patients with benefits enrollment, and a regional food bank has offered to accept direct referrals and deliver monthly produce boxes to the clinic. The quality committee has agreed to review the project monthly.
Feasibility and Scope
Scope creep is a common reason DNP projects fail. This project will be limited to one change: routine screening with a validated two-question food insecurity screen at diabetes visits in the center's two largest clinics, with a same-visit referral by a community health worker for patients who screen positive. It will not attempt to change diabetes medication management, build a food pharmacy, or address other social needs, although those may be recommended afterward. Implementation will last 16 weeks, a period long enough to observe screening and referral patterns and short enough to complete within the course. The student has protected time of eight hours weekly at the site, access to the electronic record for data extraction, and a site mentor.
Stakeholders and Their Concerns
Interviews with staff before the proposal identified concerns that the project must address. Medical assistants worried that adding questions would lengthen rooming time; the screen's brevity and its placement alongside existing depression screening are intended to answer this. Clinicians worried about identifying a need they could not meet; the same-visit handoff to a community health worker and the food bank's direct referral pathway respond to that concern. Community health workers, already busy with benefits enrollment, asked for a clear process and a limit on paperwork; the referral will use a single electronic form that feeds the food bank's intake. Patients consulted through the center's patient advisory council said the questions should be asked privately and without judgment, and that any help offered should not affect other benefits. These concerns shape the implementation plan and will be revisited during each plan-do-study-act cycle.
The PICOT Question
In adults with type 2 diabetes attending primary care visits at a community health center (P), does implementing routine screening with a two-item food insecurity screen and same-visit community health worker referral to food resources (I), compared with current practice without systematic screening (C), increase the proportion of patients screened and connected to food resources (O) over 16 weeks (T)?
The primary outcomes are process outcomes, screening rate and referral completion, because a 16-week project cannot expect a measurable change in A1c. A1c will be tracked as an exploratory outcome, and visit length as a balancing measure.
Ethical Considerations Previewed
Asking about food insecurity carries ethical responsibilities. Patients must be able to decline the questions without consequence, results must be documented in ways that protect privacy, and the project must not screen without a pathway to help, since identifying a need without offering a response can cause harm and erode trust. The project will be submitted for review as a quality improvement initiative, and the university's review process will determine whether institutional review board oversight is required; the detailed application appears in a later section of the proposal.
Why This Screen
The proposed screen consists of two statements about the past year, one about worrying that the household's food would be gone before the next paycheck and one about food running out with no money to replace it, each answered as often true, sometimes true, or never true. In its validation study among low-income families, an affirmative response to either item had a sensitivity of 97 percent and a specificity of 83 percent for household food insecurity (Hager et al., 2010). The two questions take less than a minute, which makes routine use feasible in a busy clinic. The next section will review the evidence for screening and referral in adult diabetes care in more depth.
Conclusion
Food insecurity undermines diabetes control and goes largely unrecognized at Maple Street Community Health Center. The organization has named the problem as a priority, committed sponsors and partners, and agreed to a focused scope. The PICOT question centers the project on a single, measurable practice change, routine screening with same-visit referral, that one DNP student can implement and evaluate in 16 weeks.
References
Berkowitz, S. A., Meigs, J. B., DeWalt, D., Seligman, H. K., Barnard, L. S., Bright, O.-J. M., Schow, M., Atlas, S. J., & Wexler, D. J. (2015). Material need insecurities, control of diabetes mellitus, and use of health care resources: Results of the Measuring Economic Insecurity in Diabetes study. JAMA Internal Medicine, 175(2), 257-265. https://doi.org/10.1001/jamainternmed.2014.6888
Gundersen, C., & Ziliak, J. P. (2015). Food insecurity and health outcomes. Health Affairs, 34(11), 1830-1839. https://doi.org/10.1377/hlthaff.2015.0645
Hager, E. R., Quigg, A. M., Black, M. M., Coleman, S. M., Heeren, T., Rose-Jacobs, R., Cook, J. T., de Cuba, S. A. E., Casey, P. H., Chilton, M., Cutts, D. B., Meyers, A. F., & Frank, D. A. (2010). Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics, 126(1), e26-e32. https://doi.org/10.1542/peds.2009-3146
How this DNP 880 Module 1 example is structured
DNP880 is the DNP project course, graded on a proposal (problem, PICOT, evidence and framework), an implementation plan, IRB documents, data collection and evaluation plans and the final paper and dissemination. Aspen does not publish module deliverables, so check your classroom for the exact prompt. This example delivers the problem, organizational need, feasibility, scope and PICOT section.
DNP880 Module 1 questions, answered
What does DNP880 Module 1 usually ask for?
Early work in the DNP project course typically asks for the project's problem statement, evidence of organizational need and support, feasibility and scope, and the PICOT question. Aspen does not publish module deliverables, so your classroom's instructions govern.
How do I keep a DNP project from growing too large?
Limit it to one practice change in a defined setting and period, name what the project will not do, and choose outcomes that can realistically change within the implementation time.
What is a two-item food insecurity screen?
Two questions about whether a household worried food would run out and whether food bought did not last, in the past 12 months. In its validation study, a yes to either had 97 percent sensitivity and 83 percent specificity for food insecurity.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.