Strong, Moderate, Promising: An Appraised Synthesis and Framework for Food Insecurity Screening and Referral in Diabetes Care
Student Name
Doctor of Nursing Practice Program, Aspen University
DNP880: DNP Project
Instructor Name
Month Day, Year
Strong, Moderate, Promising: An Appraised Synthesis and Framework for Food Insecurity Screening and Referral in Diabetes Care
An evidence synthesis for a DNP project must do more than list studies: it must say how strong the evidence is for each part of the proposed change and where it is thin. This section synthesizes the evidence for three links in the project's logic, that a brief screen can identify food insecurity, that screening with navigation connects patients to resources, and that addressing food insecurity can improve health outcomes in diabetes, and then explains the choice of the Iowa Model as the project's framework.
Link 1: A Brief Screen Can Identify Food Insecurity
The strongest evidence supports the screening instrument itself. In a validation study among more than 30,000 low-income families, an affirmative answer to either of two food insecurity items had a sensitivity of 97 percent and specificity of 83 percent against the full household food security survey, and a positive screen was associated with poorer reported child health and developmental risk (Hager et al., 2010). The study was large and rigorous, but it was conducted among families with young children, not adults with diabetes. The screen's use in adult primary care is widespread, but its accuracy in this population is inferred rather than directly tested, a limitation the project will acknowledge. Overall, the evidence for Link 1 is strong for validity and moderate for applicability.
Link 2: Screening With Navigation Connects Patients to Help
Screening alone does not feed anyone; it must lead to action. In a randomized trial in pediatric primary and urgent care clinics serving low-income families, caregivers who received social needs screening with in-person navigation reported a greater decrease in social needs at four months and greater improvement in their children's health than those in the active control condition (Gottlieb et al., 2016). This is high-level evidence that screening combined with navigation, not screening alone, can reduce reported needs. Its limitations for this project are that it studied children's households, addressed many needs rather than food alone, and relied on caregiver report. The evidence for Link 2 is moderate: supportive and from a trial, but from a different population and outcome.
Link 3: Addressing Food Insecurity Can Improve Health
Evidence that food resources improve outcomes in adults with diabetes is promising but weaker. In a pilot food bank intervention providing diabetes-appropriate food, education, and referral to primary care in three states, participants with elevated A1c at baseline improved from 9.52 to 9.04 percent, though the study had no control group (Seligman et al., 2015). In a study of dually eligible Medicare and Medicaid beneficiaries, participants in a medically tailored meal program had fewer emergency visits, fewer inpatient admissions, and lower medical spending than matched nonparticipants, and participants in a nontailored food program had fewer emergency visits and lower spending (Berkowitz et al., 2018). Both studies suggest benefit, but neither was randomized, and participants may differ from nonparticipants in ways the analyses could not capture. The evidence is strongest that food insecurity can be found and weakest that finding it, by itself, changes A1c. That pattern supports the project's choice of process outcomes as primary.
What the Search Did Not Find
An honest synthesis also reports absences. The search found no randomized trial of food insecurity screening with navigation specifically among adults with diabetes in primary care, no study reporting how long screening rates are sustained after an implementation project ends, and little evidence on how patients experience being asked about food in a clinical setting. It also found few studies from rural or suburban community health centers like Maple Street, since most were conducted in large urban systems. These gaps have two consequences. First, the project cannot promise clinical outcomes, and its proposal should not imply that it will. Second, the project can contribute modestly to the literature by reporting its screening, referral, and follow-up results, along with patients' comments on the experience, in a setting that is underrepresented in the evidence.
Synthesis and Implications for the Project
Across the three links, the evidence is strong for the screening instrument, moderate for screening with navigation, and promising but limited for health outcomes. The project's design follows that gradient. It uses a validated screen, pairs screening with same-visit navigation by community health workers rather than handing patients a list, and makes screening and referral completion its primary outcomes, with A1c tracked as exploratory. The synthesis also points to a design feature: because referral completion depends on what happens after the visit, the project will include a follow-up call by the community health worker within two weeks to confirm that patients reached the food bank.
The Framework: The Iowa Model
The project's framework is the Iowa Model in its 2017 revised form. The model's developers surveyed users and revised the model in response, and users identified topic priority, critique, pilot, and instituting change as the most problematic steps (Iowa Model Collaborative, 2017). The revised model moves from a triggering issue, through confirming the topic is an organizational priority, forming a team, assembling and appraising evidence, and deciding whether the evidence is sufficient, to designing and piloting the practice change, deciding whether it is appropriate for adoption, integrating and sustaining it, and disseminating results.
The model fits the project for three reasons. It begins with an organizational trigger and priority check, which this project has in the health center's strategic plan and payer incentives. It explicitly includes a pilot step, which matches the project's 16-week implementation in two clinics. And it addresses sustainment and dissemination, which the project will plan for from the start. The model's pilot step will be carried out through plan-do-study-act cycles, described in the implementation plan.
Conclusion
The evidence supports a validated two-item screen, supports screening combined with navigation more than screening alone, and suggests but does not prove that addressing food insecurity improves diabetes outcomes. The project's design, with same-visit navigation, follow-up, and process outcomes as primary, reflects that evidence, and the Iowa Model provides a framework that matches its organizational trigger, pilot, and plan for sustainment.
References
Berkowitz, S. A., Terranova, J., Hill, C., Ajayi, T., Linsky, T., Tishler, L. W., & DeWalt, D. A. (2018). Meal delivery programs reduce the use of costly health care in dually eligible Medicare and Medicaid beneficiaries. Health Affairs, 37(4), 535-542. https://doi.org/10.1377/hlthaff.2017.0999
Gottlieb, L. M., Hessler, D., Long, D., Laves, E., Burns, A. R., Amaya, A., Sweeney, P., Schudel, C., & Adler, N. E. (2016). Effects of social needs screening and in-person service navigation on child health: A randomized clinical trial. JAMA Pediatrics, 170(11), Article e162521. https://doi.org/10.1001/jamapediatrics.2016.2521
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
Iowa Model Collaborative. (2017). Iowa model of evidence-based practice: Revisions and validation. Worldviews on Evidence-Based Nursing, 14(3), 175-182. https://doi.org/10.1111/wvn.12223
Seligman, H. K., Lyles, C., Marshall, M. B., Prendergast, K., Smith, M. C., Headings, A., Bradshaw, G., Rosenmoss, S., & Waxman, E. (2015). A pilot food bank intervention featuring diabetes-appropriate food improved glycemic control among clients in three states. Health Affairs, 34(11), 1956-1963. https://doi.org/10.1377/hlthaff.2015.0641
How this DNP 880 Module 2 example is structured
DNP880 is the DNP project course; its proposal includes an evidence synthesis and a framework, and graders penalize syntheses that summarize rather than appraise. Aspen does not publish module deliverables, so check your classroom for the exact prompt. This example organizes evidence by the project's causal links, appraises strength and applicability for each, synthesizes implications for design and justifies a named framework.
DNP880 Module 2 questions, answered
What does DNP880 Module 2 usually ask for?
Work in this part of the DNP project course typically asks for an appraised evidence synthesis supporting your project and a theoretical or EBP framework to guide it. Aspen does not publish module deliverables, so your classroom's instructions govern.
How is an evidence synthesis different from a literature summary?
A synthesis judges the strength, quality and applicability of the evidence for each part of the proposed change, states where evidence is thin and shows how those judgments shape the project design.
What is the Iowa Model of evidence-based practice?
A nursing EBP framework that moves from a triggering issue and priority check through team formation, evidence appraisal and a pilot of the practice change to adoption, sustainment and dissemination.
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.