Author ORCID Identifier


Defense Date


Document Type


Degree Name

Doctor of Philosophy


Social and Behavioral Health

First Advisor

Maria D. Thomson

Second Advisor

Anika L. Hines

Third Advisor

Alan W. Dow

Fourth Advisor

Roy T. Sabo



Guideline recommendations for treating high blood pressure (hypertension) include nutrition care that may comprise dietary screening, counseling, referrals to other providers or resources, and follow-up. Along with disparities in hypertension prevalence and control among some populations, there also lies an intersecting risk of food insecurity that limits access to fresh and healthy foods. Thus, screening patients for food insecurity and providing nutrition care are imperative to clinical management of patients with hypertension, but limited time during clinical encounters is a barrier. Team-based care approaches that utilize multidisciplinary teams, coordinate care within the clinical environment and with community resources, use quality communication, have defined workflows, and have ways to monitor their performance were hypothesized to address this barrier. The work presented in this thesis aimed to characterize screening for food insecurity and nutrition care for patients with hypertension from the perspectives of primary care clinics and providers, and to examine whether these are related to aspects of providers’ nutrition competence, clinics’ team-based care attributes, and patient outcomes.


Data from primary care clinics and providers were collected using online surveys and abstracted from electronic health records. Analyses included assessing rates of food insecurity screening and nutrition care delivery and tests for association between these services and providers’ nutrition competence, team-based care attributes of primary care clinics, and a relevant patient outcome of controlled blood pressure.


Food insecurity screening rates were low and nutrition care practices varied across categories. Several statistically significant findings showed screening for food insecurity and nutrition care are distinct types of care. Clinics that reported food insecurity screening processes were found to have higher levels of coordinating-type team-based care attributes and were not associated with providers’ nutrition competence. Nutrition care practices were positively associated with both interpersonal communication-type team-based care attributes and nutrition competence. Patients’ blood pressure control was associated with communication aspects of team-based care, but there were insufficient data to indicate a relationship with food insecurity screening or nutrition care.


Through a series of three manuscripts, this study presents a novel description of food insecurity screening and nutrition care delivery and team-based care attributes associated with these services at both the provider and clinic levels. Results from this study offer 1) insight into the differing types of team-based care attributes that are useful in promoting food insecurity screening and nutrition care processes and 2) a formal set of definitions for nutrition care delivery in primary care clinical settings for application in future research. Taken together, these products contribute to our understanding of food insecurity screening and nutrition care as preventive care services delivered within team settings. Myriad opportunities for future work in this field can inform guidelines, education, and policy with the goal of improving health services quality and patient outcomes.


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Available for download on Tuesday, January 19, 2027