Beyond the Check Box: Development of the Nutrition Health Related Social Need Assessment and Referral Tool (N-HART)

Background: Food insecurity screeners focus on identifying a financial barrier to accessing food. Other social and medical factors influence an individual’s nutritional status and the need for food provision support. Yet, there are no existing tools that elicit the various life factors that influence food and nutrition needs and further identify relevant resources to address those needs. Objective: To develop the Nutrition Health Related Social Need Assessment and Referral Tool (N-HART) to facilitate individualized referrals to food and nutrition resources, based on both medical and social factors. Resources include food provision, nutrition and cooking education, and benefits assistance. Design: We used a multi-phase approach to develop and refine the N-HART from March 2023 to March 2024. An initial draft of the N-HART was developed based on a literature review and field scan. Cognitive interviews with patients were used to iteratively refine the tool. Participants: The tool was developed for use across a health system, applicable to both inpatient and ambulatory settings. We conducted cognitive interviews with 15 patients at an acute care hospital in Philadelphia, PA to inform the refinement of the N-HART. Key Results: The N-HART is a 13-item dual-function tool that screens for food and nutrition needs and recommends a best fit food resource type (e.g., medically tailored meals, non-tailored prepared meals, food pantry) based on an individual’s needs. Cognitive interviews informed changes in N-HART framing and period of focus, and led to the elimination of some items to be as efficient and actionable as possible. Conclusions: With health systems focusing on HRSN, the N-HART may provide a strategy for informing more individualized nutrition referrals using a structured approach.