Got Food? Food Accessibility Across Oahu’s Mokus

Abstract

Context: The John A. Burns School of Medicine (JABSOM) newly launched Learning Community (LC) program is comprised of six student-faculty groups assigned to a moku, or land division. The six LC groups correspond to the six mokus of Oʻahu. The LC curriculum covers various topics, including health system sciences with a focus on social determinants of health, culture, and community. There is a pressing need to promote social determinants of health (SDoH) training in undergraduate medical education, including incorporating food education into medical management.

Objective: The objective of this project was to create and implement an interactive activity for students to understand SDoH in the context of food insecurity within Hawaii’s diverse communities.

Description of Innovation: In May 2021 during the gastroenterology subunit, first-year medical students explored food insecurity within their moku. Following a lecture regarding the disproportionately high number of Hawaii households who fall below the ALICE (Asset-limited, income constrained, employed) threshold, students were assigned to shop for groceries for different patient family scenarios with constrained budgets. Additionally, they researched benefits including Supplemental Nutrition Assistance Program (SNAP), Women, Infants, Children (WIC), and school-sponsored meal options. Students then went out to their moku to shop for a week’s worth of groceries for their families. Upon completion of the visits, students generated a food insecurity chart comparing food access and availability within their respective mokus. These were compiled into a Google slideshow that represented their work across all mokus. Students also submitted a reflection to their LC mentor regarding their thoughts about food insecurity and how it will impact their future interactions with patients. An end-unit survey assessed students’ satisfaction with the project as well as how their confidence in addressing food insecurity with their patients.

Evaluation of Innovation: An end-unit survey determined that ~78.2% of students agreed or somewhat agreed that this project helped them understand barriers to food access and how to overcome those barriers and ~85.4% of agreed or somewhat agreed that this project helped them understand the importance of addressing SDoH. Students showed a statistically significant increase in confidence in their ability to identify resources for patients who are food insecure and their ability to recognize food source options in their moku.

Discussion: Through the shared Google Slideshow, the students were able to learn not only about food sources within their own moku, but how food insecurity varies across the island. The reflections demonstrated that medical students were able to better empathize with their patients through their increased knowledge on the importance of addressing food insecurity. Only a small number of medical school LCs address food insecurity in a way that involves direct community involvement. Discussing food insecurity across the island provided an opportunity to learn about and serve Hawaii’s diverse communities through the JABSOM LC program. Future directions include expanding the scope of the program while placing greater emphasis on community outreach.

Target Audience: Medical School Learning Community Programs