Research Assistant Queen's University Department of Family Medicine Midhurst, Ontario, Canada
Background: Poverty is a significant social determinant of health, especially when experienced during childhood. Financial strain influences early childhood development, altering lifelong health trajectories and perpetuating poor health outcomes intergenerationally. A single poverty screening question, “Do you ever have difficulty making ends meet at the end of the month?”, is recommended by the College of Family Physicians of Canada to identify patients living in poverty. This poverty screening question has reported 98% sensitivity and 60% specificity in the identification of adult primary care patients below the poverty line. Objective: Our primary objective was to evaluate the screening test properties of this question using self-reported family income as the criterion measure in a primary care population of families with healthy children ages 1 month to 6 years. A secondary objective was to examine known-groups construct validity of the single poverty screening question and theoretically related variables for measuring poverty. Design/Methods: Using a cross-sectional cohort study design, we recruited families with young children through a community health centre and The Applied Research Group for Kids (TARGet Kids!) primary care practice (www.targetkids.ca) in Kingston, Ontario during their scheduled health supervision visits from 2019 to 2022. Data was collected from parent-reported questionnaires. We examined the screening test properties of the poverty screening question using two different income thresholds as the criterion measure: $40,000 and $50,000 CAD. The poverty line for families in Ontario cities with populations of 100,000 to 499,999 was $43,968 in 2019 and $49,290 in 2022. Construct validity was assessed using multivariable logistic regression. Results: Of 203 families participating, 54 (26.6%) endorsed the poverty screening question, 42 (20.7%) reported a family income of less than $40,000 and 59 (29.1%) reported a family income of less than $50,000. An affirmative response to the poverty screening question had a 79% sensitivity and 87% specificity when using the $40,000 income threshold and a 68% sensitivity and 90% specificity when using the $50,000 income threshold. An affirmative response to the poverty screening question was significantly associated with low self-reported family income, marginal food security, and difficulty paying utility bills.
Conclusion(s): The poverty screening question may be an effective screening tool in primary care to identify families with young children living in poverty and connect families with community-based services or financial assistance programs.
