Screening for Social-Structural Determinants of Health

Content

?1.???Review of Social Determinants of Health Screenings used in Primary Care Settings

2.???Social Determinants of Health Screening among Primary Health Care Nurses

3.???Screening for social determinants of health in clinical care

4.???Social Determinants of Health Screening Tools

5.???Screening for Social Determinants of Health. Health System Assessment Tool

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Keywords: health; health screening; integrative review; primary care;?social determinants of health; structural Determinants of Health,?systematic review.

?Introduction

This analysis presents the finding of a scoping review of Screening for Social-Structural Determinants of Health (SDOH).

Increasingly, healthcare providers are moving toward conducting SDOH screening to identify their patients' nonmedical health needs and refer them to community resources to improve their patients and the community's health and well-being.

Social–structural determinants of health (SDOHs) are 'the social-structural conditions, the environments where people are born, live, learn, work, play, worship, access to health care, quality of health policies and age that affect a wide range of health, functioning and quality-of-life outcomes and risks.' These social, structural environmental and ecological factors greatly influence population health; addressing the social determinants of health is vital for improving health and reducing health disparities. For example, one meta-analysis found that over a third of total deaths in the U.S. in one year were attributable to social factors such as poverty, social support, racial segregation, and education. On average, the richest and poorest U.S. residents have a 15-year difference in life expectancy. (Galea, S et al 2011)

?A wide variety of Screening tools for identifying social-structural determinants are in place. However, there has yet to be a consensus on the domains to be included in screening tools for addressing and identifying determinants of health.

Addressing SDOHs is important in non-communicable disease prevention, screening, and treatment. The American Cancer Society developed a blueprint for practice, research and policy to understand and address the social determinants of health to improve cancer health equity in the U.S.

?In recent years, health systems and clinics have developed screening tools for identifying and addressing these social determinants of health to improve overall health and well-being. According to US CDC, SDOH can be grouped into five domains: However, the scoping review indicates that additional dimensions could be added.

·??????Economic Stability/ determinants

·??????Education Access and Quality

·??????Health Care Access and Quality

·??????Neighbourhood and Built Environment

·??????Social and Community Context

·??????Ecological determinants

·??????Structural determinants and

·??????Commercial determinants

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SDOH screening often prompts a referral to social work, a community resource specialist, or a nurse care manager. Referral for community resources or mental health services (Escobar et al. 2021) highlighted the need for transdisciplinary engagement to deploy a screening tool in practice and integrate the screening findings into clinical references. Support interventions included workflow improvements, decision support, and identification of process champions.

More research is needed to determine the best social-structural determinants of the health screening method, particularly in primary care con in developing countries.

1.??????An Integrative Review of Social Determinants of Health Screenings used in Primary Care Settings

?There needs to be more evidence on implementing social determinants of health (SDH) screenings. (Boch et al., 2020)?aimed to synthesise recent evidence investigating the implementation of SDH screening in primary care settings. Electronic strategies were used to find articles published between September 2008 and 2018. Articles in the review (N = 15) varied in study design and methodologic rigour, complicating the analysis.

?Many articles needed specifications on who administered the screening, where the screening was administered, and resource referral rates. Most of the screenings were administered during the clinic visit by a medical provider. The four primary SDH domains assessed were income, housing stability, education, and employment status.

According to the authors, more specific implementation research is needed on how providers can screen for SDH and how screening practices influence resource referrals, resource utilisation, and health improvements. (Boch, S., Keedy, H., Chavez, L., Dolce, M., & Chisolm, D. 2020)

2.?????Use of Social Determinants of Health Screening among Primary Health Care Nurses of Developed Countries: An Integrative Review

In their study, McGowan and colleagues (2023) aim to synthesise research investigating social determinants of health screening by primary healthcare nurses, how and when they perform social determinants of health screening and implications for advancing nursing practice. The review identified fifteen published studies which met the inclusion criteria. Studies were synthesised using reflexive thematic analysis.

This review found little evidence of primary health care nurses using standardised social determinants of health screening tools. Eleven subthemes were identified and collapsed into three main themes: organisation and health system supports are required to enable primary health care nurses; primary health care nurses are often reluctant to perform social determinants of health screening; and the importance of interpersonal relationships for social determinants of health screening.

The social determinants of health screening practices of primary health care nurses need to be better defined and understood. Evidence suggests that primary health care nurses must routinely use standardised screening tools or other objective methods. Recommendations are made for valuing therapeutic relationships, social determinants of health education and the promotion of screening by health systems and professional bodies. Further research examining the best social determinant of health screening methods is required. (McGowan, D. A., Mather, C., & Stirling, C. 2023).

3.?????Screening for social determinants of health in clinical care: moving from the margins to the mainstream.

Screening for the social determinants of health in clinical practice is still widely debated. Therefore, a scoping review was used by Andermann (2018) to (1) explore the various screening tools that are available to identify social risk, (2) examine the impact that screening for social determinants has on health and social outcomes, and (3) identify factors that promote the uptake of screening in routine clinical care.

Over the last two decades, many screening tools have been developed to help frontline health workers ask about the social determinants of health in clinical care. In addition to clinical practice guidelines that recommend screening for specific areas of social risk (e.g., violence in pregnancy), there is also a growing body of evidence exploring the use of screening or case finding for identifying multiple domains of social risk (e.g., poverty, food insecurity, violence, unemployment, and housing problems).

There is increasing traction within the medical field for improving social history taking and integrating more formal screening for social determinants of health within clinical practice. A growing number of high-quality, evidence-based reviews also identify interventions that effectively promote health equity at the individual patient level and at broader community and structural levels. (Andermann A. 2018)

4.?????Social Determinant of Health Screening Tools

?Serena Mahalingam, Halle Kahlenberg, and Shweta Pathak (2019) compiled a set of resources characterising the adult social determinant of health (SDOH) screening tools with publicly-available, validity-related data. The ultimate goal of this resource is to establish the research foundation for those seeking to create SDOH screening tools for adults that produce consistent, accurate, and correct results.

The validity-related data includes psychometric properties such as sensitivity, specificity, and content validity. Also, information about the pilot studies showing the utility or feasibility of the tool is included when it's available. The resources were identified through two searches: a grey literature search on SDOH screening tools and a scientific literature search on PubMed and Scopus on the validity of SDOH screening tools. Social Determinant of Health Domains presented in this article are:

? Cultural considerations - refugee status, sexual orientation, cultural and linguistic background, and others ? Education ? Employment/Income ? Food Insecurity ? Housing/Utilities - homelessness, unstable or unsafe housing ? Interpersonal safety - community violence and intimate partner violence ? Transportation ?

Other resources are organised into two categories: single domains and multiple domains. This document presents information on the tools identified in the searches, including sample questions from the tools, the covered domain (s), and validity data on the tools. Serena Mahalingam, Halle Kahlenberg, Shweta Pathak.(2019)

5.?????Screening for Social Determinants of Health. Health System Assessment Tool

?The American Cancer Society (nd) developed a?Screening tool for assessing ?Social Determinants of Health. The Health System Assessment Tool identified several social and environmental factors significantly influencing population health. Addressing the social determinants of health is vital for improving health and reducing health disparities.2 Despite being ranked as one of the ten wealthiest countries per capita, the U.S. experiences high rates of health disparities rooted in economic, social, and environmental factors. One meta-analysis found that over a third of total deaths in the U.S. in one year were attributable to social factors such as social support, racial segregation, and education. On average, the richest and poorest U.S. residents have a 15-year difference in life expectancy. Relatedly, the location of birth is strongly associated with life expectancy.?

Other important factors that affect a patient's health include access to transportation, food security, and personal safety. This toolkit provides health systems with essential resources to screen for SDOH. American Cancer Society Screening for Social Determinants of Health. Health System Assessment Tool (Nd)

References

McGowan, D. A., Mather, C., & Stirling, C. (2023). Use of Social Determinants of Health Screening among Primary Health Care Nurses of Developed Countries: An Integrative Review. Nursing reports (Pavia, Italy), 13(1), 194–213. https://doi.org/10.3390/nursrep13010020

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Boch, S., Keedy, H., Chavez, L., Dolce, M., & Chisolm, D. (2020). An Integrative Review of Social Determinants of Health Screenings used in Primary Care Settings. Journal of health care for the poor and underserved, 31(2), 603–622. https://doi.org/10.1353/hpu.2020.0048

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Andermann A. (2018). Screening for social determinants of health in clinical care: moving from the margins to the mainstream. Public health reviews, 39, 19. https://doi.org/10.1186/s40985-018-0094-7

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Serena Mahalingam, Halle Kahlenberg, Shweta Pathak.(2019) Social Determinant of Health Screening Tools with Validity-Related Data. https://pharmacy.unc.edu/wp-content/uploads/sites/1043/2020/02/SDoH-Report.pdf

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American Cancer Society Screening for Social Determinants of Health. Health System Assessment Tool. https://hscb.acs4ccc.org/wp-content/uploads/2022/04/Screening-for-SDOH-Health-Assessment-Tool.pdf

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Galea, S., Tracy, M., Hoggatt, K. J., DiMaggio, C., & Karpati, A. (2011). Estimated Deaths Attributable to Social Factors in the United States. American Journal of Public Health, 101(8), 1456-1465. https://doi.org/10.2105/AJPH.2010.300086

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Ruiz Escobar E, Pathak S, Blanchard CM. (2021) ?Screening and Referral Care Delivery Services and Unmet Health-Related Social Needs: A Systematic Review. Prev Chronic Dis 2021;18:200569. DOI: https://dx.doi.org/10.5888/pcd18.200569