Social determinants profoundly impact health. Many primary care practices now seek to screen their patients for health-related social needs (HRSN) and refer them to resources in the community. However, there is little empirical evidence to guide communication with patients in order to ensure their comfort with the process and increase the likelihood that it results in positive outcomes. This paper describes the first phase of the Improving Messaging Around Gaps in Needs and rEfferals (IMAGINE) study-a multi-phase study aiming to develop and test patient-centred messages about screening and referral for HRSN. In this initial qualitative phase, our objective was to identify communication strategies that might make western Colorado primary care patients more comfortable with the HRSN screening and referral process. From May to July 2020 we interviewed 10 staff members responsible for HRSN screening from primary care practices participating in the western Colorado Accountable Health Communities (AHC) initiative and 20 patients from 2 of these practices. We used a rapid qualitative analysis process that involved summarising interview transcripts across key domains of interest and then identifying emergent themes within each domain using a data matrix. Through this process, we examined current communication about HRSN screening, as well as suggestions for messages and other strategies that could improve communication. In most practices, the AHC Screening Tool was handed to patients by front desk staff at check-in with little explanation as to its purpose. Patients and staff alike recommended that patients be provided with information that: normalises the screening and referral process; assures privacy; clarifies that the purpose is to help and support rather than judge or report; emphasises community benefits; and respects patient autonomy. Interviewees also suggested broader strategies to support more effective communication, such as practice staff and clinicians building trusting relationships with patients and understanding and acknowledging the complex structural barriers that often prevent patients from accessing meaningful assistance. These findings provide actionable suggestions for improving communication about HRSN screening and referral in primary care settings. The next steps include developing specific messages based on these findings and testing their impact on screening tool completion rate, referral uptake, and patient-reported comfort with the process.

Background: Social determinants of health (SDOH) influence health outcomes. Food insecurity (FI) is the most common need related to SDOH. Many primary care practices and health systems have begun to screen for FI and refer patients to resources. How this process is viewed by multiple stakeholders, including patients, health care workers, and staff at food assistance organizations (FAOs), will influence its impact.Methods: In this mixed-methods study, we completed 42 interviews with individuals from the 3 stakeholder groups. We then conducted a survey with 126 respondents using questions developed from the qualitative results.Results: All stakeholders recognized the impact FI has on health outcomes, but perspectives varied on the value of sharing information through referrals to FAOs and concerning receipt of services, including privacy concerns and that the process would require significant work and not necessarily improve FI.Discussion: Stakeholders agree that FI impacts health but have differences in perceptions around screening and referral done in health care settings. Perspectives of multiple stakeholders need to be considered when designing these systems.Conclusion: Successfully designing systems to address FI through referral to FAOs requires input of multiple stakeholders because perspectives on the value and work required for this process vary.

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Introduction: Practice-based research networks (PBRNs) have long sought to engage with communities and address questions relevant to multiple stakeholders and real-world primary care practice. Topicgenerating processes that involve these stakeholders are crucial for identifying these questions. PBRNs often focus on certain populations or geographic areas. We are forming a new PBRN to address the health concerns and research interests of people in communities in Western Colorado.Methods: To engage with and determine the questions important to multiple stakeholders in communities in western Colorado, we conducted community meetings at which we used Photovoice followed by Nominal Group Technique in group discussions across the region. We then conducted a survey to develop a list of priority research topics.Results: Multiple stakeholders were ready and eager to engage with us to form a PBRN. Across all communities, many of the topics that emerged were related to the social determinants of health. Mental health-specifically, lack of access to services and high suicide incidence-was the most important topic according to community members. This was consistent across groups of stakeholders and corroborated other community work such as Community Health Needs Assessments.Discussion: Using participatory methods increased our stakeholder engagement and helped build strong community-academic partnerships for our PBRN-related research. Use of Photovoice allowed all participants to express their thoughts and ideas and led to a clear path forward for this new research network.