Implementing health‐related social needs screening in western Colorado primary care practices: Qualitative research to inform improved communication with patients

Abstract

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.

Patient Perspectives on Social Risk Screening and Documentation in a Dermatology Clinic

“…Third, giving patients opportunities to update their EHR data as their social circumstances change would promote empowerment, choice, and voice. These suggestions align with studies that highlight the importance of normalizing the screening process, clarifying the purpose of screening, describing the association between social needs and health, and respecting patient autonomy …”

“…Participants completed the survey on a computer tablet before, during, or after their clinic visit. The survey consisted of the 10-item Accountable Health Communities (AHC) health-related social needs screening tool, which is widely used and includes questions on housing, food, transportation, utilities, and interpersonal violence; 2 outcome measures of acceptability; and 20 questions on social risk factors associated with patient acceptability (eAppendix in Supplement 1). We modified questions from an earlier study evaluating acceptability of social risk screening in primary care clinics and EDs for use in a dermatology clinic setting.…”

Recovery After Musculoskeletal Injury: Mental and Social Health

“…There are several questionnaires that address aspects of social health including security in finances, housing, food, transportation, vocation, and avocational roles. These include the Protocol for Responding to and Assessing Patients Assets, Risks, and Experiences (PRAPARE); 27 the Health-Related Social Needs Questionnaire; 28 and the Tracking Health, Relationships, Identity, EnVironment, and Equity (THRIVE) tool. 29 These questionnaires have similar items.…”

IMAGINE: A Trial of Messaging Strategies for Social Needs Screening and Referral

“…11,12 Factors contributing to this high rate of patients declining assistance may include discomfort with the screening process, perceptions that screening and referral are unhelpful, and lack of clarity around the purpose of HRSN screening in medical settings. 11 Previous qualitative research 13,14 as well as theoretical understandings of patient-centered communication and relationship-centered care 15,16 suggest that improved communication, including changes in workflows such as who delivers the message and tailoring to patients' information needs about HRSN screening and referral, may result in more patients feeling comfortable with HRSN screening and perceiving the process as helpful. This may lead more patients to respond to screening and to accept resource navigation assistance if they have needs, which has the potential to decrease healthcare costs and improve outcomes.…”

“…17−19 In the Improving Messaging And Gaps In Needs and referrals (IMAGINE) study, qualitative research was conducted to inform a patient-and clinic staff-engaged process to improve messages and communication strategies for HRSN screening and referral. 14 A pragmatic, nonrandomized trial was conducted to test these communication strategies in 3 primary care clinics on the basis of the hypothesis that the improved communication strategies would increase the overall HRSN screening response and resource navigation assistance acceptance rate among patients with social needs. Improved communication strategies were also expected to increase patient-reported comfort with, perceived helpfulness of, and receipt of explanation about the HRSN screening process.…”