Article Figures & Data
Tables
- Table 1.
Discrepancy Between Positive Social Risk and Interest in Assistance: Examples from US Health Services Published Research*
Authors (Publication Years) Social Risk Domain Positive Screen, % Positive Screen Interested in Assistance, %† Bottino et al. (2017)19 Food insecurity 32 54 Eismann et al. (2018)26 Food insecurity 11 90 Harsh punishment 1 70 Parental stress 14 79 Parental depression 9 74 Parental substance use <1 50 Safety concern 6 71 Fox et al. (2016)20 Food insecurity 34‡ 75§ Garg et al. (2010)25 Childcare 29 64‖ Education 9 Food insecurity 11 Housing instability 12 Insurance 6 Public benefits 5 Utilities 7 Gold et al. (2018)7 Multiple social risk factors 91; 98‖,¶ 15; 21 Hassan et al. (2015)14 Education 14# 56 Financial strain 10 83 Food insecurity 29 38 Housing instability 34 37 Safety concern 16 16 Substance use 20 6 Knowles et al. (2018)21 Food insecurity 16 56 Martel et al. (2018)22 Food insecurity -†† 63 Schickedanz et al. (2019)23 Multiple social risk factors 53‖ 48‖ Swavely et al. (2018)5 Food insecurity 27 48 Tong et al. (2018)6 Education 2 67 Financial strain 11 0 Food insecurity 7 22 Housing instability 4 20 Safety concern 2 100 Social isolation 2 50 Uwemedimo and May (2018)24 Multiple social risk factors 43‖ 49 ↵* These are examples from previously published literature but do not reflect findings from a systematic literature review.
↵† Depending on study outcome, interest signifies acceptance of referral, intervention enrollment, or similar metric. Type of assistance offered differed by study and may account for some of the noted fluctuations in interest in assistance between studies.
↵‡ Thirty-four percent were eligible for/offered a referral to food bank based on being food insecure or having public insurance, and not already enrolled in Supplemental Nutrition Assistance Program (SNAP). Only 24% screened positive for food insecurity.
↵§ 75% of those eligible for referral, agreed to be referred, but only 8% were confirmed to have enrolled in the food bank.
↵‖ Authors did not provide information to separate by domain.
↵¶ Results reported are for overall percentage of participants with ≥1 endorsed social risk and percentage of those who were interested in assistance, from two different community health centers.
↵# Showing the percentage of participants who screened positive for a “major problem” in each domain.
** Included nutrition/bodyweight.
↵†† Authors only reported the total number of patients with food insecurity who accepted a referral.
- Table 2.
Potential Sources of Discrepancy Between Patients’ Social Risk Screening Results and Interest in Assistance
Source Significance Implications for Equity Validity of Social Risk Screening Lack of psychometric testing of social risk screening tools Low specificity may exaggerate social risks in some populations (high false positive rate), while underestimating them in others (low sensitivity; high false-negative rate). Social risk screening tools may be less valid/reliable in different patient populations. If resources are distributed based on screening results, there may be a disparate distribution of resources. Use of social risk screening tool as a diagnostic tool If health care teams rely on a screening tool to diagnose social risks, they may offer resources to patients without clarifying patients’ perceived needs and priorities (relates to psychometric properties of tools, but also patient preferences and priorities). Health care teams may draw incorrect conclusions about the needs of their patients based on improper use of screening tools, along with a lack of patient-centered implementation. If vulnerable patient groups have a limited understanding of what is being offered, or feel less empowered to accept resources, they may disproportionately decline assistance. Lack of Patient Interest in Assistance Patient does not think health care is an appropriate setting for social care interventions Patient experiences within health care and with social care in general may influence their view on the appropriateness of social care interventions in health care (e.g. prior discrimination). Marginalized patients may be more wary of the health care system’s involvement in their social sphere, leading them to decline assistance. Patient already getting assistance elsewhere If a patient’s needs are already being at least partially addressed elsewhere, additional resources from the health care system may not be needed. Patients may, however, be unaware of additional supports they are eligible for that could provide further benefit. Without clarifying where patients are getting support to identify potential gaps or vulnerabilities, less empowered patients may be less able to seek or ask about additional support. Patient does not prioritize social care during clinical encounters Patients may have competing interests for visits. Patients with more complex medical needs and/or poor health literacy may be less interested in discussing social risks, though risks may have profound implications for their medical care and health outcomes.
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