Table 2.

Potential Sources of Discrepancy Between Patients’ Social Risk Screening Results and Interest in Assistance

SourceSignificanceImplications for Equity
Validity of Social Risk Screening
 Lack of psychometric testing of social risk screening toolsLow 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 toolIf 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 interventionsPatient 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 elsewhereIf 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 encountersPatients 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.