ORIGINAL RESEARCH
Emilia H. De Marchis, MD, MAS; Benjamin Aceves, PhD, MPH, MA; Erika M. Brown, PhD, MPH; Vishalli Loomba, MPH; Melanie F. Molina, MD; Laura M. Gottlieb, MD, MPH
Corresponding Author: Emilia H. De Marchis, MD, MAS; Department of Family & Community Medicine - University of California, San Francisco
Email: emilia.demarchis@ucsf.edu
DOI: 10.3122/jabfm.2022.220401R1
Keywords: Implementation Science, Screening, Social Determinants of Health, Social Risk Factors, Systematic Review
Dates: Submitted: 11-28-2022; Revised: 04-05-2023; Accepted: 04-10-2023
AHEAD OF PRINT: |HTML| |PDF| FINAL PUBLICATION: |HTML| |PDF|
PURPOSE: Though a growing crop of healthcare reforms aims to encourage healthcare-based social screening, no literature has synthesized existing social screening implementation research to inform screening practice and policymaking.
METHODS: Systematic scoping review of peer-reviewed literature on social screening implementation published 1/1/2011-2/17/2022. We applied a two-concept search (healthcare-based screening; social risk factors) to PubMed and Embase. Studies had to explore the implementation of healthcare-based multi-domain social screening and describe 1+ outcome related to the reach, adoption, implementation, and/or maintenance of screening. Two reviewers extracted data related to key study elements, including sample, setting, and implementation outcomes.
RESULTS: Forty-two articles met inclusion criteria. Reach (N=7): We found differences in screening rates by patient race/ethnicity; findings varied across studies. Patients who preferred Spanish had lower screening rates than English-preferring patients. Adoption (N=13): Workforce education and dedicated quality improvement projects increased screening adoption. Implementation (N=32): Time was the most cited barrier to screening; administration time differed by tool/workforce/modality. Use of standardized screening tools/workflows improved screening integration. Use of community health workers and/or technology improved risk disclosure and facilitated screening in resource-limited settings. Maintenance (N=1): Only one study reported on maintenance; results showed a drop in screening over 21 months.
CONCLUSIONS: Critical evidence gaps in social screening implementation persist. These include gaps in knowledge about effective strategies for integrating social screening into clinical workflows and ways to maximize screening equity. Future research should leverage the rapidly increasing number of screening initiatives to elevate and scale best practices.