Blog Post

What Patients Say About Screening Social Needs: Practical Insights for Health Systems

Study Reveals Approaches to Make Social Needs Screening More Patient-Centered

February 27, 2023

By:

Print:

Allison J. Hare, MD

Payers, providers, and policymakers are increasingly recognizing that social factors — such as access to transportation or safe housing — significantly drive patient outcomes and medical costs. As a result, health systems are developing approaches to couple social needs assessments with medical care.

The hope is that by screening for social needs, health systems can develop interventions that lead to better outcomes. Implementation of these social needs screening programs is also supported by newer payment models. Less is known, however, about patient comfort and opinions regarding social needs screening.

Peter Cronholm — Peter F. Cronholm, MD, MSCE

Our team conducted a study to better understand patients’ perspectives on the ways health systems collect data about their social needs. As we reported in the American Journal of Managed Care, our main question to the 54 patients we interviewed was this: What do you think about health systems asking you sensitive questions about your life? We asked about their comfort with so-called “social needs” screening, their understanding of why the health systems conduct the screening, and any important factors affecting their experience with the screening process.

Most patients in our study said they did not mind being screened for social needs. In fact, many reported that the screening process provided a space to discuss issues they otherwise would not share with their clinician. They also appreciated the direct relationship being drawn between their social needs and their health.

Some patients raised concerns related to feelings of shame, stigma, and privacy. Some also expressed feeling reluctant to respond to social needs screening if they were unsure why the questions were being asked.

Patients valued the convenience, ease, and efficiency in the process. They viewed screenings that took place during visit waiting periods as sparing them the inconvenience of completing screenings on their own time. Barriers to technology-based screening included limited comfort with technology, difficulty reading phone-based text, and language and literacy issues. Some patients who noted that that they were not “computer people” said they were open to completing the screening if someone assisted them with the technology.

Several patients felt they needed a strong relationship with their clinician to discuss their social needs. Some raised the issue of power dynamics – particularly around status, race, and gender – as influencing the comfort in engaging around social needs.

Insights and Solutions

For primary care practices and health systems looking to implement more patient-centered social needs screening, we suggest the following:

Educate clinicians and staff about the patient experience of social needs screening to promote a shared understanding of the process.
Develop patient-friendly language for screening surveys to clarify their purpose and confidentiality.
Provide quiet and private disclosure environments or privacy-enhancing features, such as tinted screen protectors for tablets.
Leverage technology-based screening to maximize convenience and efficiency while retaining alternatives such as paper-based or face-to-face screening for patients with barriers to technology use.
Support patient choice in screening completion, modality, and frequency.
Invest in high-quality interdisciplinary teams to address patients’ social needs while preserving the patient-clinician interface.

The study “Patient Perspectives on Technology-Based Approaches to Social Needs Screening,” was published in The American Journal of Managed Care on January 16, 2023. Authors include Allison J. Hare, Katherine Honig, Peter F. Cronholm, Samira Shabazz-McKlaine, and Anna U. Morgan.