A short-form screening tool for detecting social needs efficiently in pregnancy

Abstract

Social Determinants of Health (SDoH) affect patients’ baseline health needs and their ability to access and engage in healthcare. Though maternity care organizations recommend assessing and addressing SDoH in pregnancy, how to do so is not clear. Current screeners are burdensome (>20 questions) or incompletely evaluate material (tangible) and social support (relationship-based) needs. We assessed the sensitivity and specificity of a 3-question, comprehensive digital SDoH screener relative to a validated screener. We developed a 3-question, short-form SDoH screener using domains from existing validated screeners. We cognitively tested and refined the screener with 5 pregnant/postpartum people. We tested the short-form screener as part of a nationally representative, cross-sectional online survey of pregnant/postpartum people using Centiment, an online survey panel. By design, our cohort included equal numbers of participants with public and private insurance, given differences in SDoH and access to resources in these groups. Participants completed the short-form and a validated screener (PRAPARE). We calculated descriptive statistics, the sensitivity and specificity of the short-form screener compared to PRAPARE for overall, material and social support needs. Of the 215 participants, mean age was 30.6 (+/-5.7), 77% (167/215) were White, 86.0% (185/215) were non-Hispanic. Using PRAPARE, 88.8%, 67.9%, and 81.4% had ≥1 overall, material or social need, respectively. The sensitivity and specificity of the short form screener were overall: 81.2%, 50.0%; material: 84.2%, 75.4%; social support: 63.4%, 67.5% (Table 1). A 3-question screener performed well for detecting any social need when compared to a validated screener, though detection for social support needs was lower. Lower specificity in our screener may be due to biases inherent in existing tools, which assume characteristics such as payer are equivalent to social needs. The use of short-form screeners should be considered as a strategy to improve uptake of screening and management of SDoH in routine care.