Abstract
BackgroundAddressing social and behavioral determinants of health (SBDs) may help improve health outcomes of community clinic patients. This cross-sectional study explored how assessing SBDs can be used to complement health data collection strategies and provide clinicians with a more in-depth understanding of their patients.MethodsAdult patients, ages 18 and older, at an urban community health care clinic in Tennessee, U.S.A., were asked to complete a questionnaire regarding health status, health history and SBDs while waiting for their clinic appointment. The SBD component included items from the National Academy of Medicine, the Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences instrument, and the Survey of Household Economics and Decisionmaking. Data collection and analysis occurred in 2017.ResultsOne hundred participants completed the study. The questionnaire took approximately 11 min to complete, and the response rate was 90% or higher for all items except annual household income (unanswered by 40 participants). The median number of negative SBDs was 4 (IQR 2.75–7.0), 96 participants had at least one unmet need, and the most common negative SBD was physical activity (75%; 75/100).ConclusionsThe hybrid questionnaire provided insight into a community clinic population’s SBDs and allowed for a more complete understanding than a single questionnaire alone. The brief questionnaire administration time and low non-response rate support the questionnaire’s feasibility in the community clinic setting, and results can be used by clinicians to further the personalization goals of precision medicine. Next steps include evaluating how to connect patients with appropriate resources for addressing their SBDs.
Highlights
Addressing social and behavioral determinants of health (SBDs) may help improve health outcomes of community clinic patients
Community health centers provide care for low-income, medically underserved populations; these individuals are at greater risk of preventable, chronic disease and often report higher rates of chronic conditions, such as hypertension and diabetes [1, 2]
Understanding the role of social and behavioral determinants on health is important for the care of community clinic patients and involves evaluating the impact of upstream factors affecting health, such as education, financial strain, and physical activity
Summary
Addressing social and behavioral determinants of health (SBDs) may help improve health outcomes of community clinic patients. This cross-sectional study explored how assessing SBDs can be used to complement health data collection strategies and provide clinicians with a more in-depth understanding of their patients. The National Academy of Medicine (NAM) formed a committee in 2013 which recommended a set of measures drawn from validated instruments for systematically collecting information about social and behavioral determinants of health (SBD) for incorporation into electronic health records in the United States [3,4,5]. The studies supported the feasibility, reliability and validity of administering the NAM questionnaire based on the brief completion time (5 min), low non-response rate, lack of question order effects, establishment of test re-test reliability, and observations that response patterns were consistent with the literature and the measures were associated with self-reported physical and mental health [6, 7]
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