Screening for Social Determinants of Health: How Nurses Can Dig Deeper
By Melissa Wirkus Hagstrom, contributor
Nurses and other healthcare personnel often conduct the
screening of patients with medical questionnaires. But it’s no longer
sufficient to just record the patient’s family and personal history.
Today’s screening tools are also being used to obtain social
information that can affect a patient's health and outcomes.
career as a travel nurse.
determinants of health
According to the World Health Organization (WHO), social
determinants of health (SDH) are the conditions in which people are born, grow,
work, live, and age, and the wider set of forces and systems shaping the
conditions of daily life. These forces and systems include economic policies
and systems, development agendas, social norms, social policies and political
Cindy Brach, senior healthcare researcher with the Center for Evidence and
Practice Improvement at the Agency for Healthcare Research and Quality (AHRQ),
explained that social determinants of health speak to the conditions outside of
the individual’s broader condition, including the community in which they live
and how they interact in that environment.
“Very often, when people talk about the social determinants of health and
healthcare, what they are really talking about are social needs of the
individual. If you are really being strict, SDH pertains to everybody who lives
in that community and in those circumstances. Individuals who live in that
community may or may not have a particular social risk or social need,” Brach
For example, living in a high-crime area is a SDH. Residents may
be traumatized by living in that community. Asking about and treating the
stress of living in that community is meeting a social need, but not addressing
the SDH, according to Brach.
Nursing and screening tools for SDH
Nurses can play a key role by collecting SDH information and then helping
provide access to local community resources to patients, whether in the primary
care, urgent care or acute care setting. This can be especially critical during
the global COVID-19 pandemic, as studies
have shown that patients in some communities or social situations have poorer
outcomes from the virus than others.
are a variety of tools and surveys that nurses and other healthcare
professionals can use to collect important data and then use that information
to craft a tailored care plan for each individual patient.
One such tool is the Protocol for Responding
to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE).
This is a national effort to help health centers and other providers collect
the data needed to better understand and act on their patients’ social
determinants of health.
PRAPARE assessment tool consists of a national set of core measures and an
optional set of measures for community priorities.
core set of 16 measures includes: race, ethnicity, migrant and/or seasonal farm
work, veteran status, language, housing status, housing stability,
address/neighborhood, education, employment, insurance, income, material
security, transportation, social integration and support, and stress. The
optional measures include: incarceration history, refugee status, safety, and
Be prepared to address discovered
kind of screening you want to do depends on what you plan to do in response to
those answers,” Brach said. “I am a firm believer that you should not be
collecting data for the sake of collecting data, and therefore, every question
that you ask, there has to be a reason for it and how you are going to use
believe that practices that are collecting social determinants of health data
should have specific plans of how they are going to respond to those needs, and
that usually involves linking them to community resources or using it to change
their treatment plans,” she continued.
patient has food insecurity issues, a nurse can provide resources to food
pantries and other community resources during the screening process. This
information can be used to better the lives of the patients on both a medical and
a personal level.
“You have to understand patients' lived experiences,”
Brach said. “If you are developing a treatment plan without understanding what
their lives are like, there’s a reasonable likelihood that you are going to ask
them to do something that is not going to fit into that life. It’s part of the
partnering with the patient to make sure you are on the same page and you
understand their constraints and priorities, and then together develop a
workable plan that they can follow through on, as opposed to developing
something devoid of that understanding.”
Impact of COVID-19 on PRAPARE Social Determinants of Health Domains – Fact Sheet, National Association of Community Health Centers (NACHC)
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