Social determinants of health screening tool: systematic review and Delphi study

Parry et al. (1) discuss the likely benefits of routinely collecting social determinants of health (SDOH) data in the UK, and through a systematic review and Delphi process have identified key items to include in a screening tool for use in primary care. This is a valuable starting point and a good time to explore issues to be tackled in the journey towards implementation.

One issue is the accessibility of language used in the screening tool. We acknowledge that the authors were constrained on the wording of the items to maintain validity and reliability, but clarity of meaning is suboptimal in some parts. We highlight this in relation to the proposed questions for financial situation and social support. The phrase ‘make ends meet’ is colloquial language, the meaning of which may not accurately come across to someone whose first language is not English – and translation may also be problematic. Furthermore, by saying ‘at the end of the month’ there is the assumption that people get paid monthly and at the end of each month, which is not necessarily true. A suggestion of alternative wording for this question is ‘do you have difficulty paying for the things you need from one pay cheque to the next?’ We feel this retains the meaning of the question and the connotation that this occurs more than once a year. The question on social support could also be altered for clarity of language as people's understanding of being able to ‘count on’ someone could vary.

Another issue is around how end users would prefer to complete the screening tool. An online form would enable patients to self-report with few restrictions as to where and when they complete it. It could also help reduce bias or discomfort that might be encountered if discussing social issues face to face. In addition, pressure on healthcare and administrative professionals would be also reduced as they would not need to spend appointment time filling the screening tool out with the patient. In theory an online screening tool could be offered universally, avoiding selection bias. For reasons of equity of access, alternative methods of completion e.g. paper copy, or support with completion of the online form, would need to be available but have resource implications.

A path for implementation of the tool would need to be established. Parry et al. focus on using the questionnaire in primary care settings, although the data has value in secondary and tertiary care settings. This is an example of where integrated care pathways with shared access to relevant documents would be useful. However, social circumstances change over time, and the information would be likely to go out of date, necessitating regular updating. Furthermore, some people might not wish for their social determinants of health data to be collected, or would want to choose when to share it, and with whom.

Finally, collecting data about social determinants of health should be associated with the offer of support, which should be prompt and meaningful where distressing levels of need have been identified. This is a major issue, especially if the survey is accessible for completion at any time by the public to update their records. Who has the responsibility to follow up these issues and with what resource? As a minimum, there should be associated provision of links to sources of further support for clients to access to address identified needs (2). We acknowledge that some people may need more than simple signposting to help them access relevant services: social prescribing link worker input can be a valuable way to achieve this. We have read Caicedo et al’s recent systematic review which covers literature on end user perspectives on the integration of SDOH data into the electronic healthcare record in primary care (3). It will be valuable to have patient views on the proposed screening tool, which is a logical next step.
We look forward to a future in which screening for social determinants of health is a routine part of clinical practice and leads to meaningful improvements in outcomes.

References:
1. Parry, E., Wilkie, R., & Warren, K. (2025). Social determinants of health screening tool: systematic review and Delphi study. BJGP Open, BJGPO.2024.0274. https://doi.org/10.3399/bjgpo.2024.0274
2. Singh, G., & Damarell, A. (2021). Co-producing a social determinants of health questionnaire for an urban population in community child health. Archives of Disease in Childhood Education & Practice, edpract-319940. https://doi.org/10.1136/archdischild-2020-319940
3. Caicedo, NMA., Parry, E., Arslan,N., & Park,S. (2024). Integration of social determinants of health information within the primary care electronic health record: a systematic review of patient perspectives and experiences. BJGP Open 2024; 8 (1): BJGPO.2023.0155. https://doi.org/10.3399/BJGPO.2023.0155