Effectively asking about social determinants of health (SDOH) involves creating a supportive environment and using open-ended, non-judgmental questions to uncover the underlying factors that influence an individual's well-being.
Understanding and addressing social determinants of health (SDOH) is crucial for comprehensive care and improving health outcomes. These are the non-medical factors that influence health, including socioeconomic status, education, neighborhood, physical environment, employment, and social support networks. By asking the right questions, healthcare providers and community workers can identify barriers and connect individuals to vital resources.
Why Ask About Social Determinants of Health?
Asking about SDOH helps to:
- Provide Holistic Care: Move beyond purely clinical symptoms to understand the full context of a person's health.
- Identify Barriers to Care: Uncover challenges like food insecurity, transportation issues, or housing instability that impact treatment adherence and overall health.
- Tailor Interventions: Develop more effective, personalized care plans that address root causes.
- Improve Health Equity: Address systemic inequalities that contribute to health disparities.
- Strengthen Trust: Show empathy and build stronger relationships by acknowledging the broader challenges individuals face.
Starting the Conversation: General Approaches
Initiating a conversation about SDOH requires sensitivity and a patient-centered approach. Begin with broad questions that encourage individuals to share their experiences without feeling interrogated.
Effective conversation starters include questions like:
- "What are some things that may get in the way of us being able to follow this plan?"
- "What are some ways in which you might find some help or support in following this plan?"
These types of questions can naturally lead to discussions about various aspects of a person's life that influence their ability to manage their health, paving the way for more specific inquiries.
Key Principles for Asking About SDOH
To ensure a productive and empathetic discussion, keep these principles in mind:
- Build Trust: Establish a safe, confidential, and non-judgmental space.
- Use Open-Ended Questions: Encourage detailed responses beyond a simple "yes" or "no."
- Listen Actively: Pay attention to verbal and non-verbal cues, allowing the individual to lead the narrative.
- Be Empathetic and Respectful: Validate their experiences and acknowledge their challenges.
- Focus on Strengths: Inquire about their coping mechanisms and support systems.
- Normalize the Discussion: Explain that these questions help understand their full picture and connect them to support.
- Be Prepared with Resources: Know where to refer individuals for assistance based on their needs.
Specific Areas and Example Questions
Here's a structured approach to asking about different domains of social determinants of health, often categorized by organizations like the Centers for Disease Control and Prevention (CDC):
1. Economic Stability
This domain addresses issues related to income, employment, debt, and food security.
| Aspect | Example Questions |
|---|---|
| Employment | "Are you currently employed? Does your work schedule make it difficult to attend appointments?" |
| Income | "Do you feel financially secure? Are you able to pay for necessities like food and rent?" |
| Food Security | "In the past year, have you worried about running out of food or not having enough healthy options?" |
| Housing Stability | "Do you have a safe and stable place to live? Are you concerned about eviction or homelessness?" |
2. Education Access and Quality
This domain covers opportunities for education, literacy, and early childhood development.
- "How far did you go in school?"
- "Do you feel that you have the information you need to make decisions about your health?"
- "Is there anything that makes it hard for you or your family to access quality education?"
3. Health Care Access and Quality
This domain examines access to healthcare services, health insurance, and culturally competent care.
- "Do you have health insurance? Is it usually easy to get to your appointments?"
- "What challenges, if any, do you face in getting the medical care or medications you need?"
- "Do you have a regular doctor or clinic you visit?"
4. Neighborhood and Built Environment
This domain includes aspects like housing, transportation, access to healthy foods, green spaces, and neighborhood safety.
| Aspect | Example Questions |
|---|---|
| Transportation | "How do you typically get to appointments? Is transportation a challenge for you?" |
| Housing Condition | "Do you feel safe and comfortable in your home? Are there any issues like mold or pests?" |
| Neighborhood Safety | "Do you feel safe in your neighborhood? Are there safe places for you to walk or exercise?" |
| Access to Resources | "Is it easy for you to access healthy foods or places to buy fresh groceries?" |
5. Social and Community Context
This domain involves social cohesion, civic participation, discrimination, and social support.
- "Do you have friends, family, or community members you can rely on for support?"
- "Do you feel connected to your community?"
- "Have you experienced discrimination or unfair treatment that impacts your well-being?"
- "What kind of activities do you participate in that bring you joy or a sense of belonging?"
Practical Tips for Implementation
- Integrate into Routine: Incorporate SDOH questions into standard intake forms or initial assessments.
- Training for Staff: Ensure all staff members are trained on how to ask these questions sensitively and how to respond appropriately.
- Resource Mapping: Create a comprehensive list of local community resources for housing, food, transportation, mental health, and other needs. Many organizations offer screening tools and resource directories, such as the Association of American Medical Colleges (AAMC) Social Determinants of Health resources.
- Follow-Up: Always follow up on identified needs and referrals to ensure individuals receive the support they require.
By thoughtfully asking about social determinants of health, healthcare providers and support staff can move towards a more equitable and effective system of care, addressing not just symptoms but the foundational elements of health and well-being.
