Implementation of social needs screening in primary care: a qualitative study using the health equity implementation framework.

BACKGROUND: Screening in primary care for unmet individual social needs (e.g., housing instability, food insecurity, unemployment, social isolation) is critical to addressing their deleterious effects on patients' health outcomes. To our knowledge, this is the first study to apply an implementation science framework to identify implementation factors and best practices for social needs screening and response. METHODS: Guided by the Health Equity Implementation Framework (HEIF), we collected qualitative data from clinicians and patients to evaluate barriers and facilitators to implementing the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE), a standardized social needs screening and response protocol, in a federally qualified health center. Eligible patients who received the PRAPARE as a standard of care were invited to participate in semi-structured interviews. We also obtained front-line clinician perspectives in a semi-structured focus group. HEIF domains informed a directed content analysis. RESULTS: Patients and clinicians (i.e., case managers) reported implementation barriers and facilitators across multiple domains (e.g., clinical encounters, patient and provider factors, inner context, outer context, and societal influence). Implementation barriers included structural and policy level determinants related to resource availability, discrimination, and administrative burden. Facilitators included evidence-based clinical techniques for shared decision making (e.g., motivational interviewing), team-based staffing models, and beliefs related to alignment of the PRAPARE with patient-centered care. We found high levels of patient acceptability and opportunities for adaptation to increase equitable adoption and reach. CONCLUSION: Our results provide practical insight into the implementation of the PRAPARE or similar social needs screening and response protocols in primary care at the individual encounter, organizational, community, and societal levels. Future research should focus on developing discrete implementation strategies to promote social needs screening and response, and associated multisector care coordination to improve health outcomes and equity for vulnerable and marginalized patient populations.

An evaluation of mHealth adoption and health self-management in emerging adulthood.

This study offers a description of factors that predict the adoption of mobile health technologies (mHealth) and their application for health self-management in emerging adults. Primary data collection occurred at three diverse postsecondary educational institutions (N= 1,329). The analysis used a logistic regression to identify predictors of mHealth adoption. Descriptive analyses are presented on health self-management applications and perceived ease of use and effectiveness. Use of mHealth was high in respondents (58.5%). Factors associated with increased likelihood of mHealth adoption included being female, overweight or obese, having a chronic condition, eating the recommended amount of daily fruit, and engaging in regular moderate exercise. Low household income was associated with being less likely to use mHealth. The most common self-management application for mHealth was for tracking physical activity. Findings related to ease of use and effectiveness ratings by applications may provide insight into designing more effective mHealth tools in this population.