IMAGINE: A Trial of Messaging Strategies for Social Needs Screening and Referral.

INTRODUCTION: Health-related social needs are associated with poor health outcomes. Many primary care practices now screen and refer patients with health-related social needs to assistance organizations, but some patients decline screening or assistance. Improving communication about health-related social needs screening and referral could increase screening response and assistance acceptance rates. STUDY DESIGN: This is a pragmatic, nonrandomized 3-stage trial of messages and communication strategies for health-related social needs screening and referral. Messages and strategies were informed by qualitative analysis of stakeholder interviews and were developed through an iterative, patient-, and stakeholder-engaged process. SETTING/PARTICIPANTS: Settings included 3 primary care clinics serving primarily low-income patients in western Colorado. INTERVENTION: Stage 1 includes usual clinic processes for health-related social needs screening (form given to patients at the front desk without additional explanation), Stage 2 includes adding written patient-friendly messages regarding the purpose of health-related social needs screening and referral to usual clinic processes, and Stage 3 includes adding verbal messages delivered by a medical assistant (form given to patients by a medical assistant during the rooming process). MAIN OUTCOME MEASURES: Primary outcomes include (1) screening form response rate and (2) acceptance of referral for assistance rate among patients with health-related social needs. Secondary outcomes include (1) comfort with screening, (2) perceived helpfulness of screening, and (3) receipt of explanation about screening. RESULTS: All data collection and analysis occurred in 2021. Study Stage 2 was not associated with significant changes in any outcomes. Stage 3 was associated with decreased odds of screening form response at 2 of the 3 clinics relative to those of Stage 1 (OR=0.1, 95% CI=0.1, 0.3; OR=0.4, 95% CI=0.2, 0.7) but with increased odds of assistance acceptance (OR=2.1, 95% CI=1.1, 4.0) among patients with needs who responded to the screening form. Stage 3 was also associated with higher odds of patients perceiving screening as helpful and receiving an explanation about screening. CONCLUSIONS: Altering practice workflows to provide verbal explanations of health-related social needs screening may reduce response rates but may encourage responders to accept assistance referrals. Optimal communication strategies and workflows will likely differ depending on the intended goals of health-related social needs screening and referral.

Growing PEACHnet: Building a Practice-Based Research Network in Western Colorado.

INTRODUCTION: Practice-based research networks (PBRNs) have long sought to engage with communities and address questions relevant to multiple stakeholders and real-world primary care practice. Topic-generating processes that involve these stakeholders are crucial for identifying these questions. PBRNs often focus on certain populations or geographic areas. We are forming a new PBRN to address the health concerns and research interests of people in communities in Western Colorado. METHODS: To engage with and determine the questions important to multiple stakeholders in communities in western Colorado, we conducted community meetings at which we used Photovoice followed by Nominal Group Technique in group discussions across the region. We then conducted a survey to develop a list of priority research topics. RESULTS: Multiple stakeholders were ready and eager to engage with us to form a PBRN. Across all communities, many of the topics that emerged were related to the social determinants of health. Mental health-specifically, lack of access to services and high suicide incidence-was the most important topic according to community members. This was consistent across groups of stakeholders and corroborated other community work such as Community Health Needs Assessments. DISCUSSION: Using participatory methods increased our stakeholder engagement and helped build strong community-academic partnerships for our PBRN-related research. Use of Photovoice allowed all participants to express their thoughts and ideas and led to a clear path forward for this new research network.

Multistakeholder Perspectives on Data Sharing to Address Patient Food Insecurity.

BACKGROUND: Social determinants of health (SDOH) influence health outcomes. Food insecurity (FI) is the most common need related to SDOH. Many primary care practices and health systems have begun to screen for FI and refer patients to resources. How this process is viewed by multiple stakeholders, including patients, health care workers, and staff at food assistance organizations (FAOs), will influence its impact. METHODS: In this mixed-methods study, we completed 42 interviews with individuals from the 3 stakeholder groups. We then conducted a survey with 126 respondents using questions developed from the qualitative results. RESULTS: All stakeholders recognized the impact FI has on health outcomes, but perspectives varied on the value of sharing information through referrals to FAOs and concerning receipt of services, including privacy concerns and that the process would require significant work and not necessarily improve FI. DISCUSSION: Stakeholders agree that FI impacts health but have differences in perceptions around screening and referral done in health care settings. Perspectives of multiple stakeholders need to be considered when designing these systems. CONCLUSION: Successfully designing systems to address FI through referral to FAOs requires input of multiple stakeholders because perspectives on the value and work required for this process vary.