PRP187: Using a PRECEDE-PROCEED Framework to Evaluate Social Determinants of Health Screening Tool Use in Primary Care

Ronan Cox, BA; Kerianne Chandler, MPH; Rhiana Thomas, BA; Rachel Ceballos; Mary Scott, PhD; Ivan de la Rosa


CONTEXT: Social determinants of health (SDH), such as food security, employment, housing, and access to health care, are strongly associated with poor health outcomes. While research on SDH screening tools in primary care has increased in recent years, there is limited investigation on the training that medical professionals receive. Moreover, few studies examine both patient and health care professional perspectives on how SDH screening instruments are integrated into regular patient care. OBJECTIVE: This research in progress uses the PRECEDE-PROCEED framework to identify factors that contribute to the patient-centered use of an SDH screening tool and subsequent referrals by primary care residents in a Latino-serving primary care clinic. The study identifies predisposing, enabling, and reinforcing factors that can affect the attitudes, behaviors, and environment of health care professionals who implement the screening tool during clinical encounters. STUDY DESIGN: Qualitative study using semi-structured interviews. Data analysis included two rounds of coding. First-round inductive, line-by-line thematic coding was followed by second-round deductive analytic coding using the PRECEDE-PROCEED model framework to identify predisposing, enabling, and reinforcing factors facilitate or limit the use of an SDH screening tool. SETTING: a primary care training clinic serving a large Latino and immigrant population in the U.S. Southwest. The county where the study is conducted includes urban and rural settings with cities, towns, villages, and many unincorporated communities that are all designated as medically underserved areas. POPULATION STUDIED: All residents, attending faculty, nurses, and medical assistants in a primary care residency program were eligible to participate. Any patients of participating residents or faculty members with clinic appointments during the time of the study were eligible to participate. This analysis includes five attending faculty, six residents, one nurse, and sixty-five patients. OUTCOME MEASURES: This exploratory study focused on identifying predisposing, enabling, and reinforcing factors that constitute barriers or facilitators to the use of the SDH screening tool for patients and health care professionals. Preliminary analysis of the data indicates that while patients and health care professionals recognize social needs as important to health, there is variability in perspectives and attitudes towards the use of a screening tool

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