Centering multilingual patient voices in the co-design of a health-related social needs screening tool in an urban safety-net hospital

BACKGROUND: Health-related social needs (HRSNs) such as housing instability, food insecurity, and transportation barriers are associated with adverse health outcomes and disproportionately affect racially and ethnically marginalized populations. Despite federal mandates and increased investments in screening infrastructure, HRSN screening tools are often implemented without sufficient patient input, potentially reducing engagement and reinforcing stigma. 

OBJECTIVE: To describe a community-participatory process evaluation to co-design a HRSN screening tool with patients in a linguistically diverse safety-net setting. 

METHODS: Between February and August 2023, Boston Medical Center conducted six community-participatory design sessions with 37 patients who speak English, Spanish, and Haitian Creole. Participants reviewed the existing hospital HRSN screener (THRIVE), completed a mock form, and provided feedback on language, usability, layout, and cultural relevance. Sessions were facilitated by bilingual staff and supported with printed materials in English, Spanish, and Haitian Creole, plain-language summaries, and real-time documentation. 

RESULTS: Three themes emerged across groups: (1) trust and psychological safety, (2) clarity and usability, and (3) cultural and contextual relevance. Participants emphasized transparency, simplified language, and culturally sensitive framing as key to improving engagement. 

CONCLUSION: Community-participatory design is a promising approach to improve the relevance, equity, and effectiveness of HRSN screening in clinical settings serving diverse populations.