Feasible and acceptable social drivers of health screening among patients with chronic liver disease

BACKGROUND: Social drivers of health (SDoH) contribute to health disparities among patients with chronic liver disease (CLD). Little is known about the feasibility and acceptability of SDoH screening in hepatology clinics. This study aimed to define SDoH prevalence among CLD patients, identify a feasible and acceptable screening approach, and assess the convergent validity of a locally developed screener. 

METHODS: Among adult patients with CLD receiving care in hepatology clinics, 2 SDoH screeners were administered to eligible participants: (1) default electronic medical record (EMR) questions and (2) Screener for Intensifying Community Referrals for Health (SINCERE). The primary outcomes were (1) prevalence of SDoH, (2) SDoH screening feasibility and acceptability, and (3) factors associated with screening acceptability. As a secondary outcome, the convergent validity of SINCERE to EMR was assessed. 

RESULTS: Among 250 participants, the mean age was 56 years, 56% were women, 22% were Hispanic, 7% were American Indian/Alaska Native, 58% had cirrhosis, 29% completed high school or less, 22% were unemployed/disabled, and 29% had an annual income <$35,000. Based on SINCERE, 26% had food insecurity, 8% transportation needs, 43% financial strain, 5% lack of social support, and 24% housing instability. Most respondents (69%) were comfortable or very comfortable completing SDoH screening. Using the McNemar test, there were statistically significant differences between screeners for financial strain and housing instability. 

CONCLUSIONS: Among CLD patients at our center, SDoH were prevalent, and screening within the hepatology clinic was feasible and acceptable. To detect social needs, SINCERE, a locally developed screener, had overall acceptable convergent validity. These data support SDoH screening in hepatology clinics. Future multicenter studies evaluating the effective implementation of SDoH screening for CLD patients, including contextualized care plans and connection to available resources, should be conducted.