"It would be a burden off my back": Veterans' perceptions of social risk and needs screening acceptability

BACKGROUND: Many health systems seek to identify social risks (individual-level social and economic conditions such as food insecurity, financial strain) and address needs. However, the impact of these efforts relies in part on patient acceptability of screening. 

OBJECTIVE: To investigate the acceptability of social risk and needs screening among Department of Veterans Affairs (VA) patients, including suggestions to optimize screenings. 

DESIGN: Qualitative study 

PARTICIPANTS: Veterans who endorsed ≥ 1 social risk in a national VA survey (administered March-June 2024) and agreed to a follow-up interview. 

APPROACH: We conducted semi-structured interviews informed by the Theoretical Framework of Acceptability (TFA), which describes seven determinants (italicized below) of an intervention's acceptability based on recipients' anticipated or experienced cognitive and emotional responses. We used rapid directed content analysis to analyze patient preferences and recommendations. 

KEY RESULTS: Interviews (n = 25) took place July-October 2024. Affective attitudes about social risk and needs screening were dependent on resource receipt after screening. Burden was low, contingent on screening not interfering with health care visit goals. Ethicality of screening aligned with Veterans' core values of serving those who served; however, staff must explain how screenings are part of VA health care for Veterans to feel comfortable disclosing needs. In terms of Intervention coherence, Veterans wanted clarification on how social risks impact health. Opportunity costs did not outweigh screening benefits; however, Veterans worried that sensitive information could be used against them. Effectiveness was anticipated if VA provided timely and appropriate resources. Self-efficacy can be optimized by having designated VA staff provide guidance and varied ways of accessing resources. 

CONCLUSIONS: Veterans found social risk and needs screening to be acceptable. Suggestions to optimize screening included explaining its purpose and relevance to health, offering appropriate resources in response to disclosed needs, and designating a point of contact and multiple avenues to access support.