Measuring patient experience to promote health equity: Development and validation of the patient experience of social needs screening questionnaire

INTRODUCTION: Screening for social determinants of health (SDOH) is a critical strategy to advance health equity among underserved and vulnerable populations. Despite growing adoption, few validated, quantitative tools exist to measure patients' experiences with screening tools and clinical workflows. The Patient Experience of Social Needs Screening (PESNS) questionnaire was developed to fill this gap. 

OBJECTIVE: To develop and validate a 9-item PESNS questionnaire to measure patient perceptions of SDOH screening tools and workflows in ambulatory, inpatient, and emergency department settings, with a focus on supporting health equity and patient-centered care. 

METHODS: A comprehensive literature review informed the development of 27 constructs. Using a modified Delphi process with eight experts, 29 preliminary items were refined across four rounds, resulting in a final 9-item questionnaire. Spanish translation followed best practices, including cognitive testing with six patients. The PESNS questionnaire was administered via telephone to 262 Medicare and Medicaid patients. Principal component analysis, exploratory factor analysis, and polychoric correlations assessed construct validity. Internal consistency was measured using Cronbach's α. 

RESULTS: Two components emerged-Enhancing User Experience Essentials and Patient-Centered User Experience-accounting for 60% of variance. Cronbach's α was 0.841 overall, with factors 1 and 2 scoring 0.790 and 0.848, respectively. All items showed acceptable correlations (0.438-0.669), supporting scale reliability and construct validity. Component 1 captures the usability and effectiveness of the PESNS questionnaire, and Component 2 assesses privacy and environmental comfort. These dimensions align with health equity goals by highlighting patient-centered barriers and facilitators to SDOH screening. 

Conclusion: The PESNS questionnaire offers a reliable, valid, and equity-focused tool to assess patient experience with SDOH screening. Its adoption can inform quality improvement and support more inclusive and effective health care delivery.