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A randomized trial on screening for social determinants of health: The iScreen Study

L. Gottlieb, D. Hessler, D. Long, A. Amaya, N. Adler
Pediatrics

Background: There is growing interest in clinical screening for pediatric social determinants of health, but little evidence on formats that maximize disclosure rates on a wide range of potentially sensitive topics. We designed a study to examine disclosure rates and hypothesized that there would be no difference in disclosure rates on face-to-face versus electronic screening formats for items other than highly sensitive items.

Methods: We conducted a randomized trial of electronic versus face-to-face social screening formats in a pediatric emergency department. Consenting English-speaking and Spanish-speaking adult caregivers familiar with the presenting child's household were randomized to social screening via tablet computer (with option for audio assist) versus a face-to-face interview conducted by a fully bilingual/bicultural researcher.

Results: Almost all caregivers (96.8%) reported at least 1 social need, but rates of reporting on the more sensitive issues (household violence and substance abuse) were significantly higher in electronic format, and disclosure was marginally higher in electronic format for financial insecurity and neighborhood and school safety. There was a significant difference in the proportion of social needs items with higher endorsement in the computer-based group (70%) than the face-to-face group (30%).

Conclusions: Pediatric clinical sites interested in incorporating caregiver-reported socioeconomic, environmental, and behavioral needs screening should consider electronic screening when feasible, particularly when assessing sensitive topics such as child safety and household member substance use.

Gottlieb L, Hessler D, Long D, Amaya A, Adler N. A randomized trial on screening for social determinants of health: The iScreen Study. Pediatrics. 2014;134(6):e1611-1618. PMID: 25367545. DOI: 10.1542/peds.2014-1439.

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Publication year
Resource type
Peer Reviewed Research
Outcomes
Process
Population
Children and Youth
Screening research
Yes
Social Determinant of Health
Childcare
Economic Security
Food/Hunger
Health Care Access
Housing Quality
Housing Stability
Immigration
Public Benefits
Violence/Safety
Study design
Randomized Controlled Trial (RCT)
Keywords