Research letter: Scoping review of the protocol for responding to and assessing patient assets, risks, and experiences (PRAPARE®) to evaluate social determinants of health among persons with TBI

OBJECTIVE: Social determinants of health (SDoH) affect health care access and outcomes. Screening for SDoH is needed to advance health care equity for persons with traumatic brain injury (TBI). The purpose of this scoping review was to examine whether the Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences (PRAPARE®), can be used successfully with persons with more severe TBI (ie, TBI of sufficient severity to require inpatient rehabilitation). We sought to determine whether the tool had been previously used with persons with TBI (or similar populations) and if any difficulties were encountered and/or if any accommodations were provided to foster completion. We also sought to determine whether findings were relevant to improving health care access for persons with TBI. We sought input from persons with TBI regarding difficulties or discomfort with responding to the questions. 

SETTING: Community. 

DESIGN: Scoping review of the literature from 2014 through December 21, 2023, using 8 databases. During the last stage, we sought input from 17 persons living with TBI. 

MAIN MEASURES: PRAPARE®. 

RESULTS: After screening 140 articles, the scoping review identified 2 studies meeting the inclusion criteria. These studies included patients with glioma (n = 100) and with chronic conditions (n > 7000). No study specified inclusion of persons with TBI. The glioma study allowed for assistance by another person. While the participants in the glioma study were low risk, the study of persons with chronic conditions found that persons with a greater comorbidity burden were more likely to be from socioeconomically disadvantaged or racial/ethnic minoritized backgrounds and have transportation and childcare needs. Input from persons with TBI suggested items are generally well understood. Six items presenting with minor challenges may require accommodations during administration. 

CONCLUSIONS: PRAPARE® may be used with individuals with TBI to screen for social SDoH. Screening considerations include respect of privacy, an individual's choice and priorities, availability of resources, being trauma-informed, and clarifying items that are sensitive and/or difficult to understand.