Social determinants of health screening tool: Systematic review and Delphi study

BACKGROUND: Social determinants of health (SDOH) critically influence population and individual-level outcomes, but we do not collect this information routinely in primary care. 

AIM: To develop a screening tool for SDOH relevant to UK settings using systematic review and Delphi methodology to identify suitable questions. 

DESIGN & SETTING: A systematic review and Delphi study were undertaken. 

METHOD: For the systematic review, five databases and grey literature were searched. Selected studies included questions or tools that screened for SDOH relevant to UK settings. Included questions and tools were measured against the eight gold standard steps for measure development. Data were thematically analysed and arranged into pre-specified domains. For the Delphi study, individuals with an interest in SDOH were invited to take part in a three-stage modified Delphi study. Ranking of 172 items in survey 1, rating of 111 items in survey 2, and ranking of 56 items in survey 3 led to one question being selected per 10 pre-specified domains. Inductive content analysis of free-text responses from the surveys was performed. 

RESULTS: Of 7889 citations, 104 studies were included in the systematic review. Screening primarily took place in clinical settings using written formats. Seven participants took part in the first Delphi survey. Prioritised questions were direct, had binary answers, had specific wording, were concerned with current situation, and had immediate impacts on health. 

CONCLUSION: The review provides a comprehensive overview of screening questions and tools for collecting information on SDOH. We present a 10-item screening tool from the highest ranked questions that can be used to screen for SDOH in primary care settings in the UK.