Validation of a standardised approach to collect sociodemographic and social needs data in Canadian primary care: Cross-sectional study of the SPARK tool

OBJECTIVE: This study validates the previously tested Screening for Poverty And Related social determinants to improve Knowledge of and access to resources ('SPARK Tool') against comparison questions from well-established national surveys (Post Survey Questionnaire (PSQ)) to inform the development of a standardised tool to collect patients' demographic and social needs data in healthcare. DESIGN: Cross-sectional study. 

SETTING: Pan-Canadian study of participants from four Canadian provinces (SK, MB, ON and NL). 

PARTICIPANTS: 192 participants were interviewed concurrently, completing both the SPARK tool and PSQ survey. 

MAIN OUTCOMES: Survey topics included demographics: language, immigration, race, disability, sex, gender identity, sexual orientation; and social needs: education, income, medication access, transportation, housing, social support and employment status. Concurrent validity was performed to assess agreement and correlation between SPARK and comparison questions at an individual level as well as within domain clusters. We report on Cohen's kappa measure of inter-rater reliability, Pearson correlation coefficient and Cramer's V to assess overall capture of needs in the SPARK and PSQ as well as within each domain. Agreement between the surveys was described using correct (true positive and true negative) and incorrect (false positive and false negative) classification. RESULTS: There was a moderate correlation between SPARK and PSQ (0.44, p<0.0001). SPARK correctly classified 71.4% of participants with or without a social need. There was strong agreement with most demographic questions. SPARK correctly classified 74.3% of participants as having financial insecurity. Clustering financial security questions had fewer false negatives (6.4%, n=11/171 vs 9.9%, n=17/171) and more false positives (19.3%, n=33/171 vs 11.1%, n=19/171) when compared with the question 'difficulty making ends meet'. When looking specifically at participants with high UCLA loneliness scores (>60), SPARK correctly classified 90.5% (n=176/191). 

CONCLUSIONS: SPARK provides a brief 15 min screening tool for primary care clinics to capture social and access needs. SPARK was able to correctly classify most participants within each domain. Related ongoing research is needed to further validate SPARK in a large representative sample and explore primary care implementation strategies to support integration.