Understanding social needs: Maven’s research on social determinants of health screening

Social determinants of health (SDOH)—like housing, education, and systemic racism—play an outsized role in pregnancy outcomes, leading to vast inequities and disparities among races, classes, and geographies. According to the World Health Organization, social determinants of health account for 30-55% of health outcomes.

To improve these outcomes, health systems and plans seek the best approaches to identify and manage unmet social needs. However, SDOH screenings often burden members, and many providers lack the resources to provide meaningful follow-up care to those with unmet social needs. What’s more, little is known about individual preferences for integrating medical care and social services. 

As the leading digital family health company, Maven’s clinical research team tested innovative ways to make SDOH screening for identifying social needs more effective, efficient, and patient-centered. We conducted a survey examining the effectiveness of shorter screeners and individuals’ preferences and attitudes towards addressing social needs with their maternity care team. Our findings were published in AJOG Global Reports.

Many pregnant and postpartum people face unmet social needs

Social determinants of health can affect every individual, and pregnant people and parents are no exception. In our study, we found that 66% of pregnant people with private insurance had an unmet social need. The number only increased for those with public insurance, with 89% of participants reporting at least one unmet social need. Of these respondents, they reported a range of needs:

• 43% need supplies for their babies and families
• 41% experience social isolation
• 38% feel uncertainty about their employment

To address how SDOH impact pregnant people and parents, they first need to be identified. But because each individual’s circumstances and reactions to them differ, doing so on a large scale has been a challenge for health plans and providers. A 2019 JAMA study found that only 24% of hospitals screened for social determinants of health, meaning that the vast majority of people don’t get an opportunity to share their needs with their providers. The numbers are even smaller in pregnancy. 

Addressing shortcomings of SDOH screening

Because our providers and Care Advocates interact with members every day, Maven’s clinical research team recognized the opportunity to study how digital health could improve SDOH screening. Here’s what our recent studies found:

Understanding people’s willingness to complete SDOH screening

Some argue that people’s unwillingness to report on their social needs limits the effectiveness of SDOH initiatives. In our study, Maven set out to determine individuals’ openness to discussing their social needs with their providers. We examined social needs in two categories: material needs, which included needs for food, housing, and other tangible resources; and support needs, which included needs around caregiving, as well as flags for loneliness and feeling unsafe. We found that:

• Over 80% of pregnant people or recent parents say it’s important for their care team to know their material needs (81%) and support needs (93%)
• Over 85% of the same group say they are comfortable sharing their social needs with their care team
• Over 55% say that they’re comfortable sharing their social needs with their provider, even if their care team can’t help meet them

These results clearly show that people want to discuss their social needs with their care team. For many people, this remains true even if the care team is unable to connect them to community resources to address their unmet needs. These findings may show that individuals need a different kind of help. In open-ended responses, people reflected a desire for their provider to show empathy or reach out, showing that support can be provided even in the absence of concrete resources. 

Eliminating burdensome screening tools with short-form screeners

Many SDOH screeners used by health plans today are long and burdensome, asking respondents over 20 questions about their health needs outside of physical health. Instead, Maven developed a three-question screener to see if it adequately captured the same range of social needs. Participants in the study completed both the longer, industry-standard survey (PRAPARE) and the shorter Maven version. Comparing responses on the two versions, we found that 89% reported overall social needs through PRAPARE survey, and 81% reported the same through the Maven survey. 

Given these findings, shorter screeners—like Maven’s three-question survey—can be a useful tool in determining individuals’ social needs while avoiding the need for lengthy screeners that require a greater time commitment from members and providers. 

Encouraging equity during SDOH screening 

As people with unmet social needs face the greatest barriers to care and the worst health outcomes, it’s essential to ensure that SDOH screening methods don’t exacerbate existing inequities. Our study set out to discover SDOH screening preferences among different groups. Overall, there were few differences among the groups’ screening preferences, and rates of acceptability were high for all methods of screening, including text, email, app, care team conversation, and non-medical health worker conversation. However, respondents did indicate subtle preferences and concerns:

• People with social needs, like housing insecurity or isolation, had a greater preference for SMS text screening and indicated that they are more concerned about retribution for sharing their needs compared to those without social needs. 
• People with public insurance also had a greater preference for SMS text screening and reported they were concerned about providers judging them for their responses. This group was also more likely to believe that the care team can help with SDOH needs, compared to those who have private insurance. 
• Black respondents indicated a lower preference for having a face-to-face conversation with their care team about their social needs compared to white participants. Black pregnant people and parents also indicated increased concern about provider judgment and were less likely to believe that their care team can help with social needs. 

When screening for social needs, these sentiments should be taken into consideration to maximize the benefit of SDOH surveys. Providing multiple ways to communicate with the care team during and after screening can ensure that varied member preferences are met. Additionally, care teams should work to respect members’ privacy and mitigate concerns about negative consequences.

Read the full study in AJOG Global Reports

Explore how Maven can support your members

Maven is the leading partner for health plans looking to provide equitable care to members on their path to and through parenthood. Our comprehensive program includes proactive check-ins, ongoing assessments, community support, and human touchpoints, helping members identify risks early, increase positive outcomes, and prevent expensive complications. Ready to provide the next level of family health care to your members? Contact us today.