Table 3 HEIF domains and summary of key points

Characteristics of the Innovation

Characteristics related to the evidence-based approach: (in this case) both the PRAPARE screening and response protocols and any ongoing case management. Includes being simple or intuitive (Ease of Use) or beneficial or useful (Effectiveness), and how the integration of patient preferences and amount of time (Time) affected usability (Patient Preferences).

Patients appreciated the timing and convenience of the social needs screening, often inserted between encounters with clinicians; however, additional administrative responsibilities were time-consuming for clinicians.

Accurate and up-to-date information about community resources enabled a timely and tailored referral response to identified social needs.

Clinical Encounter

The clinical encounter or workflows that led to interaction between patient and provider or between recipients. These delivery mechanisms are of particular importance to vulnerable populations due to their unique characteristics or preferences for engagement.

Empathetic communication and rapport between patients and clinicians helped patients to feel comfortable with sharing their social needs.

Establishing rapport and trust during the clinical encounter facilitated patient acceptance of referrals in response to identified social needs.

Patient Factors

Patient-specific factors that affect implementation, including the individual’s beliefs, acceptability, privacy concerns, situation, preferences for communication or engagement, and attitudes towards relevant stakeholders or institutions.

Patients viewed social needs screening as not only an acceptable but an essential and appropriate component of high-quality, patient-centered care.

The co-occurrence of various social and medical conditions complicated the process of accessing services for patients and of making referrals for clinicians.

Provider Factors

Factors specific to the provider or care team including methods or techniques used to screen and respond for social needs (Methods of Communication); implementation considerations related to treatment, care planning, and addressing medical needs (Treatment); clinical techniques utilized during PRAPARE administration (Clinical Training); and provider beliefs regarding the role, purpose, and characteristics of the PRAPARE, or delivery style (Provider Beliefs).

Clinicians expressed that the overall goals of social needs screening aligned with their professional goals and that patient engagement techniques from their clinical training were integral to its effective administration.

Clinicians’ knowledge of and familiarity with available community resources facilitated social needs response.

Context

Inner context factors include formal policies, previous experiences, or descriptions of political, social, or economic implementation drivers associated with the clinic, community based organizations, or locally administered social services. Outer context factors include engagement with health care systems at large or factors associated with access, quality, or institutional policies.

Sustainable screening processes required clinician perspectives to be incorporated into organizational decisions regarding screening workflows, compatibility with current workloads, and design of the screening assessment.

Staffing and time constraints strained clinicians’ efforts to manage a wide range of responsibilities while providing high-quality patient care. Fragmentation between health care systems also hindered care coordination.

Societal Influence

A description of factors that affect implementation but are subject to larger, structural forces including stigma, discrimination, societal expectations, economic policy, and/or political climate.

The appropriateness and effectiveness of screening depended on the availability of community resources to address identified social needs.

Structural inequities and scarcities in resource distribution impeded social needs response in specific domains such as housing. Administrative burden, means testing, and discrimination often prevented patients from accessing services.