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      Screening for social determinants of health in clinical care: moving from the margins to the mainstream

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          Abstract

          Background

          Screening for the social determinants of health in clinical practice is still widely debated.

          Methods

          A scoping review was used to (1) explore the various screening tools that are available to identify social risk, (2) examine the impact that screening for social determinants has on health and social outcomes, and (3) identify factors that promote the uptake of screening in routine clinical care.

          Results

          Over the last two decades, a growing number of screening tools have been developed to help frontline health workers ask about the social determinants of health in clinical care. In addition to clinical practice guidelines that recommend screening for specific areas of social risk (e.g., violence in pregnancy), there is also a growing body of evidence exploring the use of screening or case finding for identifying multiple domains of social risk (e.g., poverty, food insecurity, violence, unemployment, and housing problems).

          Conclusion

          There is increasing traction within the medical field for improving social history taking and integrating more formal screening for social determinants of health within clinical practice. There is also a growing number of high-quality evidence-based reviews that identify interventions that are effective in promoting health equity at the individual patient level, and at broader community and structural levels.

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          Most cited references 54

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          Reducing violence using community-based advocacy for women with abusive partners.

          An intensive community-based advocacy intervention was designed and evaluated by randomly assigning 278 battered women to an experimental or control condition. Participants were interviewed 6 times over a period of 2 years. Retention rate averaged 95% over the 2 years. The 10-week postshelter intervention involved providing trained advocates to work 1-on-1 with women, helping generate and access the community resources they needed to reduce their risk of future violence from their abusive partners. Women who worked with advocates experienced less violence over time, reported higher quality of life and social support, and had less difficulty obtaining community resources. More than twice as many women receiving advocacy services experienced no violence across the 2 years postintervention compared with women who did not receive such services.
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            Absence of evidence is not evidence of absence.

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              Implementing successful intimate partner violence screening programs in health care settings: evidence generated from a realist-informed systematic review.

              We undertook a synthesis of existing studies to re-evaluate the evidence on program mechanisms of intimate partner violence (IPV) universal screening and disclosure within a health care context by addressing how, for whom, and in what circumstances these programs work. Our review is informed by a realist review approach, which focuses on program mechanisms. Systematic, realist reviews can help reveal why and how interventions work and can yield information to inform policies and programs. A review of the scholarly literature from January 1990 to July 2010 identified 5046 articles, 23 of which were included in our study. We identified studies on 17 programs that evaluated IPV screening. We found that programs that took a comprehensive approach (i.e., incorporated multiple program components, including institutional support) were successful in increasing IPV screening and disclosure/identification rates. Four program components appeared to increase provider self-efficacy for screening, including institutional support, effective screening protocols, thorough initial and ongoing training, and immediate access/referrals to onsite and/or offsite support services. These findings support a multi-component comprehensive IPV screening program approach that seeks to build provider self-efficacy for screening. Further implications for IPV screening intervention planning and implementation in health care settings are discussed. Copyright © 2011 Elsevier Ltd. All rights reserved.
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                Author and article information

                Contributors
                anne.andermann@mail.mcgill.ca
                Journal
                Public Health Rev
                Public Health Rev
                Public Health Reviews
                BioMed Central (London )
                0301-0422
                2107-6952
                22 June 2018
                22 June 2018
                2018
                : 39
                Affiliations
                [1 ]ISNI 0000 0004 1936 8649, GRID grid.14709.3b, St Mary’s Research Centre, , McGill University, ; Montréal, Canada
                [2 ]ISNI 0000 0004 1936 8649, GRID grid.14709.3b, Department of Family Medicine and Department of Epidemiology, Biostatistics and Occupational Health, , McGill University, ; Montréal, Canada
                Article
                94
                10.1186/s40985-018-0094-7
                6014006
                © The Author(s). 2018

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;
                Funded by: FundRef http://dx.doi.org/10.13039/501100000156, Fonds de Recherche du Québec - Santé;
                Funded by: FundRef http://dx.doi.org/10.13039/501100004828, Grand Challenges Canada;
                Funded by: St Mary's Research Centre
                Categories
                Review
                Custom metadata
                © The Author(s) 2018

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