Although it is known that the social determinants of health have a larger influence on health outcomes than health care, there currently is no structured way for primary care providers to identify and address nonmedical social needs experienced by patients seen in a clinic setting. We developed and piloted WellRx, an 11-question instrument used to screen 3048 patients for social determinants in 3 family medicine clinics over a 90-day period. Results showed that 46% of patients screened positive for at least 1 area of social need, and 63% of those had multiple needs. Most of these needs were previously unknown to the clinicians. Medical assistants and community health workers then offered to connect patients with appropriate services and resources to address the identified needs. The WellRx pilot demonstrated that it is feasible for a clinic to implement such an assessment system, that the assessment can reveal important information, and that having information about patients' social needs improves provider ease of practice. Demonstrated feasibility and favorable outcomes led to institutionalization of the WellRx process at a university teaching hospital and influenced the state department of health to require managed care organizations to have community health workers available to care for Medicaid patients.

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In this article, we explore women’s everyday experiences with food insecurity. Women’s narratives from a Hispanic community in New Mexico depict the poignant struggles women confront as they actively engage with buffering the experience of hunger to hide scarcity and mask and cope with emotional distress. These data give us a lens for understanding women’s lives in the context of disparity as it relates to food insecurity as a public health issue and provide a way to conceptualize how social determinants operate and integrate with quotidian life activities and processes.

BackgroundDiabetes risk is extremely high for Latinos from low-income households. Health guidelines recommend that individuals learn strategies to self-manage their diabetes, but getting people to adopt required lifestyle changes is challenging and many people are not able to prevent their pre-diabetes from escalating or effectively control their diabetes. Systematic reviews show that culturally competent self-management programs can significantly improve diabetes outcomes and different models for culturally competent programming have been developed.MethodsThis patient-engaged study will compare the effectiveness of two distinct evidence-based models for culturally competent diabetes health promotion at two sites that serve a large Latino patient population from low-income households: 1) The Diabetes Self-Management Support Empowerment Model, an educational session approach, and 2) The Chronic Care Model, a holistic community-based program. Data collection will involve interviews, focus groups, surveys and assessments of each program; and testing of patient participants for A1c, depression, Body Mass Index (BMI), and chronic stress with hair cortisol levels. We will recruit a total of 240 patient-social support pairs: Patients will be adults (men and women over the age of 18) who: 1.) Enter one of the two diabetes programs during the study; 2.) Self-identify as “Latino;” 3.) Are able to identify a social support person or key member of their social network who also agrees to participate with them; 4.) Are not pregnant (participants who become pregnant during the study will be excluded); and 5.) Have household income 250% of the Federal Poverty Level (FPL) or below. Social supports will be adults who are identified by the patient participants. PRIMARY OUTCOME: Improved capacity for diabetes self-management measured through improvements in diabetes knowledge and diabetes-related patient activation. SECONDARY OUTCOME: Successful diabetes self-management as measured by improvements in A1c, depression scale scores, BMI, and circulating levels of cortisol to determine chronic stress.DiscussionOur hypothesis is that the program model that interfaces most synergistically with patients’ culture and everyday life circumstances will have the best diabetes health outcomes.Trial registrationThis study was registered with ClinicalTrials.gov on December 16, 2016 (Registration #NCT03004664).

The HRPO is the Institutional Review Board (IRB) ethics committee for research with human subjects at UNM. All participants provided signed informed consent. Declaration of Conflicting Interests We wish to draw the attention of the Editor to the following fact that may be considered as a potential conflict of interest regarding this manuscript. We note that Jackie Perez works for the Hopkins Center, and previously worked for the Center under its previous name, St. Joseph Center for Children and Families. Tamara Thiedeman previously worked for the St. Joseph Center for Children and Families. Perez is currently the Director of the Center and Thiedeman was it's previous Director. Both are licensed mental health professionals and they provide/provided services to clients, including some of the women who participated in this study. Both were involved in establishing the Women's Social Isolation Support Group discussed here and both participated in the research. However, we believe that this relationship did not interfere with their ability to carry out the research, as they were interested in an objective analysis of the dynamics of the group process as part of an assessment of the services they provide.