Mechanisms Associated with Clinical Improvement in Interventions That Address Health-Related Social Needs: A Mixed-Methods Analysis

Berkowitz, Seth A.; Hulberg, Amy Catherine; Placzek, Hilary; Dangora, Anya; Gomez, Jason; Standish, Sara; Atlas, Steven J.

doi:10.1089/pop.2018.0162

Cited by 23 publications

(30 citation statements)

References 16 publications

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“…The miscellaneous category comprised 1 RCT and 5 before-after analyses, which included interventions such as educational programs and community gardens ( Table 1 ). 31 , 32 , 43 , 44 , 52 , 54 Three of the 5 before-after studies had similar outcomes that were associated with improvements in food insecurity 43 , 52 , 54 ( Figure 2 ).…”

Section: Resultsmentioning

confidence: 88%

“…A total of 39 publications, including 170 605 participants, met inclusion criteria ( Figure 1 ). Of these 39 studies, 8 were RCTs, 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 1 was a quasi-experimental study, 33 12 were before-after studies without controls, 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 9 were before-after studies with controls, 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 1 was a time-series study, 55 and 8 were cross-sectional studies. 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 Thirty-four studies were of interventions in the US, and 5 were of interventions in Canada.…”

Section: Resultsmentioning

confidence: 99%

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Interventions to Address Food Insecurity Among Adults in Canada and the US

et al. 2021

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IMPORTANCE Inadequate access to food is a risk factor for poor health and the effectiveness of federal programs targeting food insecurity, such as the Supplemental Nutrition Assistance Program (SNAP), are well-documented. The associations between other types of interventions to provide adequate food access and food insecurity status, health outcomes, and health care utilization, however, are unclear.OBJECTIVE To review evidence on the association between food insecurity interventions and food insecurity status, clinically-relevant health outcomes, and health care utilization among adults, excluding SNAP. DATA SOURCESA systematic search for English-language literature was performed in PubMed Central and Cochrane Trials databases (inception to January 23, 2020), the Social Interventions Research and Evaluation Network database (December 10, 2019); and the gray literature using Google (February 1, 2021). STUDY SELECTION Studies of any design that assessed the association between food insecurity interventions for adult participants and food insecurity status, health outcomes, and health care utilization were screened for inclusion. Studies of interventions that described addressing participants' food needs or reporting food insecurity as an outcome were included. Interventions were categorized as home-delivered food, food offered at a secondary site, monetary assistance in the form of subsidies or income supplements, food desert interventions, and miscellaneous. DATA EXTRACTION AND SYNTHESIS Data extraction was performed independently by 3 reviewers. Study quality was assessed using the Cochrane Risk of Bias Tool, the ROBINS-I (Risk of Bias in Non-Randomized Studies of Interventions) tool, and a modified version of the National Institutes of Health's Quality Assessment Tool for Before-After Studies With No Control. The certainty of evidence was based on GRADE (Grading of Recommendations Assessment, Development, and Evaluation) criteria and supplemented with mechanistic and parallel evidence. For outcomes withinintervention categories with at least 3 studies, random effects meta-analysis was performed. MAIN OUTCOMES AND MEASURESFood insecurity (measured through surveys; eg, the 2-item Hunger Vital Sign), health outcomes (eg, hemoglobin A 1c ), and health care utilization (eg, hospitalizations, costs). RESULTS A total of 39 studies comprising 170 605 participants were included (8 randomized clinical trials and 31 observational studies). Of these, 14 studies provided high-certainty evidence of an association between offering food and reduced food insecurity (pooled random effects; adjusted odds ratio, 0.53; 95% CI, 0.33-0.67). Ten studies provided moderate-certainty evidence of an association between offering monetary assistance and reduced food insecurity (pooled random (continued) Key Points Question Are food insecurity interventions associated with improvements in food insecurity status, health outcomes, or health care utilization? Findings In this systematic review and meta-analysis of 39 randomized and observationa...

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Section: Resultsmentioning

confidence: 88%

Section: Resultsmentioning

confidence: 99%

Interventions to Address Food Insecurity Among Adults in Canada and the US

et al. 2021

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“…One recent study, for example, found that a navigation program likely improved cardiovascular health by improving access to transportation and medications, not by addressing food insecurity. 35 More studies like this are needed to help identify the most effective and cost-effective interventions.…”

Section: What Are the Most Effective And Cost-effective Interventionsmentioning

confidence: 99%

Improving Social Needs Intervention Research: Key Questions for Advancing the Field

Fichtenberg

Alley

Mistry

2019

American Journal of Preventive Medicine

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Spurred by accumulated evidence documenting how social determinants of health shape health outcomes as well as the push for better value, the healthcare sector is embracing interventions that address patients' health-related social needs. An increasing number of healthcare organizations and payers are experimenting with strategies to identify needs and connect patients to resources that address identified needs with the goal of improving health outcomes, reducing avoidable utilization of costly health services, and improving health equity. Although many studies link social factors to health, relatively little published research exists about how the healthcare sector can effectively intervene to help identify and address social needs. This paper summarizes emerging evidence and identifies key areas where more research is needed to advance implementation and policy development. Although some healthcare-based social needs interventions have been shown to improve health and reduce avoidable utilization, important gaps remain in terms of comparative effectiveness and cost effectiveness of social needs intervention approaches. Additionally, the field would benefit from an increased understanding of mechanisms of action to maximize practitioners' ability to tailor interventions. More research is also needed to guard against unintended consequences and ensure these interventions reduce health inequities. Finally, implementation science research should identify supports and incentives for adoption of effective interventions. Focusing both public and private research efforts on these evidence gaps can help advance identification of interventions that maximize both health equity and healthcare value.

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“…Conceptually, the mechanism for this effect is intuitive: decreased social risks may help families prioritize healthy behaviors, such as nutritious food or physical activity, or decrease unhealthy exposures, such as mold. However, work by Berkowitz et al16 suggests that the pathways through which reducing social risks improves health outcomes may be nonlinear. Our study does not clarify the pathways through which the intervention operated.…”

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confidence: 99%

Effects of In-Person Navigation to Address Family Social Needs on Child Health Care Utilization

et al. 2020

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IMPORTANCE While many organizations endorse screening for social risk factors in clinical settings, few studies have examined the health and utilization effects of interventions to address social needs. OBJECTIVE To compare the acute care utilization effects of a written resources handout vs an in-person navigation service intervention to address social needs. DESIGN, SETTINGS, AND PARTICIPANTS In this secondary analysis of a randomized clinical trial, 1809 adult caregivers of pediatric patients seen in primary and urgent care clinics of 2 safety-net hospitals in northern California were recruited between October 13, 2013, and August 27, 2015. Each participating family was randomly assigned to an in-person navigator intervention vs active control to address the family's social needs. Analyses were conducted between February 28, 2018, and September 25, 2019. INTERVENTIONS Caregivers either received written information about relevant local resources related to social needs (active control) or met with a patient navigator focused on helping them resolve social needs (navigator intervention). After an initial in-person visit, navigation services included telephone, email, and/or in-person follow-up for up to 3 months. MAIN OUTCOME AND MEASURES Child emergency department visit or hospitalization within 12 months of study enrollment. RESULTS Among the 1300 caregivers enrolled in the study without missing follow-up data, most spoke English (878 [67.5%]) and were women (1127 [86.7%]), with a mean (SD) age of 33.0 (9.33) years. Most children were aged 0 to 5 years (779 of 1300 [59.9%]), 723 children (55.6%) had Hispanic ethnicity, and 462 children (35.5%) were in excellent health; 840 families (64.6%) were recruited from urgent care. In total, 637 families (49.0%) were randomized to the in-person navigator group and 663 (51.0%) to the active control group. There was no difference in risk of an emergency department visit between the 2 groups. Children enrolled in the in-person navigator group had a decreased risk of hospitalization within 12 months (hazard ratio, 0.59; 05% CI, 0.38-0.94; P = .03), making them 69% less likely to be hospitalized. CONCLUSIONS AND RELEVANCE In this randomized clinical trial evaluating heath care utilization effects of programs designed to address social needs among families, children enrolled in the navigation group were significantly less likely to be hospitalized after the intervention but equally likely to have an emergency department visit. These findings strengthen our understanding of the (continued) Key Points Question Can an in-person service navigation intervention to address family social needs decrease child health care utilization? Findings In this randomized clinical trial of 1300 families, provision of an in-person resource navigator significantly decreased the risk of child hospitalization during a 1-year period compared with written information. Meaning These findings suggest that providing a patient navigator to address family social needs can decrease child health care utiliz...

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Mechanisms Associated with Clinical Improvement in Interventions That Address Health-Related Social Needs: A Mixed-Methods Analysis

Cited by 23 publications

References 16 publications

Interventions to Address Food Insecurity Among Adults in Canada and the US

Interventions to Address Food Insecurity Among Adults in Canada and the US

Improving Social Needs Intervention Research: Key Questions for Advancing the Field

Effects of In-Person Navigation to Address Family Social Needs on Child Health Care Utilization

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