A Randomized Trial on Screening for Social Determinants of Health: the iScreen Study
A Randomized Trial on Screening for Social Determinants of Health: the iScreen Study
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DOI：
10.1542/peds.2014-1439
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发表时间：
2014-12-01
期刊：
影响因子：
8
通讯作者：
Adler, Nancy
中科院分区：
文献类型：
--
作者：
Gottlieb, Laura;Hessler, Danielle;Adler, Nancy
背景技术背景：越来越多的人对儿科健康的社会决定因素的临床筛查感兴趣，但很少有证据表明，在广泛的潜在敏感话题上，最大限度地提高披露率的格式。我们设计了一项研究，以检查披露率，并假设将有没有差异的披露率，面对面与电子筛选格式的项目以外的其他高度敏感的items.METHODS：我们进行了一项随机试验，电子与面对面的社会筛选格式在儿科急诊科。熟悉患儿家庭的讲英语和西班牙语的成年看护者被随机通过平板电脑进行社会筛查（可选择音频辅助）与由完全双语/双文化研究人员进行的面对面访谈。结果：几乎所有护理人员（96.8%）报告至少有一项社会需求，但报告更敏感问题的比率（家庭暴力和药物滥用）在电子格式中显着更高，而在财务不安全以及社区和学校安全方面，电子格式的披露略高。有一个显着差异的社会需求项目的比例更高的赞同在基于计算机的组（70%）比面对面组（30%）。有兴趣纳入儿童报告的社会经济、环境和行为需求筛查的儿科临床研究中心应在可行时考虑电子筛查，特别是在评估儿童安全和家庭成员药物使用等敏感问题时。
BACKGROUND: There is growing interest in clinical screening for pediatric social determinants of health, but little evidence on formats that maximize disclosure rates on a wide range of potentially sensitive topics. We designed a study to examine disclosure rates and hypothesized that there would be no difference in disclosure rates on face-to-face versus electronic screening formats for items other than highly sensitive items.METHODS: We conducted a randomized trial of electronic versus face-to-face social screening formats in a pediatric emergency department. Consenting English-speaking and Spanish-speaking adult caregivers familiar with the presenting child's household were randomized to social screening via tablet computer (with option for audio assist) versus a face-to-face interview conducted by a fully bilingual/bicultural researcher.RESULTS: Almost all caregivers (96.8%) reported at least 1 social need, but rates of reporting on the more sensitive issues (household violence and substance abuse) were significantly higher in electronic format, and disclosure was marginally higher in electronic format for financial insecurity and neighborhood and school safety. There was a significant difference in the proportion of social needs items with higher endorsement in the computer-based group (70%) than the face-to-face group (30%).CONCLUSIONS: Pediatric clinical sites interested in incorporating caregiver-reported socioeconomic, environmental, and behavioral needs screening should consider electronic screening when feasible, particularly when assessing sensitive topics such as child safety and household member substance use.