Addressing unmet social needs using a health navigator for patients at a major metropolitan hospital in Australia: a mixed-methods feasibility study
Authors: Neadley K , Shoubridge C , Smith A , Martin S , Boyd M , Hocking C 
Published: April 2024

Introduction

Integrating health and social care to address unmet social needs is an emerging priority for health systems worldwide. Screening and referral interventions for unmet social needs in healthcare settings have shown promising results. Most screening and referral interventions are implemented in primary care, despite evidence that disadvantaged populations face substantial barriers to accessing such care. There are few social care interventions in hospital settings. To address this gap, we designed a hospital-based intervention screening an outpatient population for unmet social needs and using a Health Navigator to provide referrals and follow-up to appropriate community and government resources. Here we present a protocol for a feasibility and acceptability study of a hospital-based Health Navigator intervention.

Methods and Analysis

We will conduct a single-centre study to explore the feasibility and acceptability of screening and referral for unmet social needs for patients attending an outpatient cancer clinic at a major metropolitan hospital serving a disadvantaged population in South Australia. Eligible participants are 18 years of age or older receiving treatment at the Northern Adelaide Cancer Centre, with an expected prognosis of minimum six months. Eligible participants will be asked to complete unmet social needs screening and baseline assessments. Participants with unmet social needs who request assistance will be connected with a Health Navigator (HN). The HN will work with participants to prioritise their needs and provide referrals to community and government services with follow-up of over six months from enrolment. Post-HN intervention, all participants will be asked to complete repeat unmet social needs screening and repeat assessments. The primary criteria for determining feasibility success are: 1) recruitment rates will be successful if 80% of eligible participants agree to unmet needs screening, 2) intervention uptake will be successful if 80% complete follow-up, 3) reasons for not completing intervention and 4) participant and clinician acceptability of the intervention. Secondary outcomes include changes to clinical measures such as coping capacity, quality of life and patient-reported experience measures. Thematic analysis will be applied to focus groups with clinicians and participants to assess intervention acceptability. Secondary clinical outcomes will be reported as effect size estimates for future trial. As feasibility studies are designed to test whether an intervention is appropriate for larger studies, rather than finding specific associations or outcomes, no sample size calculation is necessary. Study findings will be used to optimise recruitment and intervention components, and develop suitable outcome measures for larger, randomized studies.

Ethics and Dissemination

The protocol has ethical approval from the Central Adelaide Local Health Network Human Research Ethics Committee (approval ID: 16448).

Trial registration: ACTRN12622000802707p

Protocol date and version: 07 June 2022, V1

Strengths and limitations of this study

Most screening and referral interventions for unmet social needs occur in primary care, despite disadvantaged populations facing significant barriers to accessing primary care. This study takes place in a hospital setting.

There are few interventions for unmet social needs in Australia. This study is a valuable contribution to screening and referral research in Australia.

This study employs a screening tool for unmet needs co-designed with clinicians and community, and is one of few validated screening tools for unmet needs.

The study population is limited to people living with cancer who experience substantial healthcare needs and treatment adverse effects. Findings are unlikely to be representative of the general population.