A collaborator-engaged approach to tailoring strategies for implementing systematic health-related social needs assessment: Results from a cross-center study.
Authors: Birken Sarah , Gabbard Jennifer J. , Nederveld Andrea , Rendle Katharine A. , Beidas Rinad S. , Walsh-Bailey Callie , Blumenthal Daniel , Schnoll Robert A. , Randazzo Aliza , Wagi Cheyenne , White Jenna , Foley Kristie 
Published: September 2024

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Background:
Health-related social needs (HRSNs) exacerbate inequities in cancer incidence, morbidity and mortality. To improve health equity, policymakers recommend systematic HRSN screening in oncology clinics. In preliminary studies, we found low rates (<10%) of HRSN screening in oncology. Building upon these findings and transdisciplinary expertise across four Implementation Science Centers in Cancer Control (ISC3), in the current study, we engaged oncology care teams in tailoring site-specific strategies to implement HRSN screening.
Methods:
Centers varied in collaborator engagement methods, including Context-Driven Co-Design (CD2), which aims to harmonize the intervention (i.e., HRSN screening), context (e.g., oncology clinic), and implementation strategies. First, site leads conducted semi-structured interviews with 8-10 care team members and clinic observations to identify current HRSN assessment processes and opportunities and barriers to systematic HRSN screening. Second, site leads engaged collaborators in one-on-one interviews or, when using CD2, in 3-4 iterative co-design workshops in which they used context assessment data and user-centered design activities (e.g., storyboarding) to prioritize contextual factors, identify necessary adaptations to HRSN screening, and co-design implementation strategies to address salient barriers. Centers met monthly to share knowledge and troubleshoot.
Results:
Most Centers’ oncology clinics had established informal HRSN screening approaches. Across Centers, collaborators (e.g., providers, nurses, medical assistants, patients) identified similar opportunities (e.g., desire for a standardized approach to HRSN screening; well-functioning clinical teams and physical space). Common challenges included limited familiarity with HRSN screening and documentation tools; lack of standardized screening protocol; and limited awareness of HRSN screening’s purpose. Implementation strategies included pencil-and-paper screening tools; clinic signage regarding HRSN screening’s purpose; training and creation of standardized screening protocol; and a centralized resource for responding to HRSN with adjustment, assistance, alignment, and/or advocacy.
Conclusions:
Four ISC3 Centers developed multicomponent implementation plans tailored to their oncology clinic. Centers’ varied approaches and timelines presented challenges and opportunities for cross-Center learning. Oncology clinics exhibited substantial overlap in opportunities and challenges in HRSN screening. Much of CD2’s benefits were related to its collaborator-driven approach to implementation strategy development. Next steps include deploying implementation plans and assessing their impact on equitable reach and adoption of HRSN screening and response to identified needs.