title: Improving Social Determinants of Health: Effectiveness of a Web-Based Intervention.
abstract: BACKGROUND
  Although patients who experience health-related social problems such as food insecurity are at increased risk for negative health outcomes, there are few systems for screening and intervention. The study aimed to determine whether a web-based intervention can (1) connect youth to services to address these problems and (2) increase their resolution.
  
  
  METHODS
  Prospective intervention study.
  
  
  METHODS
  A total of 401 youth, aged 15-25 years, from an urban adolescent/young adult clinic were recruited.
  
  
  METHODS
  A self-administered, web-based tool was developed to screen participants for problems in nine health-related social domains, identify and provide feedback about potential problems, and facilitate a patient-centered selection process of recommended local health and human service agencies to assist in addressing selected problems (conducted in 2008-2010). Follow-up phone calls 1-2 months later determined if patients had contacted recommended agencies and resolved their top-priority problem.
  
  
  METHODS
  Outcome measures included prevalence of identified problems, selected problems, and priority problem selected by domain. We also examined frequencies of referral agencies contacted and resolution of priority problem at time of follow-up analysis conducted in 2011-2013.
  
  
  RESULTS
  Seventy-eight percent (313/401) of youth selected at least one problem to address. The most frequent domains selected as priority were income security (21%); nutrition/fitness (15%); and healthcare access (15%). Eighty-three percent (259/313) were reached at follow-up; overall, 40% contacted a selected agency and 47% reported "completely" or "mostly" resolving their priority problem.
  
  
  CONCLUSIONS
  When provided with services to address health-related social problems, the majority of youth choose to receive help, with nearly half successfully addressing their priority concern. Further research to understand the barriers to contacting and utilizing services is needed. A technology-based patient-centered feedback and referral system for social determinants of health can facilitate screening and connect patients with resources to address these problems.
authors.affiliation: Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts. Electronic address: areej.hassan@childrens.harvard.edu.
authors.forename: Areej
authors.initials: A
authors.lastname: Hassan
authors.affiliation: Department of Community and Family Medicine, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire.
authors.forename: Emily A
authors.initials: EA
authors.lastname: Scherer
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Aaron
authors.initials: A
authors.lastname: Pikcilingis
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Emily
authors.initials: E
authors.lastname: Krull
authors.affiliation: Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: LaQuita
authors.initials: L
authors.lastname: McNickles
authors.affiliation: Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Glenn
authors.initials: G
authors.lastname: Marmon
authors.affiliation: Division of Adolescent/Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics, Harvard Medical School, Boston, Massachusetts.
authors.forename: Elizabeth R
authors.initials: ER
authors.lastname: Woods
authors.affiliation: Department of Pediatrics, Harvard Medical School, Boston, Massachusetts; Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Eric W
authors.initials: EW
authors.lastname: Fleegler
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006293:Health Promotion; D006801:Humans; D020407:Internet; D008297:Male; D015397:Program Evaluation; D011446:Prospective Studies; D064890:Social Determinants of Health; D011795:Surveys and Questionnaires; D014505:Urban Population; D055815:Young Adult