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Identifying and Addressing Social Determinants of Health in Primary Care
Dissertation

Identifying and Addressing Social Determinants of Health in Primary Care

Paige McCaw
University of Iowa
Doctor of Nursing Practice (DNP), University of Iowa
Spring 2026
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Abstract

Background: Social determinants of health (SDOH)—including critical factors such as housing, food security, transportation, and social support—are increasingly recognized as pivotal influences on patient outcomes. Primary care providers play a pivotal role in identifying patients’ needs and connecting them to community resources. However, despite growing awareness of SDOH, many primary care settings lack systematic, efficient, and sustainable processes for screening and addressing social needs. Purpose: This project aimed to improve the identification of SDOH by implementing a standardized SDOH screening tool in a primary care clinic. Patients who screen positive for social needs will receive a targeted community resource handout to support timely access to appropriate services. Methods: The Iowa Model for Evidence Based Practice was used to implement standardized SDOH screening during preventive visits in a family medicine clinic at an independent Midwestern medical center. The patient sample consisted of all individuals attending well‑child checks, wellness exams, and annual physicals during the six‑month implementation period. Outcomes measured included provider and staff knowledge, SDOH screening rates, and documentation of community resource referrals. Findings: During the project period, 486 patients were screened for social determinants of health, with eight patients screening positive for at least one social need. Of those patients, three received an appropriate community resource handout, representing a 37.5% resource distribution rate among patients with identified needs. Three staff members completed a retrospective pre–post Likert‑scale survey assessing knowledge, barriers, behaviors, and attitudes related to SDOH screening, demonstrating improvement across assessed domains following implementation. Discussion: Implementation of standardized SDOH screening and resource handout demonstrated high completion rates and successful integration into routine primary care workflows. Staff knowledge, attitudes, and behaviors related to SDOH improved, supporting the value of systematic screening and the need for sustainable referral infrastructure to address social needs and promote health equity.
social determinants of health health equity social needs primary care screening tool

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