Hospital-Based Interventions Addressing Social Needs: A Systematic Narrative Review.

Abstract

Healthcare settings worldwide are adopting screening and referral interventions to address patients' social needs. Some interventions provide one-off lists of resources ("light-touch" interventions) while others employ Health Navigators to provide ongoing assistance and advocacy with community organizations ("high-touch" interventions). Understanding the manner in which these interventions are integrated in hospital settings, and their effects on medical and social outcomes, is limited. This systematic narrative review uses narrative synthesis to explore workflows for screening and referral interventions for social needs in hospital settings, and barriers and enablers to intervention success. Health and social science databases (Embase, CINAHL, PubMed, PsycInfo, Scopus, Web of Science) and grey literature (ProQuest) were searched. Conference abstracts and editorial papers were excluded. This review was prospectively registered in PROSPERO (registration number: CRD42023462535). Data were collected and analyzed from January 2023 to August 2024. All studies (n=37) occurred in the U.S. Interventions took place in emergency departments, inpatient and outpatient clinics, and hospital-based primary care clinics. Overall, studies were of moderate quality (n=22, 59%), and provided limited methodological data regarding workflows for screening and responding to social needs. High-touch interventions underreported caseload and other methodological data, and Health Navigator roles varied substantially. Few studies reported social needs outcomes, and intervention effects on outcomes were mixed. To improve the evidence base for hospital-based interventions, researchers should prioritize reporting methodological data and publishing in-depth protocols. Social needs outcomes should be consistently reported to better understand how these interventions may benefit disadvantaged populations, and trauma-informed principles should be applied to the collection and storage of social needs data.