Addressing the Individual Social Needs of Patients with Diabetes
Learn about resources you can use to help patients who have immediate and pressing social needs.
As health care professionals continue to learn about social determinants of health—policy-level, structural inequalities that have effects on health—it becomes increasingly important to also consider an individual patient’s social needs, such as whether they are able to pay their rent or have enough food to feed their family.
In this latest post from our Social Determinants of Health series, Dr. Matthew Kreuter explains how health care professionals can help address patients’ individual social needs so that they can give more time and attention to their health. Resources include identifying the patient’s needs using screeners from SIREN (Social Interventions Research & Evaluation Network) at the University of California, San Francisco, and directing patients to dial 211 or visit 211.org to connect with live community resource specialists in their area.
Management of diabetes involves a wide range of behaviors, from dietary behaviors and activity behaviors, and medication compliance, and follow-up visits in health care systems.
When you are trying to feed your family, when you're trying to pay the rent, when you are looking for work or a better job or a second or a third job, oftentimes those needs are going to supersede the sorts of diabetes management or prevention behaviors that we'd like people to focus on.
The first thing that I typically tell clinicians when they ask about how they can help patients who have some of these social needs is to understand the context of their lives and frame your interactions with them accordingly.
If you're sitting in an exam room with a patient and they're struggling with individual social needs, it just isn't a very satisfactory response to say, “Well, my health care system is really behind the movement towards a livable increased minimum wage.” Which would be a tremendous structural policy change for addressing disparities, but it's not going to help you pay your rent tomorrow when it's due, and it's not going to help you feed your kids tonight when they're hungry and you go home from this appointment. So, dealing with the more immediate and pressing individual social needs is something that health care providers can do. I can tell you that there are certain needs that really no matter where you look, are pretty common.
So in low-income families and low-income patients, by far for the last five years, the most common request is for help with housing. And within housing, the most common request is for rent assistance. We also see a lot of requests for utility assistance. After that, I would say food-related requests. And that depends a bit on the population, but certainly people now more than ever are looking for food pantries in their community. In some populations, you also see an increased demand for home-delivered meals, and also for eligibility for food-related programs like SNAP or WIC.
There's been just tremendous work done nationally in the last decade in trying to simplify the process of identifying individual social needs that patients have. And so, there are many brief screeners that, using anywhere from four to eight or 10 items, providers can get a pretty good snapshot of what the individual social needs might be for a particular patient and their family at a moment in time.
People who are looking for those, I would send them to the SIREN website at the University of California, San Francisco.
And also, if you dial 211 from anywhere in the US, your call is going to be answered by a live person at a call center in a community near you somewhere in your state. And that person is going to be sitting in front of a computer, and that computer is attached to a database, and that database has every health and social service that's available in their service area.
And so those information specialists are going to listen to you, figure out what it is you need, and then begin searching for resources in your community that might be able to address that. So certainly, for providers who are trying to help their patients, their diabetic patients, knowing 211 and making sure their patients know 211 is a really easy first step.
Health care professionals, I think we are often guilty of assuming that everybody shares and values health in the same way that we do. I think we sometimes assume that people think that concepts like risk reduction and wellness and increased longevity are super motivating for people. And I think the truth is that for most people, they aren't. Most people are motivated by other aspects of their lives, by other values, and by other challenges that may not directly, at least in their minds, have to do with health. So the sooner you can figure that out, which is asking questions and listening, I think the more effective you're going to be in interacting with people.