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- Title
Evaluating Intensity, Complexity, and Potential for Causal Inference in Social Needs Interventions: A Review of a Scoping Review.
- Authors
Viswanathan, Meera; Kennedy, Sara M.; Sathe, Nila; Eder, Michelle L.; Ng, Valerie; Kugley, Shannon; Lewis, Megan A.; Gottlieb, Laura M.
- Abstract
This review of a scoping review analyzes the intensity and complexity of social needs interventions in randomized clinical trials and whether the trials were designed to assess the effect of individual intervention components on health outcomes. Key Points: Question: What is the intensity and complexity of different social needs interventions, and what is the potential for causal inference about specific intervention components? Findings: This review of a scoping review examined 77 randomized clinical trials of social needs interventions; the majority (68 studies [88%]) described features indicating high intervention intensity and all studies reported features indicating high intervention complexity. Study designs permitted conclusions on overall effectiveness but typically did not permit casual inferences about individual intervention components. Meaning: These findings suggest that social needs–related interventions undertaken in health care settings are often complex and intensive and have generally not been designed to assess the causal effects of specific components. Importance: Interventions that address needs such as low income, housing instability, and safety are increasingly appearing in the health care sector as part of multifaceted efforts to improve health and health equity, but evidence relevant to scaling these social needs interventions is limited. Objective: To summarize the intensity and complexity of social needs interventions included in randomized clinical trials (RCTs) and assess whether these RCTs were designed to measure the causal effects of intervention components on behavioral, health, or health care utilization outcomes. Evidence Review: This review of a scoping review was based on a Patient-Centered Outcomes Research Institute–funded evidence map of English-language US-based RCTs of social needs interventions published between January 1, 1995, and April 6, 2023. Studies were assessed for features related to intensity (defined using modal values as providing as-needed interaction, 8 participant contacts or more, contacts occurring every 2 weeks or more often, encounters of 30 minutes or longer, contacts over 6 months or longer, or home visits), complexity (defined as addressing multiple social needs, having dedicated staff, involving multiple intervention components or practitioners, aiming to change multiple participant behaviors [knowledge, action, or practice], requiring or providing resources or active assistance with resources, and permitting tailoring), and the ability to assess causal inferences of components (assessing interventions, comparators, and context). Findings: This review of a scoping review of social needs interventions identified 77 RCTs in 93 publications with a total of 135 690 participants. Most articles (68 RCTs [88%]) reported 1 or more features of high intensity. All studies reported 1 or more features indicative of high complexity. Because most studies compared usual care with multicomponent interventions that were moderately or highly dependent on context and individual factors, their designs permitted causal inferences about overall effectiveness but not about individual components. Conclusions and Relevance: Social needs interventions are complex, intense, and include multiple components. Our findings suggest that RCTs of these interventions address overall intervention effectiveness but are rarely designed to distinguish the causal effects of specific components despite being resource intensive. Future studies with hybrid effectiveness-implementation and sequential designs, and more standardized reporting of intervention intensity and complexity could help stakeholders assess the return on investment of these interventions.
- Subjects
BEHAVIORAL assessment; MEDICAL care use; HEALTH services accessibility; HEALTH status indicators; ENDOWMENTS; SOCIAL determinants of health; RESEARCH funding; FOOD security; DESCRIPTIVE statistics; SOCIAL case work; SYSTEMATIC reviews; MEDLINE; BASIC needs; MEDICAL databases; NEEDS assessment; MEDICAL needs assessment; HOUSING stability; ATTRIBUTION (Social psychology); SOCIAL isolation
- Publication
JAMA Network Open, 2024, Vol 7, Issue 6, pe2417994
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.17994