A Critical Review of the Existing Methodologies for Evaluating the Evidence on Social Determinant of Health Interventions

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Publication Date

4-12-2023

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Presentation: 21:45

Abstract

The need to address and alter upstream factors that impact the negative feedback loop of poor health and health-outcomes by those negatively impacted by the social determinants of health (SDOH) is gaining attention. Studies have sought to address and improve factors for those who are impacted by worse SDOH by addressing health related social needs (HRSNs). However, there is no universal evidence-based evaluation system to assess SDOH/HRSN interventions. The focus of this Capstone is on evidence assessments and highlights why there is a need to develop a universal, widely accepted, easily executed, evidence-based system to accurately evaluate SDOH/HRSN interventions. This is achieved by summarizing and providing a critical review of the strengths and weaknesses of existing evidence assessment methodologies. The overarching deficiency and critique of the evidence assessment methodologies reviewed is an over reliance on the classical hierarchy of the levels of evidence with meta-analysis, systematic reviews, and randomized controlled trials (RCTs) being seen as the gold standard. These methodologies are not always appropriate, ethnical, or feasible when evaluating an evidence-based solution to a SDOH/HRSN intervention. It is recommended that future SDOH/HRSN evaluation methodology not be prolonged in the evaluation period; it is suggested that the evaluation period be six-months or less. Additionally, future methodology should be an easily accessible and usable tool that is able to be utilized by many and does not require specific collaboration with an entity. Finally, there needs to be a shift in lens which allows for acceptance of a new hierarchy of strong evidence for SDOH/HRSN interventions. This lens should acknowledge that a lack of or unsuccessful meta-analysis, systematic review, or RCT does not inherently imply low-quality evidence when considering a SDOH/HRSN intervention. Instead, it should consider accepting expert opinion and consensus as a higher level of evidence when evaluating SDOH interventions.

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English

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