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International Journal for Equity in Health
Published in: International Journal for Equity in Health 1/2019

Open Access 01-12-2019 | Systematic review

A systematic review of reasons for and against asking patients about their socioeconomic contexts

Authors: Andrew Moscrop, Sue Ziebland, Nia Roberts, Andrew Papanikitas

Published in: International Journal for Equity in Health | Issue 1/2019

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Abstract

Background

People’s social and economic circumstances are important determinants of their health, health experiences, healthcare access, and healthcare outcomes. However, patients’ socioeconomic circumstances are rarely asked about or documented in healthcare settings. We conducted a systematic review of published reasons for why patients’ socioeconomic contexts (including education, employment, occupation, housing, income, or wealth) should, or should not, be enquired about.

Methods

Systematic review of literature published up to and including 2016. A structured literature search using databases of medicine and nursing (pubmed, embase, global health), ethics (Ethicsweb), social sciences (Web of Science), and psychology (PsychINFO) was followed by a ‘snowball’ search. Eligible publications contained one or more reasons for: asking patients about socioeconomic circumstances; collecting patients’ socioeconomic information; ‘screening’ patients for adverse socioeconomic circumstances; or linking other sources of individual socioeconomic data to patients’ healthcare records. Two authors conducted the screening: the first screened all references, the second author screened a 20% sample with inter-rater reliability statistically confirmed. ‘Reason data’ was extracted from eligible publications by two authors, then analysed and organised.

Results

We identified 138 eligible publications. Most offered reasons for why patients’ should be asked about their socioeconomic circumstances. Reasons included potential improvements in: individual healthcare outcomes; healthcare service monitoring and provision; population health research and policies. Many authors also expressed concerns for improving equity in health. Eight publications suggested patients should not be asked about their socioeconomic circumstances, due to: potential harms; professional boundaries; and the information obtained being inaccurate or unnecessary.

Conclusions

This first summary of literature on the subject found many published reasons for why patients’ social and economic circumstances should be enquired about in healthcare settings. These reasons include potential benefits at the levels of individuals, health service provision, and population, as well as the potential to improve healthcare equity. Cautions and caveats include concerns about the clinician’s role in responding to patients’ social problems; the perceived importance of social health determinants compared with biomedical factors; the use of average population data from geographic areas to infer the socioeconomic experience of individuals. Actual evidence of outcomes is lacking: our review suggests hypotheses that can be tested in future research.
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Metadata
Title
A systematic review of reasons for and against asking patients about their socioeconomic contexts
Authors
Andrew Moscrop
Sue Ziebland
Nia Roberts
Andrew Papanikitas
Publication date
01-12-2019
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2019
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-019-1014-2

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