(185) Exploring Postpartum Social Determinants through Patient-Reported Outcome Measures: a Systematic Review

Social determinants of health (SDOH) pose specific challenges for the postpartum (PP) period. Although existing tools screen SDOH generally, few address SDOH in this unique life stage. We aimed to evaluate patient-reported outcome measures (PROMs) used to screen for SDOH during the PP period.

Study Design:

This PROSPERO-registered systematic review included studies using a PROM to assess at least one SDOH in the PP period (up to 12 months after birth) in the United States. An academic librarian conducted a strategic search across 6 platforms using a protocol developed with clinical experts (Figure 1). Two authors independently screened all search results. For articles meeting inclusion criteria, authors extracted data and assessed quality of evidence with GRADE criteria and risk of bias using NIH tools.

Results:

Of 4952 articles screened, 6 studies used a PROM to evaluate SDOH in PP people (Figure 2). Most studies were rated low-quality evidence and fair risk of bias. Among 11 PROMs identified across studies, only 5 were created specifically for PP administration. Of the 5 CDC-designated SDOH domains, Economic Stability was measured most through food or housing insecurity, followed by Social and Community Context through assessing social support. Only 6 PROMs measured social stability (e.g., employment status), and none covered all 5 SDOH domains.

Conclusion:

Few PROMs exist to screen for PP SDOH. Areas such as change in insurance, childcare support, and maternal food assistance are rarely assessed even though these impact the PP period. To improve effectiveness for this population, PROMs should address PP-specific challenges, account for medical factors impacting level of social needs, such as parity and comorbidities, and measure resource access longevity through social stability metrics. Developing a comprehensive PP-specific SDOH PROM for routine PP care can address this evidence gap to better target unmet social needs and promote patient-centered care. Collaboration between community stakeholders, social workers, and clinicians to create a PP-specific SDOH PROM is vital for this process.