# Screening tools for employment in clinical healthcare delivery systems: a content analysis

## TL;DR

This study examines how employment-related questions are included in screening tools used in healthcare to address social determinants of health.

## Contribution

The study identifies and characterizes employment-related questions in clinical screening tools for the first time.

## Key findings

- Employment-related questions in screening tools focus on four domains: Social Risk Factor, Social Need, Employment Exposure, and Legal Need.
- Most employment-related questions have low contextualization and focus on employment status.
- Screening tools vary widely in how they capture employment-related social risk.

## Abstract

The relationship between work and health is complex and bidirectional, where work can have both health-harming and health-enhancing effects. Though employment is recognized as a social determinant of health, and clinical healthcare delivery systems are increasingly using screening tools to ask patients about social needs, little research has explored the extent to which employment-related social risk is captured in these screening tools. This study aimed to identify and characterize employment- and work-related questions in social risk screening tools that have been implemented in clinical healthcare delivery systems.

We conducted a qualitative content analysis of employment-related items in screening tools that have been implemented in clinical healthcare service delivery systems. Three content areas guided data extraction and analysis: Setting, Domain, and Level of Contextualization.

Screening tools that asked employment-related questions were implemented in settings that were diverse in the populations served and the scope of care provided. The intent of employment-related items focused on four domains: Social Risk Factor, Social Need, Employment Exposure, and Legal Need. Most questions were found to have a low Level of Contextualization and were largely focused on identifying an individual’s employment status.

Several existing screening tools include measures of employment-related social risk, but these items do not have a clear purpose and range widely depending on the setting in which they are implemented. In order to maximize the utility of these tools, clinical healthcare delivery systems should carefully consider what domain(s) they aim to capture and how they anticipate using the screening tools to address social determinants of health.

The online version contains supplementary material available at 10.1186/s12913-024-10976-3.