Addressing unmet social needs using a health navigator for patients at a major metropolitan hospital in Australia: a mixed-methods feasibility study

Introduction Integrating health and social care to address unmet social needs is an emerging priority for health systems worldwide. Screening and referral interventions for unmet social needs in healthcare settings have shown promising results. Most screening and referral interventions are implemented in primary care, despite evidence that disadvantaged populations face substantial barriers to accessing such care. There are few social care interventions in hospital settings. To address this gap, we designed a hospital-based intervention screening an outpatient population for unmet social needs and using a Health Navigator to provide referrals and follow-up to appropriate community and government resources. Here we present a protocol for a feasibility and acceptability study of a hospital-based Health Navigator intervention.

and Analysis We will conduct a single-centre study to explore the feasibility and acceptability of screening and referral for unmet social needs for patients attending an outpatient cancer clinic at a major metropolitan hospital serving a disadvantaged population in South Australia. Eligible participants are 18 years of age or older receiving treatment at the Northern Adelaide Cancer Centre, with an expected prognosis of minimum six months. Eligible participants will be asked to complete unmet social needs screening and baseline assessments. Participants with unmet social needs who request assistance will be connected with a Health Navigator (HN). The HN will work with participants to prioritise their needs and provide referrals to community and government services with follow-up of over six months from enrolment. Post-HN intervention, all participants will be asked to complete repeat unmet social needs screening and repeat assessments. The primary criteria for determining feasibility success are: 1) recruitment rates will be successful if 80% of eligible participants agree to unmet needs screening, 2) intervention uptake will be successful if 80% complete follow-up, 3) reasons for not completing intervention and 4) participant and clinician acceptability of the intervention. Secondary outcomes include changes to clinical measures such as coping capacity, quality of life and patient-reported experience measures. Thematic analysis will be applied to focus groups with clinicians and participants to assess intervention acceptability. Secondary clinical outcomes will be reported as effect size estimates for future trial. As feasibility studies are designed to test whether an intervention is appropriate for larger studies, rather than finding specific associations or outcomes, no sample size calculation is necessary. Study findings will be used to optimise recruitment and intervention components, and develop suitable outcome measures for larger, randomized studies. Ethics and Dissemination The protocol has ethical approval from the Central Adelaide Local Health Network Human Research Ethics Committee (approval ID: 16448). Trial registration: ACTRN12622000802707p Protocol date and version: 07 June 2022, V1 Strengths and limitations of this study Most screening and referral interventions for unmet social needs occur in primary care, despite disadvantaged populations facing significant barriers to accessing primary care. This study takes place in a hospital setting. There are few interventions for unmet social needs in Australia. This study is a valuable contribution to screening and referral research in Australia. This study employs a screening tool for unmet needs co-designed with clinicians and community, and is one of few validated screening tools for unmet needs. The study population is limited to people living with cancer who experience substantial healthcare needs and treatment adverse effects. Findings are unlikely to be representative of the general population. Competing Interest Statement The authors have declared no competing interest. Clinical Trial ACTRN12622000802707p Funding Statement This study was funded by The Hospital Research Foundation. Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee of The Central Adelaide Local Health Network Human Research Ethics Committee gave ethical approval for this work. I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Data Availability All data produced in the present study are available upon reasonable request to the authors