Expert Consensus on Indicators of Social Determinants of Health: A Modified Delphi Study

The purpose of this study was to gain consensus on Social Determinants of Health indicators among researchers actively publishing on SDH. We used a modified Delphi Method, an approach to gather expert opinions and gain consensus. We recruited participants in February 2024 via email from a PubMed search of researchers who had published on SDH in the last year. Participants (n = 22) completed 3 rounds of surveys. In each survey participants ranked the importance of each indicator. Fourteen participants completed all 3 surveys. Participants agreed to add indicators of Income (n = 14), Transportation (n = 14), Access to Quality Education (n = 13), Experiences of Racism and Discrimination (n = 12), Type of Healthcare Coverage (n = 11), Adverse Childhood Events (n = 9), Access to Higher Education (n = 8), Costs of Care (n = 8), and Provider Cultural and Linguistic Competency (n = 8). Participants agreed on significant modifications to an existing SDH framework, including adding more nuanced indicators on education, insurance coverage, transportation, and social context. However, the low response rate and over-representation of early career researchers indicate that further study is needed. Future research may also include a qualitative interview component to more fully understand participant rationale for responses. Our future goal is to develop a SDH instrument for use in population level public health surveillance based on the consensus of SDH indicators. To achieve this goal, additional research is needed to include a broader range of SDH researchers.