Social determinants of health in the emergency department: knowledge, practices, and barriers

Social and structural factors strongly influence health outcomes but are inconsistently addressed in emergency care. This study used a mixed methods approach to assess the knowledge, attitudes, and practices of emergency department staff regarding social determinants of health, and to explore barriers and enablers to their integration into clinical care.

We conducted a mixed methods study in a single urban emergency department in Atlantic Canada. A 23-item electronic survey was distributed to 306 clinical staff between May and August 2023. Descriptive statistics with 95% confidence intervals were used to summarize responses. A subsequent qualitative component involved semi-structured interviews with a purposeful sample of staff. Interview transcripts were analyzed using inductive thematic analysis with iterative coding and theme development.

Seventy staff members responded to the survey (23% response rate). Most respondents (93%) reported at least moderate understanding of the term "social determinants of health" and 86% correctly identified the Public Health Agency of Canada definition. However, only 23% reported routinely considering social determinants of health in clinical decision-making. Fewer than one in four respondents routinely inquired about social support or ability to afford medications. Most staff (93%) reported difficulty accessing information on community resources. Qualitative interviews revealed strong support for addressing social determinants of health in principle, but described time pressures, staffing shortages, and unclear referral pathways as key barriers.

Emergency department staff are aware of the impact of social determinants of health and support their integration into care, but consistent implementation is limited by practical and structural constraints. Enhancing access to resources, developing standardized screening tools, and clarifying system-supported referral pathways may help bridge the gap between awareness and action.