Institute of Medicine Measures of Social and Behavioral Determinants of Health: A Feasibility Study

Am J Prev Med. 2017 Feb;52(2):199-206. doi: 10.1016/j.amepre.2016.07.033. Epub 2016 Sep 19.


Introduction: Social and behavioral factors are known to affect health but are not routinely assessed in medical practice. To date, no studies have assessed a parsimonious panel of measures of social and behavioral determinants of health (SBDs). This study evaluated the panel of SBD measures recommended by the Institute of Medicine and examined the effect of question order.

Methods: Adults, aged ≥18 years, were recruited using for this randomized, parallel design study conducted in 2015 (data analyzed in 2015-2016). Three versions of the SBD measures, sharing the same items but in different orders of presentation (Versions 1-3), were developed. Randomized to six groups, participants completed each version at least 1 week apart (Weeks 1-3). Version order was counterbalanced across each administration and randomization was stratified by gender, race, and age. Main outcomes were effect of question order, completion time, and non-response rates.

Results: Of 781 participants, 624 (80%) completed the Week 1 questionnaire; median completion time for answering all SBD questions was 5 minutes, 583/624 participants answered all items, and no statistically significant differences associated with question order were observed when comparing responses across all versions. No significant differences in responses within assignment groups over time were found, with the exception of the stress measure for Group 5 (p=0.036).

Conclusion: Question order did not significantly impact participant responses. Time to complete the questionnaire was brief, and non-response rate was low. Findings support the feasibility of using the Institute of Medicine-recommended questionnaire to capture SBDs.

Publication types

  • Evaluation Study

MeSH terms

  • Adult
  • Feasibility Studies
  • Female
  • Health Surveys / methods*
  • Health Surveys / statistics & numerical data
  • Humans
  • Male
  • Middle Aged
  • National Academies of Science, Engineering, and Medicine, U.S., Health and Medicine Division
  • Random Allocation
  • Social Determinants of Health / statistics & numerical data*
  • Time Factors
  • United States
  • Young Adult