Implementing the screening for poverty and related social determinants and intervening to improve knowledge of and links to resources (SPARK) in primary care clinics across Canada

Abstract

Background: Routine systematic collection of social determinants data can inform improvements to health service delivery and system and policy planning.

Objective: This cohort study reports on the implementation of the SPARK tool to collect and integrate demographic and social needs data in primary care.

Methods: The 20-question SPARK tool was implemented from September 2022 to October 2023 at five primary care clinics. Implementation was evaluated using the following outcomes: acceptability, appropriateness, adoption, feasibility, fidelity, cost, penetration, and sustainability. Data included: clinic checklists (n = 5), training evaluations (n = 33), SPARK tool responses (n = 2063), patient surveys (n = 1368), and provider and staff surveys (n = 36). Survey responses were analyzed using frequency (%) and mean (SD). Open-ended responses were analyzed to identify key themes.

Results: There was strong acceptability and adoption of the tool. Collection methods contributed to variation in perceived relevance, compatibility and barriers. Among patients, 90.5% indicated the tool was clear and easy to complete, and 84.5% had a positive experience. A minority of patients (7.8%) indicated difficulty answering ≥1 question on SPARK. Among clinic staff and providers, 96.7% reported the tool was useful, and 81.8% had a positive experience. Clinics highlighted concerns with resource allocation and suggested adjustments to collection, integration, and personnel to support implementation.

Conclusions: The SPARK tool is acceptable and feasible for adoption in primary care clinics. This study provides practical insight into implementing demographic and social needs data collection, including adaptations to clinic workflows, enhanced integration platforms, and supports that ensure the sustainability of social needs screening in primary care.

Keywords: electronic health record; health service research; patient-centered care; primary health care; social conditions; social determinants of health.