Social Determinants of Health Questions to Ask Patients
A practical screening set for clinicians, nurses, care managers, and community health workers. Twenty questions on housing, food, money, transport, safety, and support, with wording that gets honest answers.
The questions
Open any question for the note
Before we talk about test results, would it be okay if I asked a few questions about things outside the clinic that can affect your health?
Why ask it
Asking permission first turns a screening checklist into a conversation and signals that the questions are routine rather than an accusation. Patients who agree up front give fuller answers to the harder items later.
What is your living situation today?
Why ask it
An open version of the housing question catches situations a yes or no box misses: doubling up with relatives, a motel, a car, or a lease about to end. Housing instability predicts missed appointments and readmissions more reliably than most vital signs.
Are there problems where you live, like mold, pests, no heat, water leaks, or broken smoke detectors?
Why ask it
Housing quality shows up in the chart as asthma exacerbations, recurrent falls, and lead exposure. Naming specific hazards prompts recall better than asking whether the home is safe.
In the last 12 months, did you ever worry your food would run out before you had money to buy more?
Why ask it
This is the first item of the validated Hunger Vital Sign, and it detects food insecurity without the shame that words like hungry or poor carry. A yes reshapes any diabetes, hypertension, or weight-loss plan you were about to write.
In the past 12 months, has the gas, electric, oil, or water company threatened to shut off service at your home?
Why ask it
Utility insecurity flags households choosing between heat and medication, and it matters clinically for anyone using a nebulizer, CPAP, insulin, or refrigerated drug. Many utilities also honor a medical hold letter, so a yes is directly actionable.
In the past 12 months, has lack of reliable transportation kept you from appointments, work, or getting what you need for daily life?
Why ask it
Transportation is the most common reason patients no-show, and it often gets recorded as noncompliance instead. The answer tells you whether to arrange a ride benefit, switch to telehealth, or consolidate visits.
What does your work situation look like right now?
Why ask it
Employment reveals income stability, exposures, shift patterns that wreck sleep and medication timing, and whether the patient can take paid leave for a procedure. Hourly workers frequently decline referrals they cannot afford to attend.
How hard is it for you right now to pay for basics like food, rent, heat, and medical care? Very hard, somewhat hard, or not hard?
Why ask it
A graded question borrowed from the PRAPARE tool gives you severity rather than a binary, which helps you triage who needs a same-day social work referral. It also captures strain in patients who would never describe themselves as poor.
In the past year, have you skipped doses, split pills, or delayed filling a prescription because of what it cost?
Why ask it
Cost-related nonadherence is invisible on a medication list that looks perfectly reconciled. Hearing it lets you switch to a generic, apply a patient assistance program, or stop escalating a dose that was never actually taken.
Are you responsible for caring for a child, a parent, or anyone else at home?
Why ask it
Caregiving determines whether the patient can attend a morning appointment, recover after surgery, or take a sedating medication. Caregivers also carry their own health risks that rarely get raised unless you ask.
If you needed help getting to an appointment or picking up medication, who could you call?
Why ask it
Asking for a specific name tests real support rather than reported support. A patient who cannot name anyone needs a different discharge plan than one who lists a neighbor and two adult children.
In a typical week, how often do you talk to or see people you care about, apart from anyone you live with?
Why ask it
Social isolation is associated with worse health outcomes independent of diagnosis, and the frequency framing gets past the reflex answer of I do fine. Low numbers point toward group programs, community health workers, or a depression screen.
How confident do you feel filling out medical forms or reading instructions from us on your own?
Why ask it
Asking about confidence rather than ability keeps this from reading as a reading test, which is why patients answer it at all. A hesitant reply is the signal to switch to teach-back and a printed plain-language sheet instead of a portal message or a written taper schedule.
What language do you feel most comfortable using when you talk about your health?
Why ask it
Patients often speak enough conversational English to decline an interpreter but not enough to consent to a procedure or understand a taper schedule. The comfort framing separates everyday fluency from medical fluency.
Do you have a phone plan and internet at home that would let you join a video visit or check your results?
Why ask it
Telehealth and patient portals quietly assume data, a device, and privacy at home, none of which are universal. Knowing the gap keeps you from building a follow-up plan the patient cannot access.
Do you feel safe in your neighborhood and on the way to and from your home?
Why ask it
Perceived neighborhood safety shapes whether exercise advice is realistic, whether a patient will walk to a pharmacy, and how much of their day is spent under stress. It also opens the door to violence exposure without asking about it directly.
Thinking about the past month, how stressed have you been? Not at all, a little, somewhat, quite a bit, or very much?
Why ask it
A stress question with fixed options gives you a number you can revisit at the next visit and legitimizes distress as clinical information. High ratings often surface the underlying issue the earlier questions only hinted at.
Have you ever felt you were treated unfairly or dismissed in a health care setting?
Why ask it
Past discrimination explains delayed presentations, declined referrals, and guarded histories far better than a label like difficult patient. Naming it gives you a chance to say what you will do differently.
Does anyone at home or in your life hurt you, threaten you, or make you afraid? I ask everyone this, and it stays between us unless you want otherwise.
Why ask it
Adapted from the HITS and HARK screeners, this belongs late in the interview and only when the patient is alone. Pairing it with the universal framing and a clear statement about confidentiality makes disclosure more likely, and both parts matter.
Of everything we just covered, which one thing would help you most if we could get you support for it?
Why ask it
Letting the patient rank their own needs stops you from routing them to three programs they will not use. Their choice is usually the one that unblocks the rest of the treatment plan.
How to Screen for Social Needs Without Losing the Room
Practical guidance for the conversation itself
Before You Ask
Say why you are asking, in one sentence
Try: "We ask everyone about things like housing and food, because they affect health as much as medication does." Universal framing is the single biggest driver of disclosure. Patients who think they were singled out because of how they look or what insurance they carry will give you clean, empty answers.
Get the room right
Never ask about safety, income, or immigration with a partner, adult child, or driver in the room, and do not use a family member as the interpreter. Step the companion out for the last portion as a matter of routine so it does not look like suspicion of a specific person.
Do not ask what you cannot act on
Screening without a referral pathway erodes trust and is the most common reason programs get abandoned. Before you roll this out, know your food pantry hours, your ride benefit, your medical hold letter for utilities, your patient assistance forms, and one named person you can warm-hand-off to.
Decide who asks and where it lands
Front-desk tablets get more honest answers on money and food; a clinician in the room gets more on violence and stress. Whichever you choose, agree in advance where answers are documented, who reviews positives the same day, and what happens to a positive found at 4:55 pm on a Friday.
Phrasing That Shuts Patients Down
- Are you homeless. Most people in unstable housing do not use that word about themselves. Ask what their living situation is today instead.
- Do you go hungry. It reads as an accusation of failure. The validated wording is about worrying that food will run out.
- Do you have a way to get here. A yes is easy and meaningless. Ask whether transportation has actually stopped them in the past year.
- Can you afford this medication. Patients say yes to avoid embarrassment. Ask whether they have skipped or split doses because of cost.
- Is everything okay at home. Too vague to answer and too easy to deflect. Name the behavior: hurt, threaten, make you afraid.
- Why did you miss your appointment, asked as a reprimand. It closes off the transportation, childcare, and shift-work answers you needed.
- Chart phrases like noncompliant, refuses, or poor historian. They record a social barrier as a character flaw and follow the patient for years.
What to Do With a Positive Answer
Reflect it back before you fix it
"So you are stretching your insulin to the end of the month." One sentence of acknowledgment before problem solving is what makes the patient tell you the next thing. Jumping straight to a pamphlet signals you were checking a box.
Ask consent to refer, and expect no sometimes
"Would it be all right if our social worker called you about food resources?" Some patients disclose a need but do not want an intervention, and forcing the referral costs you the next disclosure. Note the decline and offer again at the next visit.
Change the medical plan, not just the referral list
Food insecurity means avoiding a sulfonylurea that can cause hypoglycemia when meals run out. No refrigeration changes your insulin choice. No transportation means consolidating labs into one visit. The screening only pays off if it edits the prescription.
Document with Z codes and close the loop
ICD-10 Z55 through Z65 capture housing, food, and economic risk and increasingly drive risk adjustment and program funding. Then put a real follow-up on the calendar: ask at the next visit whether the referral actually reached them, because most closed-loop rates are far worse than teams assume.
Validated Tools Worth Borrowing From
- PRAPARE, from the National Association of Community Health Centers, covers housing, income, transportation, social integration, and stress and maps to EHR templates.
- The CMS Accountable Health Communities Health-Related Social Needs tool is ten items across five core domains and is designed for fast intake use.
- Hunger Vital Sign is a two-item food insecurity screen, which is why the food question above uses its exact wording rather than a paraphrase.
- HITS and HARK are short partner-violence screeners; use their behavior-specific language rather than inventing your own.
- The Single Item Literacy Screener asks how often someone needs help reading material from a doctor or pharmacy, which fits inside a visit better than a full reading assessment.
- WellRx and the AAFP Social Needs Screening Tool are useful shorter options for primary care practices building a first version.