Validating a Community-Based Social Determinants of Health Screening Tool: A Psychometric Analysis for Policy and Practice

Background and Significance: Validated screening tools for social determinants of health (SDOH) are critical for identifying patient needs, yet many existing screening instruments lack psychometric rigor and fail to reflect the priorities of marginalized populations who experience structural barriers to care. The absence of culturally and contextually valid tools limits their effectiveness in identifying patient needs and informing equity-focused interventions. This study evaluates the psychometric properties of a newly developed community based SDOH screening tool implemented at a community health clinic, examining its validity and reliability to support evidence-based practice and policy interventions.

Objective: This study aims to assess the construct validity, reliability, and measurement invariance of the SDOH screening tool using a multi-step psychometric approach. The goal is to ensure the instrument provides robust, interpretable, and actionable data to inform both clinical decision-making and population health policy.

Methods: A cross-sectional study was conducted with patient survey responses (N=855) at a community clinic in central Texas. Normality was assessed using the Henze-Zirkler test, and factorability was determined through the Kaiser-Meyer-Olkin (KMO) measure and Bartlett’s test of sphericity. EFA with Principal Axis Factoring identified latent constructs, and CFA tested model fit. Internal consistency was measured with Cronbach’s alpha, while measurement invariance was examined across demographic subgroups. Receiver Operating Characteristic (ROC) curve analysis was used to explore classification thresholds for high-risk patients, informing potential policy applications for resource allocation.

Results: The five-factor EFA model demonstrated strong model fit and explained significant variance in patient needs. Cronbach’s alpha indicated high internal consistency for most factors. Measurement invariance testing revealed better model fit among female, Spanish-speaking, and pediatric patients, suggesting the need for tailored modifications. ROC analysis identified a potential threshold score to classify high-risk patients, reinforcing the tool’s utility in clinical decision-making and policy planning.

Discussion and Conclusions: Findings support the validity and reliability of the community based SDOH screening tool. By identifying social risks at the point of care, this tool enables clinicians and policymakers to allocate resources more effectively, advocate for targeted interventions, and refine practice guidelines. Additionally, findings highlight the importance of culturally responsive refinements to ensure equitable measurement across diverse populations. Future research should integrate community feedback and qualitative insights to enhance implementation strategies, ensuring that validated SDOH screening tools translate into meaningful improvements in healthcare access and equity.