Skip to content

SDOH Framework

Social determinants of health (SDOH) are the conditions in which people live, learn, work, and age that affect health outcomes. GiveCare applies SDOH not to patients, but to caregivers — the people whose own health deteriorates while they provide care.

Why SDOH for caregivers

Clinical SDOH frameworks (PRAPARE2, AHC3, NAM1) were designed for patient populations. They ask: "What social factors affect this patient's health?" GiveCare asks a different question: "What social factors affect this caregiver's ability to sustain care?"

The distinction matters because:

  1. Caregivers are not patients — they often do not identify as needing help. Standard patient-facing SDOH screens miss them entirely.
  2. Caregiver SDOH domains differ — legal navigation (power of attorney, guardianship) is critical for caregivers but absent from patient SDOH tools. Caregiver-specific financial strain ($7,242/yr out-of-pocket4) is distinct from patient financial hardship.
  3. Intervention targets differ — a patient SDOH screen might trigger a referral to social work. A caregiver SDOH screen triggers benefits discovery, respite coordination, or legal navigation.
  4. Temporal dynamics differ — caregiver SDOH changes as the care recipient's condition progresses. What was manageable at diagnosis becomes crushing at year three.

Standard frameworks adapted

NAM SDOH Framework (2017)

The National Academy of Medicine defined five broad SDOH domains1:

  1. Economic stability
  2. Education access and quality
  3. Health care access and quality
  4. Neighborhood and built environment
  5. Social and community context

GiveCare maps these to caregiver-specific zones, preserving the multi-dimensional structure while reframing every domain through a caregiving lens.

PRAPARE (2019)

The Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences2 is a standardized clinical SDOH screening tool. GiveCare draws from PRAPARE for:

  • P1 (Social Support): Social integration and isolation questions
  • P3 (Housing & Environment): Housing stability and safety
  • P4 (Financial Resources): Income adequacy and material hardship

AHC Screening Tool

The Accountable Health Communities screening tool3 focuses on community-level social needs. GiveCare draws from AHC for:

  • P3 (Housing & Environment): Housing quality, utilities, safety
  • P4 (Financial Resources): Food security, transportation access

How zones map to standard SDOH domains

GiveCare Zone NAM Domain PRAPARE Domain AHC Domain
P1: Social Support Social & community context Social integration Interpersonal safety
P2: Physical Health Health care access Health literacy —
P3: Housing & Environment Neighborhood & built environment Housing Housing instability
P4: Financial Resources Economic stability Material needs, employment Food insecurity, utilities
P5: Legal & Navigation — (not in standard SDOH) — —
P6: Emotional Wellbeing — (partially in health access) Stress —

Note that P5 (Legal & Navigation) and P6 (Emotional Wellbeing) have no direct analog in standard SDOH frameworks. These are caregiver-specific domains that emerged from the evidence on what uniquely drives caregiver signal degradation:

  • P5 reflects the navigation burden unique to caregivers — healthcare system complexity, legal documents (POA, wills, guardianship), insurance appeals
  • P6 reflects the emotional load that standard SDOH tools under-measure — anticipatory grief, identity loss, chronic uncertainty

Design principles

  1. Strength-framed language: Zones identify "supports" (strengths to lean on) and "pressures" (areas where help makes a difference), not "risk factors."
  2. Adaptive depth: Quick screening first (SDOH-6), deep-dive only where flagged (SDOH-30). See Assessments.
  3. Action-linked: Every flagged zone connects to specific benefit programs and intervention strategies.
  4. Longitudinal tracking: Zones are reassessed over time. The GiveCare Score tracks composite trends.

Evidence synthesis

For the full research synthesis on applying SDOH to caregiving populations, see SDOH in Caregiving.

  1. NAM. "Social Determinants of Health Framework." 2017. Source → ↩↩

  2. NACHC. "PRAPARE Implementation and Action Toolkit." 2019. Source → ↩↩

  3. CMS. "Accountable Health Communities Health-Related Social Needs Screening Tool." Source → ↩↩

  4. AARP/NAC. "Caregiving in the United States 2025." Source → ↩