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 (PRAPARE1, AHC2) 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:
- Caregivers are not patients — they often do not identify as needing help. Standard patient-facing SDOH screens miss them entirely.
- Caregiver SDOH domains differ — legal navigation (power of attorney, guardianship) is critical for caregivers but absent from patient SDOH tools. Caregiver-specific financial strain is distinct from patient financial hardship.
- 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.
- 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¶
PRAPARE (2019)¶
The Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences1 is a standardized clinical SDOH screening tool. GiveCare draws from PRAPARE for:
- GC1 (Social Support): Social integration and isolation questions
- GC3 (Housing & Environment): Housing stability and safety
- GC4 (Financial Resources): Income adequacy and material hardship
AHC Screening Tool¶
The Accountable Health Communities screening tool2 focuses on community-level social needs. GiveCare draws from AHC for:
- GC3 (Housing & Environment): Housing quality, utilities, safety
- GC4 (Financial Resources): Food security, transportation access
How GiveCare domains map to standard SDOH domains¶
| GiveCare Domain | PRAPARE Domain | AHC Domain |
|---|---|---|
| GC1: Social Support | Social integration | Interpersonal safety |
| GC2: Physical Health | Health literacy | — |
| GC3: Housing & Environment | Housing | Housing instability |
| GC4: Financial Resources | Material needs, employment | Food insecurity, utilities |
| GC5: Navigation | — | — |
| GC6: Emotional Wellbeing | Stress | — |
Note that GC5 (Navigation) and GC6 (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:
- GC5 reflects the navigation burden unique to caregivers — healthcare system complexity, legal documents (POA, wills, guardianship), insurance appeals
- GC6 reflects the emotional load that standard SDOH tools under-measure — anticipatory grief, identity loss, chronic uncertainty
Two additional constructs inform the caregiver lens. PROMIS measures healthcare access satisfaction4 and illness burden5 as distinct instruments. In caregiver-facing use, these represent two different structural pressures on the household: the caregiver's own ability to access care, and the care-recipient's overall illness load shaping day-to-day caregiving demand.
Design principles¶
- Strength-framed language: Domains identify "supports" (strengths to lean on) and "pressures" (areas where help makes a difference), not "risk factors."
- Adaptive depth: GC-SDOH-6 first, then four optional GC-SDOH-30 questions in one flagged domain. See Assessments.
- Action-linked: Every flagged domain can inform specific benefit programs and intervention strategies.
- Longitudinal tracking: Domains 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.