The Keys to Improving Patient Experience in Marginalized Communities


Very little is easy about running a healthcare facility, especially at federally qualified healthcare centers (FQHCs) and community health centers (CHCs), where the needs of the marginalized populations served are diverse and numerous barriers exist to quality care. Challenging? Definitely. Overwhelming? Staff and clinicians would say so, with a recent study finding that four in five physicians don’t feel confident in their capacity to meet their patients’ social needs.

Improving patient experience for individuals in underserved demographics is, of course, not simple or linear – it’s a multilayered responsibility involving education, communication, and ongoing community and patient engagement. But facilities can more effectively influence positive change by assuring that providers are routinely considering the 5 social determinants of health in care delivery and that their patient experience manager or functional leader is weighing regular patient feedback as they take targeted actions to increase equal access – all leading to better outcomes, healthier communities, and more satisfied and loyal patients walking through your doors.

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The 5 Social Determinants of Health

Central to improving patient experience are the social determinants of health (SDOH), which, according to the World Health Organization, are “the nonmedical factors that influence health outcomes. They’re the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.” Though widely familiar to FQHCs and CHCs due to their strong influence on healthcare delivery among marginalized communities, they’re highly complicated and often interdependent on each other, requiring review when receiving patients and consideration in patient survey questions. Here’s a quick examination of the 5 social determinants of health and their complexity:

1. Economic Stability

Determining how economically stable a person is goes beyond how much money they have, though that’s obviously important. 2022 U.S. census data shows that 11.5% of Americans live in poverty, or nearly 38 million people, with many unable to afford healthcare insurance. Steady employment can provide insurance; however, it doesn’t always supply sufficient income, so workers can still lack the resources to live healthfully.

Food and housing insecurity are also factors in economic stability. Low-income neighborhoods may not have nutritious food available or exist far from supermarkets, driving up prices on healthy items. Individuals and families may also spend the bulk of their income on rent, be forced into dangerous housing, be evicted, or be denied housing altogether. It’s critically important to consider how these factors may not only lead to negative health effects, but also how they influence patient behaviors.

2. Education Access and Quality

The impact of a strong education or lack thereof is directly tied to one’s health: Those who attain a bachelor’s degree tend to live longer. But the level of education completed isn’t a standalone measure in determining how schooling affects health; the quality of one’s education is also critical to what the individual can do with what they learn and how they establish their lifestyle, and together these factors influence other SDOHs.

Without the right knowledge and skills, for example, a graduate can’t secure the job and income they need, which can lead to a less-than-ideal living situation and limit their access to healthcare. Depending on the neighborhood they can afford, their children may experience the pitfalls of underfunded education that stunt their own development, creating an endless cycle of poor health. Understanding these generational issues is just as important as genetic history.

3. Neighborhood and Built Environment

One’s neighborhood can in part determine food security, but there are larger implications to where someone lives for overall health and safety. In some neighborhoods, building overcrowding is common and can expose unwitting tenants to harmful toxins and infectious diseases. Water quality and pollution pose threats, as do crime and violence, most worryingly for children. Poorly constructed or maintained “built environments” – inclusive of manufactured structures like sidewalks, playgrounds, and green space – present additional safety and livability challenges, which need to be studied at the community level.

4. Healthcare Access and Quality

There are multiple reasons why someone may not receive the care they need, with the most common being no insurance, lack of primary care provider options, high out-of-pocket costs, and the absence of physical access, such as transportation (personal vehicle or public transit). Skipping appointments can lower life expectancy and lead to higher costs down the line when treatment is unavoidable. When improving patient experience, facilities must investigate the reasons for why patients don’t make it to visits and follow up with steps to improve access.

5. Social and Community Context

Relationships with family, friends, and co-workers play a significant role in one’s health and well-being, particularly when there’s cohesion and connectedness among community members. That unity helps people overcome challenges and dangers outside of their control, such as unsafe neighborhoods, bias, and lack of personal resources, all potentially damaging to one’s health. Key factors include social cohesion, civic participation, discrimination/inequality, and incarceration, all of which FQHCs and CHCs can support with programs that help efforts to combat inequity.

Free eBook – The Care Necessities: A Simple Guide to Elevating Patient Experience

Supporting Diversity, Equity, and Inclusion in Healthcare

Understanding the 5 social determinants of health is just one building block for improving patient experience. To promote true diversity, equity, and inclusion in healthcare that helps lead to better patient reviews and retention, a patient experience manager should implement efforts such as:

  • Consistent SDOH screenings and data collection. While most FQHCs – 71% – collect SDOH data, many in the South don’t, according to a study in the American Journal of Preventive Medicine. Screening can allow these facilities to identify patients’ social needs and help address them, and the questions from these screening tools make an impactful addition to your customizable patient surveys.
  • Programs to promote empowerment. While meeting patients’ social needs can feel overwhelming, facilities can build trust and strength in their communities by promoting civic engagement – offering information on local elections, voter registration, and forums for discussion. They can counter disempowerment narratives and promote social cohesion with support for and education on issues like immigrant rights and the criminal justice system.
  • Health literacy training for clinicians. It can be difficult for doctors to understand their patients’ lack of health literacy (HL), defined by the Centers for Disease Control and Prevention as “the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others.” Limited health literacy (LHL) is associated with SDOHs like low education level and income, as well as ethnic minority status, and can lead to increased hospitalization rates, disease development, and higher mortality. In high-volume clinics, brief training is recommended to educate providers on LHL’s prevalence and impact, help assess HL, and provide guidance on communicating with patients with LHL.
  • Real-time surveying. The funding that keeps comprehensive care available to underserved and uninsured populations hinges on positive outcomes and improving patient experience scores, so what you don’t know about your patients can literally hurt you – and them. In time- and resource-strapped facilities, it’s essential to use digital surveying methods to get real-time input on the challenges your patients face – before it’s too late to course-correct. Surveys should be conducted before, during, and after visits to capture the full scope of needs, and cover domains related to SDOH such as social connections and isolation, literacy/learning style, transportation, discrimination, and stress. Sample questions might include:
    • How hard is it for you to pay for basic food, housing, medical care, and air conditioning and heating?
    • Do you have access to a variety of food, including fruits and vegetables?
    • Has a lack of transportation kept you from medical appointments or from getting medications?
    • How often do you feel lonely or isolated from those around you?

Choosing a Partner to Help Your Patient Experience Manager

With our XM Platform, Feedtrail makes improving patient experience simple, allowing you to gather timely patient feedback, instantly share input that needs to be addressed, and seamlessly direct happy patients to leave reviews on your preferred site. The platform’s easy customizability is tailored to the needs of FQHCs, CHCs, and physician practices whose staff are pulled in many directions but are invested in delivering the best possible care to all patients. To learn more, book a demo today.

The Care Necessities: A SimpleGuide to Elevating Patient Experience


About Mallory Magelli McKeown, Customer Success: Meet Mallory, a healthcare professional dedicated to improving the patient experience. With a background in roles like chaplain and family advocate, Mallory’s mission is simplifying healthcare for patients and families. From advisory councils to patient advocacy, she amplifies the patient’s voice. At Feedtrail, she redefines the patient-provider relationship, asking vital questions to guide healthcare leaders toward patient-centered changes. Her goal: revolutionizing healthcare by putting patients’ needs first.