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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Medical Home: Usual Source of Sick Care.

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Strategy. Promotion of Non-Medical Influences on Health

Approach. Promote understanding of the non-medical influences on health in clinics and communities through training

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Overview. Non-medical influences on health affect access to and utilization of sick care services for children.[1] Factors such as patients' socioeconomic status, housing, food sufficiency, education level and citizenship status can significantly impact a family's ability to access healthcare resources.[2,3] Some nom-medical influences like housing instability or food insecurity can exacerbate health issues, making consistent access to sick care even more critical.[4,5] Evidence shows that addressing non-medical influences on health through tailored interventions and policy change is essential in ensuring healthcare is usable for all children.[6]

Evidence. Moderate Evidence. Strategies with this rating are likely to work...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Pre- and post- training knowledge assessments
  • Training satisfaction data
  • Patient satisfaction data

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Health Care Access for All MCH Populations.
  • Policy. This strategy helps to promote decisions, laws, and regulations that promote public health practices and interventions.
  • Community Health Factors.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Population/Systems-Focused

Examples from the Field. There are currently no ESMs that use this strategy. Search similar intervention components in the ESM database.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of healthcare organizations providing training on non-medical influences on health to staff and providers. (Measures adoption of training)
  • Number of healthcare professionals completing training on non-medical influences on health concepts and interventions. (Assesses training participation)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of non-medical influences on health training programs incorporating interactive skill-building components. (Measures quality of training design)
  • Percent of non-medical influences on health training content tailored to workforce needs and contexts. (Assesses relevance of training)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of providers demonstrating increased knowledge in identifying and addressing non-medical influences on health in patient care. (Measures impact of training on workforce capacity)
  • Number of partnerships established to share training best practices across settings who report high levels of engagement. (Measures knowledge dissemination efforts)
  • Number of healthcare systems integrating training standards into their programs. (Assesses field-level adoption of training)
  • Number of communities experiencing improvements in health indicators due to trained workforce. (Measures population-level impact)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of training programs developed in partnership with communities. (Measures community engagement in training design)
  • Percent of training content addressing systemic factors impacting health. (Assesses integration of systems change frameworks)
  • Percent reduction in differences in training access among healthcare workforces. (Measures progress towards workforce training)
  • Percent of training participants from reporting increased agency to address non-medical influences on health. (Assesses support impact of training)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

[1] Weller BE, Faubert SJ, Ault AK. Youth Access to Medical Homes and Medical Home Components by Race and Ethnicity. Matern Child Health J. 2020 Feb;24(2):241-249. doi: 10.1007/s10995-019-02831-3. PMID: 31828575.

[2] Boone KM, Nelin MA, Chisolm DJ, Keim SA. Gaps and Factors Related to Receipt of Care within a Medical Home for Toddlers Born Preterm. J Pediatr. 2019 Apr;207:161-168.e1. doi: 10.1016/j.jpeds.2018.10.065. Epub 2018 Dec 19. Erratum in: J Pediatr. 2019 Dec;215:289. PMID: 30579584; PMCID: PMC6440840.

[3] Baumann KJ, Adera T. Sociodemographic Characteristics and Inadequate Usual Sources of Healthcare in a National Sample of US Refugees. Int J Environ Res Public Health. 2022 Jun 13;19(12):7234. doi: 10.3390/ijerph19127234. PMID: 35742484; PMCID: PMC9223584.

[4] Wang K. Housing Instability and Socioeconomic differences in Health: Evidence from the U.S. Economic Recession. J Racial Ethn Health Disparities. 2022 Dec;9(6):2451-2467. doi: 10.1007/s40615-021-01181-7. Epub 2021 Nov 26. PMID: 34837164.

[5] Gundersen C, Ziliak JP. Food Insecurity And Health Outcomes. Health Aff (Millwood). 2015 Nov;34(11):1830-9. doi: 10.1377/hlthaff.2015.0645. PMID: 26526240.

[6] Thornton RL, Glover CM, Cené CW, Glik DC, Henderson JA, Williams DR. Evaluating Strategies For Reducing Health Disparities By Addressing The Social Determinants Of Health. Health Aff (Millwood). 2016 Aug 1;35(8):1416-23. doi: 10.1377/hlthaff.2015.1357. PMID: 27503966; PMCID: PMC5524193.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.