Communication and interview techniques for building a health history may differ with each patient depending on their social determinants of health, such as age, gender, ethnicity, and environmental situations. For example, communication techniques with a patient from a different cultural background may require the use of interpreters or the need to adjust language and terminology to ensure effective communication. Questions targeting social determinants of health may include those related to socioeconomic status, education level, occupation, living situation, and access to healthcare.
Risk assessment instruments that may be appropriate to use with each patient may include those related to the specific health risks associated with their age, gender, ethnicity, or environmental setting. For example, an older patient may require screening for fall risk, while a female patient may require screening for breast cancer. Environmental factors such as exposure to pollution may require screening for respiratory conditions.
One risk assessment instrument that may be applicable to a selected patient is the ACE (Adverse Childhood Experiences) questionnaire. This tool assesses the patient’s exposure to childhood traumatic experiences and can help identify potential health-related risks such as depression, substance abuse, and chronic diseases. Some targeted questions that could be asked using this instrument include:
- Did you experience any abuse (physical, emotional, or sexual) during your childhood?
- Did you witness any violence in your household during your childhood?
- Did any household members have a mental health condition or substance abuse problem during your childhood?
- Did any household members go to prison during your childhood?
- Did your parents divorce or separate during your childhood?
When building a health history, it is important to use effective communication techniques, such as active listening, empathy, and cultural sensitivity. The use of open-ended questions can help elicit more detailed information from the patient. The risk assessment instrument selected should be applicable to the specific patient and their social determinants of health to ensure the most accurate assessment of their health risks.
References: Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2019). Seidel’s guide to physical examination. Elsevier Health Sciences.
Centers for Disease Control and Prevention. (2019). Adverse childhood experiences (ACEs). Retrieved from https://www.cdc.gov/violenceprevention/childabuseandneglect/acestudy/index.html
National Institute of Minority Health and Health Disparities. (2021). Social determinants of health. Retrieved from https://www.nimhd.nih.gov/programs/extramural/research-areas/social-determinants-health/index.html