Development and validation of a self-report social determinants of health questionnaire in Australia

Social determinants of health have a significant effect on health and wellbeing. There is increasing recognition of the need for health professionals to measure and address the social determinants affecting the health and wellbeing of their clients, yet efforts to do so are hampered by the lack of a validated, brief self-report measure that covers a range of determinants in a single measure. This study aimed to develop and conduct initial validation of a measure of social determinants of health, the Steps to Better Health Questionnaire (STBH-Q). Construct validity was assessed via factorial validity using exploratory factor analysis and second order confirmatory factor analysis (CFA), followed by convergent validity against the EQ-5D-5L quality of life measure. Reliability was assessed by exploring internal consistency. A convenience sampling approach was used, and 330 Australian adults aged 18 and over completed the survey. This initial validation suggests an underlying structure of STBH-Q consisting of Access; Employment, Finances & Education; Safety; Physical & Mental Health; and Family & Childhood, confirmed by second-order CFA. Results of convergent validity testing with the EQ-5D-5L demonstrated significant correlations of modest to moderate strength with the instrument as a whole and with the sub-scales in the expected direction. Cronbach's alpha for the five scales ranged from 0.561 to 0.827. Further development and validation of the STBH-Q is needed to explore alternative questions regarding social connection and habits/addictions and add additional items to factors with only two items. Lay Summary Health and wellbeing are influenced by a range of factors, including the circumstances in which we are born and live our lives, called social determinants of health. It is important to measure social determinants of health at an individual level so they can be addressed, yet existing questionnaires tend to focus on a limited number of determinants or are time consuming and complex for individuals to fill in. We developed a simple measure of social determinants of health that can be easily completed and conducted a study to determine the validity and reliability of the questionnaire. We found that the questionnaire is a valid and reliable measure of social determinants of health.