Table 1.
Social and behavioural determinants of health items on the new patient form
| Item | Response | Explanation | Reference/s |
|---|---|---|---|
| Social determinants | |||
| In which country were you born? | Free text response. | Related to health literacy and understanding of the Australian health system. | [22] |
| Do you speak English at home? | Yes/no. | Linked with health literacy | [8, 22] |
| Do you live alone? | Yes/no. | Linked with health literacy and social support | [22] |
| Do you have private health insurance? | Yes/no. | Linked with health literacy and health system access | [22] |
| Do you have a healthcare card? | Yes/no. | Linked with health literacy and health system access | [22] |
| Are you confident completing medical forms? | Not at all confident to Extremely confident. | Health literacy screening item | [23] |
| What is the highest level of education you have completed? | Primary school or less to University. | Linked with health literacy | [8, 22] |
| Behavioural determinants | |||
| Do you smoke? | Yes/no. | Linked with health literacy and increased incidence of other non-communicable chronic diseases | [22] |
| How many hours of sleep do you get each night? | Less than 6 h to 9 or more hours. | Related to chronic musculoskeletal complaints | |
| How many serves of fruit do you consume each day? | 0 to 7. | Linked with health literacy and general health behaviours. Evaluated in Australian National Health Survey | [24] |
| How many serves of vegetables do you consume each day? | Linked with health literacy and general health behaviours. Evaluated in Australian National Health Survey | [24] | |
| Over the last week, how many days did you exercise for at least 30 min per day? | 0 to 7. | Establish health behaviours in relation to Australian guidelines | |
| How long would each typical exercise session last?a | Less than 30 min to Greater than 90 min. | Establish health behaviours in relation to Australian guidelines | |
| On average, rate the intensity of your exercise over the last week?a | Sedentary to High. | Establish health behaviours in relation to Australian guidelines | |
| On a usual week day, how much time do you spend sitting: - As part of work or volunteer activities? In other leisure time? | 0–3 h to 12 h or more. | Linked with health literacy and general health behaviours. Evaluated in Australian National Health Survey | [24] |
| Have you had your blood pressure checked by a doctor or health professional in the past 12 months? | Yes/no. | Linked with health literacy and general health behaviours. | |
| Have you had a skin cancer check in the past 12 months? | Yes/no. | Common issue in Australia and linked with general health behaviours. | |
| Chronic disease status | |||
| Common chronic diseases: arthritis, back pain, asthma, heart problems, high cholesterol, high blood pressure, asthma, cancer, mental health disorder, stroke, diabetes, kidney disease | Currently suffering/Previously suffering/Both. | Common chronic diseases evaluated in the Australian National Health Survey. The list on the form varied from 2016 to 2017 due to a change in the prevalence of some chronic diseases relative to others | [2, 3] |
| Global health status | |||
| Please rate your general health | Poor to Excellent. | Evaluated in Australian National Health Survey. | [24] |
| Quality of life | |||
| Overall, how satisfied are you with your life? | 0 (not at all satisfied) to 5 (extremely satisfied). | Potential screen for a range of mental health disorders and health literacy. | [8] |
a Only completed by patients attending the clinic in 2016