Table 3.

Assessment of potentially most relevant tools in relation to reflective questions.

First Author(s) [date(s)]*–article type	Tool	Includes diverse patient life trajectories, mobility, vulnerabilities and assets?	Indicators tapping eco-social contexts for health?	State of application?†	Aspects applicable to practices-communities in diverse rural, resource development regions?	Challenges uncovered/ addressed for operationalizing?
Mullan et al. (59)—concept and specific application	Geographic retrofitting	Likely	Not yet	Promising approach	Good potential to map patient sources for primary care, emergency utilization, including unincorporated rural areas	Sparseness of census and other data in rural, remote areas
Dulin et al. (60)—case study of application	Geographic information system (GIS) integration and analysis	Yes through Multi Attribute Primary Care Targeting Strategy (MAPCATS)	Not yet	Promising approach	Good potential to map patient sources for primary care, insurance coverage, emergency and hospitalization use, for regions with rural and urban centers	Smaller populations translate into data limitations from nationally representative surveys where small communities may have few people representing an area
Lebrun et al. (61)—multiple case study [also part of COPC literature]	Community health assessment	Likely	In some health centers engaged with environmental justice organizations	Substantial examples, with some empirical evaluation	Included health centers in rural areas. Complemented community health assessment with community needs assessments, ongoing data collection and analysis, use of surveillance data, and program evaluation	Limited integration and interoperability of data sources, within health centers as well as between health centers and partner organizations
Andermann (44)—review	Screening tools as part of patient encounters	Yes, on vulnerabilities	Housing perhaps	Promising approach	Expanding to eco-social contexts for eco-social concerns and impacts as optional template on electronic health records.	Lewis et al. (62) documented the challenges community health center clinicians faced in identifying, treating and accounting/billing for social determinants of health. Included clinician skills and tools, organizational response capacity, and economics of reimbursement. Similarly Gold et al. (63) re: electronic health record integration challenges.
	Analogous to Social Prescribing referrals	Yes, particularly vulnerabilities	Some, as per Young et al. (64)	Interesting idea	Potential for navigator and champion roles in eco-social prescribing e.g., to community member who shares snow shoes with youth and takes them out for walks in woodlands.	Potential challenges due to smaller tax bases, less health and social service capacity in rural areas. Yet also more green space for land-based healing.
Furst et al. (65)—review	Eight mental healthcare ecosystems description/assessment tools	Mostly diagnosis or demographic descriptors	Ecosystem term applied to health care system at different scales but not explicitly eco-social factors	Empirical evaluations	Relevant to mental health services in broad regions, but lack rural specifics	Several challenges in application for health services research

^*Chronological.

^†State of Application categories: interesting idea, promising approach, empirical evaluation, decades of institutionalization.