Social determinants of health and unmet social needs in people with MS

• A/Prof Claudia Marck

  claudia.marck@unimelb.edu.au
  

Project Details

A/Prof Claudia Marck has led several projects to better understand how social determinants of health shape health outcomes for people with MS. This program of work so far comprises three complementary studies that together establish the evidence base for integrating social needs assessment into Australian MS clinical care. The research programme is grounded in the recognition that social determinants of health—encompassing factors such as socioeconomic status, housing, employment, and access to services—account for 30–55% of health outcomes and profoundly shape health inequalities among people with MS.

A/Prof Marck was part of an international working group which published a foundational review led by Dobson in 2022, which provides the theoretical and empirical framework by establishing that social determinants significantly influence MS disease trajectories and health outcomes. This international review demonstrates that individuals from disadvantaged backgrounds, including those with lower socioeconomic status, limited education, ethnic minorities, and those in rural areas, experience substantial disparities in access to timely diagnosis, disease-modifying therapies, and comprehensive MS care. This work establishes the compelling case for why healthcare systems must move beyond purely biomedical approaches to incorporate assessment and intervention on social needs as integral components of MS management.

Building on this foundation, the team led by A/Prof Marck obtained funding from MS Australia in 2025 to further assess how unmet social needs can be addressed through MS care. The first study was led by Isabelle Weld-Blundell, conducting a scoping review which systematically identified and critically analysed existing social needs screening tools available for clinical populations in Australia and New Zealand. This review maps the landscape of available instruments, evaluating their comprehensiveness, relevance, and feasibility for potential application in MS care settings. By synthesising evidence on existing tools and their characteristics, this work provides essential information about what instruments are available and their suitability for implementation in the Australian MS context.

The second, a qualitative study led by Megan Hawkins then translates this evidence into actionable insights by directly exploring the feasibility, barriers, and enablers to implementing social needs screening in Australian MS clinical practice. Through focus groups and interviews with both clinicians and people with lived experience of MS, this study identifies the specific challenges and facilitators to social needs assessment in the MS care setting. The research reveals that whilst social needs screening tools are considered conditionally acceptable and feasible, successful implementation requires accompanying resources such as referral pathways, algorithms, and user manuals; adequate staffing and time; and demonstrated evidence of clinical value. The study identifies key barriers including clinician knowledge gaps regarding available resources, insufficient time and staffing, and lack of evidence demonstrating the benefit of screening. Importantly, it also identifies enablers such as strong patient–clinician rapport, good care coordination, and clinician commitment to holistic care.

Together, these three studies form a coherent research programme that progresses from establishing the theoretical importance of social determinants in MS (Dobson et al.), through mapping available tools and resources (Weld-Blundell et al.), to understanding the practical implementation context and stakeholder perspectives (Hawkins et al.). The programme provides a comprehensive evidence base for developing and testing a co-designed social needs screening tool specifically tailored to the Australian MS care context, with accompanying implementation resources and support structures. The findings collectively support the development of pilot trials to generate local evidence of the impact of social needs screening on health outcomes, healthcare utilisation, and quality of life for Australians with MS, ultimately contributing to more equitable and comprehensive MS management.

Publications:
1.        Hawkins MR, Learmonth YC, Weld-Blundell I, Ayton D, Haartsen J, Kavanagh A, Kalincik T, Klaic M, Marck CH. Assessing unmet social needs in multiple sclerosis care in Australia: a qualitative assessment of feasibility, barriers and enablers. Health Expectations. 2026 (accepted)
2.        Weld-Blundell I, Learmonth YC, Klaic M, Haartsen J, Ayton D, Kavanagh A, Hawkins MR, Marck CH (2026) Social Needs Screening Tools for Clinical Populations in Australia and New Zealand: A Scoping Review and Critical Analysis. Health Expectations 29:e70626
3.        Dobson R, Rice DR, D'Hooghe M, Horne R, Learmonth Y, Mateen FJ, Marck CH, Reyes S, Williams MJ, Giovannoni G, Ford HL (2022) Social determinants of health in multiple sclerosis. Nat Rev Neurol 18:723-734

Researchers

From the University of Melbourne:

Claudia Marck

Megan Hawkins

Isabelle Weld-Blundell

Tomas Kalincik

Anne Kavanagh

Marlena Klaic

Collaborators

Yvonne Learmonth, University of New South Wales

Darshini Ayton, Monash University

Jodi Haartsen, Alfred Hospital