Protocol - Perceptions of Housing Insecurity

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The AHC HRSN screening tool assesses the current living situation, including perception of stability, as well as decency and safety, with two items.

Specific Instructions





If someone chooses the underlined answers, they might have an unmet health-related social need.

Living Situation

  1. What is your living situation today?
    1. [ ] I have a steady place to live
    2. [ ] I have a place to live today, but I am worried about losing it in the future
    3. [ ] I do not have a steady place to live (I am temporarily staying with others, in a hotel, in a shelter,living outside on the street, on a beach, in a car, abandoned building, bus or train station, or in a park)
  2. Think about the place you live. Do you have problems with any of the following?
    1. [ ] Pests such as bugs, ants, or mice
    2. [ ] Mold
    3. [ ] Lead paint or pipes
    4. [ ] Lack of heat
    5. [ ] Oven or stove not working
    6. [ ] Smoke detectors missing or not working
    7. [ ] Water leaks
    8. [ ] None of the above


Underlined answer options indicate positive responses for the associated health-related social need.

Item 1: The second answer option is intended to identify beneficiaries who are at risk of losing their housing for any reason, including inability to pay a mortgage or rent. The third answer option is intended to identify beneficiaries who are homeless. Selecting either option 2 or option 3 would indicate that the beneficiary has a housing need for the purposes of the AHC Model.

Item 2: Selecting any answer option other than “none of the above”would indicate that the beneficiary has a housing need for the purposes of the AHC Model.

Personnel and Training Required

The interviewer must be trained to conduct personal interviews with individuals from the general population. The interviewer must be trained and found to be competent (i.e., tested by an expert) at the completion of personal interviews. The interviewer should be trained to prompt respondents further if a “don’t know” response is provided.

Equipment Needs

The PhenX Working Group acknowledges these questions can be administered in a computerized or noncomputerized format (i.e., paper-and-pencil instrument). Computer software is necessary to develop computer-assisted instruments. The interviewer will require a laptop computer/handheld computer to administer a computer-assisted questionnaire.

Requirement CategoryRequired
Major equipment No
Specialized training No
Specialized requirements for biospecimen collection No
Average time of greater than 15 minutes in an unaffected individual No
Mode of Administration

Interviewer-administered questionnaire




Adults aged 18 or older

Selection Rationale

The AHC HRSN screening tool is validated and freely available.



Derived Variables


Process and Review

Not Applicable

Protocol Name from Source

The Accountable Health Communities (AHC) Health-Related Social Needs (HRSN) Screening Tool


Billioux, A., Verlander, K., Anthony, S., & Alley, D. (2017). Standardized screening for health-related social needs in clinical settings: the accountable health communities screening tool. [Discussion paper]. NAM Perspectives. National Academy of Medicine. https://doi.org/10.31478/201705b

Nuruzzaman, N., Broadwin, M., Kourouma, K., & Olson, D. P. (2015). Making the social determinants of health a routine part of medical care. Journal of Healthcare for the Poor and Underserved, 26(2), 321-327. https://doi.org/10.1353/hpu.2015.0036

General References

Broaddus-Shea, E. T., Fife Duarte, K., Jantz, K., Reno, J., Connelly, L., & Nederveld, A. (2022). Implementing health-related social needs screening in western Colorado primary care practices: Qualitative research to inform improved communication with patients. Health & Social Care in the Community. Advance online publication. https://doi.org/10.1111/hsc.13752

Bushman, G., & Mehdipanah, R. (2022). Housing and health inequities during COVID-19: findings from the national Household Pulse Survey. Journal of epidemiology and community health, 76(2), 121-127. https://doi.org/10.1136/jech-2021-216764

Holcomb, J., Highfield, L., Ferguson, G. M., & Morgan, R. O. (2022). Association of social needs and healthcare utilization among Medicare and Medicaid beneficiaries in the Accountable Health Communities Model. Journal of General Internal Medicine. Advance online publication. https://doi.org/10.1007/s11606-022-07403-w 

National Association of Community Health Centers, Association of Asian Pacific Community Health Organizations, and their partners. (2017). The Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE). Available at https://prapare.org

O'Gurek, D. T., & Henke, C. (2018). A practical approach to screening for social determinants of health. Family Practice Management, 25(3), 7-12.

Protocol ID


Export Variables
Variable Name Variable IDVariable DescriptiondbGaP Mapping
PX281401010000 What is your living situation today? N/A
PX281401020000 Think about the place you live. Do you have more
problems with any of the following? CHOOSE ALL THAT APPLY show less
Individual Social Determinants of Health
Measure Name

Perceptions of Housing Insecurity

Release Date

December 14, 2022


This measure captures an individual’s perception about how secure and stable the housing situation is.


A lack of stable housing, including homelessness, is associated with increased risk of symptoms of chronic disease, as well as odds of disease such as diabetes and depression. Housing insecurity is associated with increased exposure to health and safety risks like vermin and mold.


Housing, instability, housing insecurity, living situation, address, hotel, shelter, environment, home, house, residence, neighborhood built environment

Measure Protocols
Protocol ID Protocol Name
281401 Perceptions of Housing Insecurity

There are no publications listed for this protocol.