Abstract
Social determinants of health (SDOH) knowledge and skills are crucial to improving health outcomes and achieving health equity. Yet, many barriers exist including gaps in training for nurse practitioner (NP) faculty, challenges in curricular integration, and translation of SDOH skills to NP practice. With the pedagogical shift to competency-based education, SDOH can be integrated throughout NP education utilizing a structured approach. To improve NP faculty knowledge of SDOH and enhance curricular inclusion, a team of NP educators developed a faculty enrichment initiative that consisted of a comprehensive toolkit and 3-part webinar series. As a result, the toolkit provides evidence-based strategies for SDOH curricular integration as well as assignment exemplars to streamline the process for NP faculty. The webinar series, structured using evidence-based teaching strategies, faculty engagement, and competency-driven learning objectives, focuses on disseminating knowledge, skills, and the practical application of SDOH principles in NP curricula. In conclusion, with successful faculty enrichment initiatives, existing barriers can be overcome resulting in knowledgeable faculty, robust curricular integration, and practice-ready NPs that improve health outcomes and promote health equity.
Keywords
Highlights
● Faculty enrichment initiatives enhance SDOH integration in NP education.
● Resources, such as a toolkit and webinar series improve NP faculty knowledge and teaching of SDOH.
● Structured resources support competency-based NP curricular design.
● Evidence-based exemplars streamline SDOH implementation in coursework.
● Empowered NP faculty promote health equity through improved outcomes.
Aim
Design an educational initiative aimed at equipping nurse practitioner faculty with the knowledge, tools, and strategies needed to integrate SDOH into NP education.
Introduction
Social determinants of health (SDOH) are critical to improving health outcomes and achieving health equity. The Healthy People 2030 framework defines SDOH as the environmental conditions where people are born and raised, live, learn, work, play, worship, and age that affect health outcomes and risks. 1 The framework categorizes SDOH into 5 domains: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context. Historically, the drivers of health—commonly referred to as SDOH—emerged during the Industrial Revolution, contributing to increased allostatic load and being closely linked to both disease and poverty. 2 Some postulate that the embryonic development may have initiated with Hippocrates and over time involved other scholars including Louis Villerme (1782-1863), Rudolph Virchow (1821-1902), Emile Durkheim (1858-1917) and Edgar Sydenstricker (1881-1936). 3 Nursing scholars Lillian Wald and Mary Brewster also played significant roles in addressing SDOH, influencing public health through the establishment of the Henry Street Settlement in 1893. 4 While no particular individual is attributed to have coined the term, SDOH was formally recognized in the last 2 decades notably by the World Health Organization (WHO). 5 The WHO was instrumental in adopting the concept and advancing a comprehensive framework to mitigate adverse health outcomes. Addressing these determinants is essential for the provision of holistic, patient-centered care by advanced practice nurses (APNs), particularly nurse practitioners (NPs) who serve as primary care providers. 6 Given their comprehensive approach to patient care, NPs are uniquely positioned to incorporate SDOH assessment and interventions into routine practice. 7 APNs play a pivotal role in the tripartite mission of scholarship, education, and practice. Research demonstrates that addressing SDOH leads to better health outcomes,5,8 reduced hospital readmissions8,9 and lower healthcare costs.10,11
Background
SDOH in Healthcare and Advanced Practice Nursing
There is limited evidence related to APN training grounds related to SDOH. In the National Advisory Committee on Nurse Education and Practice (NACNEP) report, 12 the authors acknowledged that nurses did not require the necessary training to address SDOH. The report ignited interest in calling for more robust training in SDOH and iterative stages of curricula design to further address the gap. Although a novelty within the realm of nursing, collaborative efforts with other disciplines can integrate an interprofessional approach to promoting healthier wellbeing for all.
Kotter’s Change Model 13 is an 8-step framework that identifies the need for change. This model is appropriate when considering the urgency of introducing SDOH in APN education. The first phase is urgency. There is an urgent call to action to address integration of SDOH in APN education because of related inequities associated with social drivers of health and poor health outcomes. 14 Both social and structural drivers are pivotal to the well-being of humans thereby necessitating the need to embed such content in APN education. Hood et al found 15 that more than 50% of health outcomes are related to SDOH.
As the largest and most trusted health profession, nursing is well positioned to integrate and conceptualize the intersection of SDOH through both academic and clinical perspectives, emphasizing pedagogical strategies and the use of validated screening instruments in clinical practice. Incorporating valid and reliable instruments into APN education enhances the ability to screen for key drivers such as food insecurity, housing instability, and transportation access. Early integration of SDOH into APN education is transformative, fostering strategies that help reduce health disparities and improve patient outcomes. Understanding the etiology of SDOH and their impact on health outcomes creates opportunities to integrate evidence-based practices into NP education. These complexities underscore the importance of workforce development initiatives that prioritize early detection and prevention, both of which directly influence health outcomes. 12
Challenges Faced in Integrating SDOH Content Into Curricula
A major challenge in integrating SDOH into NP education is the limited comprehensive training available for NP faculty. Because faculty often receive little formal education on SDOH, their ability to effectively teach these concepts to students is hindered. 12 The lack of structured workforce development programs further exacerbates the issue, leading to inconsistencies in how SDOH content is incorporated into NP curricula. 16
Siloed workforces present barriers to effectively incorporating SDOH into education and practice. An interprofessional approach—enhanced through simulation—expands opportunities for experiential learning. When combined with objective structured clinical exams (OSCEs) and interdisciplinary intensives, this approach allows learners to address issues such as food insecurity, poverty, transportation, and health care access, ultimately strengthening diagnostic reasoning and clinical decision-making skills. Health inequities disproportionately affect population health and SDOH have been linked to poor health outcomes; 5 therefore, addressing gaps in training is critical. Providing faculty with resources on developing comprehensive curricula that incorporate the WHO and Office of Disease Prevention and Health Promotion (ODPHP) framework is 1 step toward addressing and improving population health. Another approach is disseminating information about available tools to assess and evaluate a patient’s SDOH, and the available resources offered by various agencies such as local health departments and community health centers. This information can be utilized to prepare and assist NP faculty in teaching SDOH.
NP faculty face multiple barriers when attempting to integrate SDOH into curricula. These challenges include competing curricular demands, lack of institutional support, and limited instructional resources. 17 Constraints related to financial costs and research to demonstrate supportive data are confounding. For NP faculty, these challenges are further compounded by the lack of comprehensive curricular frameworks that explicitly incorporate SDOH competencies into NP education. 18 Integrating SDOH in NP education requires a careful review of the existing or current curriculum and identification of courses where SDOH may be incorporated. Curriculum mapping is indicated including applying educational frameworks such as Bloom’s Taxonomy to develop objectives, determine teaching strategies, and evaluate learning. 19 Faculty may struggle with effectively translating SDOH concepts into actionable, practice-based interventions for NP students.
Gaps remain in faculty awareness and use of screening tools to assess drivers of health outcomes. Embedding these tools into practice is a critical step toward effectively assessing SDOH. Instruments such as PRAPARE, 20 Hunger Vital Sign, 21 and WellRx Screening Tool 22 can be taught to NP students to assess various non-medical factors that influence patients’ health. NP faculty have an opportunity to highlight the importance of including SDOH screening when NP students are assessing patients to maximize health outcomes. Holistic management of patients’ conditions, including medical issues and non-medical factors, can promote health equity and reduce unmet social needs and other environmental concerns.6,9 Addressing faculty-level gaps is critical to ensure that NP graduates are well-equipped to mitigate health disparities and provide person-centered care.
Despite the recognized importance of SDOH, there remain significant gaps in its integration into clinical practice. Many healthcare providers, including NPs, lack standardized protocols for screening and addressing SDOH. 23 Barriers such as time constraints, inadequate reimbursement, and insufficient training hinder the systematic inclusion of SDOH assessments in primary care settings. 24 Many NP faculty report insufficient resources, institutional support, and clinical training opportunities to effectively teach SDOH concepts. 16 Additionally, faculty development programs often lack structured guidance on integrating SDOH into experiential learning, leaving educators underprepared to train future NPs in addressing social determinants in practice. The complexity of SDOH requires an interdisciplinary approach, which is best applied in the clinical setting; yet NP programs may lack partnerships with disciplines such as social work, public health, and community organizations necessary for comprehensive education.16,25
Rationale for Faculty Development for Advancing SDOH Education
Given these challenges, structured faculty development programs are essential to enhance SDOH education in NP programs. Faculty development initiatives can equip educators with the necessary knowledge and skills to integrate SDOH content effectively. Programs focused on case-based learning, interprofessional collaboration, and experiential learning have shown promise in improving faculty competency in teaching SDOH. 26 Providing faculty with training and resources in SDOH can improve the preparation and readiness of future NPs to address social determinants in clinical practice, ultimately enhancing patient care and health equity.
Competency-Based Education in SDOH
Competency-based education (CBE) offers a structured framework for integrating SDOH into NP training. CBE emphasizes measurable outcomes and skill-based learning, ensuring that students attain proficiency in addressing SDOH. 27 The National Organization of Nurse Practitioner Faculties (NONPF) has advocated for the integration of SDOH competencies in NP education, emphasizing the need for structured assessments and practical applications. 28 Similarly, the American Association of Colleges of Nursing (AACN) has underscored the importance of integrating SDOH into competency-based frameworks to better prepare APNs for addressing health disparities. 29 Research indicates that CBE approaches improve clinical decision-making and patient advocacy, particularly in underserved populations. 27 Implementing CBE strategies in NP programs can enhance the ability of graduates to provide holistic, person-centered care that addresses both medical and social needs.
Methods
Faculty Toolkit
Because of the strong evidence supporting the integration of SDOH screening in clinical practice and the widespread health disparities from unmet social needs, members of NONPF identified a gap in addressing SDOH in NP education nationally. A think tank was created and an innovative vision led to the establishment of a Determinants of Health Special Interest Group (DOH SIG) in 2021. The DOH SIG included NP faculty from across the United States who met regularly to discuss strategies to increase awareness regarding the role of SDOH in health outcomes, to empower NP faculty with SDOH frameworks, models, and tools to integrate SDOH into NP education, and to promote health equity.
Because of the barriers to integrating SDOH concepts into NP curricula, the DOH SIG developed and disseminated tools for NP faculty to facilitate feasible, streamlined SDOH curriculum integration. Faculty of the DOH SIG submitted a proposal to the Executive Board of NONPF to develop a curriculum integration toolkit. The target population for this proposal comprised members of NONPF, all of whom are NP faculty teaching across diverse academic institutions nationwide. No selection criteria were formally applied since the toolkit was intended to be widely available to all members of the target population. The purpose of the toolkit was to provide structured, tangible strategies to sustainably integrate SDOH concepts into NP curricula.
The proposal was approved in July 2022. Over the course of the academic year 2022 to 2023, fourteen faculty members in the group collaboratively developed a 70-page curriculum integration toolkit inclusive of the WHO and ODPHP framework, SDOH screening tools and resources, educator resources for curriculum integration, benchmark DNP projects focused on SDOH, and actionable assignment exemplars. The toolkit underwent peer review in October 2023 and was published by NONPF in 2024. After publication, the toolkit was disseminated by NONPF via a monthly newsletter and posted to the NONPF website as a faculty resource. For ongoing evaluation and feedback, individuals who used the toolkit were invited to participate in a voluntary survey. The feedback received from the survey was used for ongoing iterative refinement of the toolkit.
Webinar Series
Following the publication of the toolkit, the authors and other members identified a complementary need for interactive faculty development on SDOH in NP education. As such, the DOH SIG proposed a webinar series to further disseminate resources for NP faculty to effectively incorporate SDOH content into NP education. It also sought to create a platform to foster contextualized dialog and reflective practice on the application of these concepts. The proposal was submitted to and approved by the Faculty Institute of NONPF in 2024. Given the breadth of the content and the value placed on faculty engagement, the webinar series was delivered weekly via the Zoom platform as a 3-part series in early 2025. All NONPF members received an email invitation to participate in the webinar series with the opportunity to earn continuing education units. Participation was voluntary and inclusive.
The webinar series was progressively designed beginning with foundational knowledge and advancing toward practical application. The planning committee conducted a review of best practices in SDOH education, incorporating case studies, real-world exemplars, and validated screening tools. Using a scaffolding approach, the webinar series coached participants to utilize the toolkit to embed SDOH concepts into coursework, clinical training, and assessment and to map these concepts to the NONPF NP Competencies and AACN Essentials. Speakers were recruited among the DOH SIG faculty. The series utilized evidence-based teaching strategies, faculty engagement, and competency-driven learning objectives to ensure logical progression and tools to immediately implement SDOH in NP education. The webinar was evaluated through post-webinar surveys and attendance metrics to assess effectiveness.
Results
Faculty Toolkit
The first educational initiative was the creation of a toolkit entitled Integration of Social Determinants of Health throughout Nurse Practitioner Curricula: A Toolkit. 19 By displaying evidence-based strategies for SDOH curriculum integration and providing assignment exemplars, the goal of the SDOH toolkit was to promote faculty’s expertise in SDOH and expand the knowledge and skills of future NPs to manage patients’ health risks and outcomes. The toolkit was made accessible on the NONPF website for faculty and addressed SDOH as both an NP education core competency and a global health priority to promote health equity. It explores key aspects of the NP role including the impact of culture, policy, advocacy, clinical documentation, billing, coding, and interprofessional collaboration. Specifically, the toolkit consisted of numerous examples of student DNP projects related to SDOH for educators to use and to inspire students to conduct more scholarship work in this area. Finally, the bulk of the toolkit consisted of 15 innovative assignment exemplars related to SDOH for NP faculty to readily use in their courses.
Five faculty members who accessed the toolkit volunteered to participate in the feedback survey. Respondents represented diverse academic roles, including program directors, specialty track coordinators, course faculty, and other leadership positions. Participants taught in a range of nurse practitioner programs, including MSN, DNP, combined MSN/DNP, and other program types. Most had substantial teaching experience, with 60% reporting 6 to 10 years and 40% reporting more than 16 years in NP education. Respondents’ primary purposes for accessing the toolkit included integrating SDOH content throughout curricula (100%), reviewing assignment exemplars (75%), identifying SDOH resources (75%), and gaining new SDOH knowledge (75%). Seventy-five percent of respondents strongly agreed they found the information, resources and assignments included in the toolkit relevant to NP practice and presented in an easy-to-use format. Perceptions of toolkit comprehensiveness were positive, with 67% strongly agreeing. Self-reported confidence in integrating SDOH into courses increased from a pre-toolkit mean score of 3.50 to a post-toolkit mean of 4.67 (0-5 scale). Two-thirds had already implemented toolkit resources in their teaching, and all planned to implement in the future. The mean likelihood of recommending the toolkit to peers was 4.00 (0-5 scale).
Webinar Series
The “Social Determinants of Health Webinar Series” 30 addressed gaps in NP education utilizing the AACN Essentials 29 and NONPF NP Role Core Competencies 28 as foundations to develop the 3-part series. Both AACN and NONPF recognize SDOH as a fundamental component of professional nursing and NP education and practice. The webinar was successfully launched in February 2025 and was delivered synchronously in 3 weekly, hour-long formats with an on-demand option for registered attendees who were not able to attend the live sessions. Each webinar was evaluated by participants utilizing a multiple-choice questionnaire with open ended questions developed by NONPF committee members.
Webinar 1—Social Determinants of Health and Health Outcomes
The first webinar focused on establishing a foundational understanding of SDOH and its influence on health outcomes. The session provided an overview of key factors such as socioeconomic status, education, environment, and access to healthcare, emphasizing both upstream influences like political and economic systems and downstream effects on individual social needs Additionally, Healthy People 2030s 5 key areas of SDOH were incorporated along with validated screening tools to assess social risks related to food insecurity, housing instability, and financial barriers to care. Attendees examined strategies for integrating SDOH screening into clinical practice and NP education. The session emphasized universal screening for social risks, trauma-informed care, and medical-legal partnerships as strategies to support vulnerable populations. This session concluded with a discussion on health equity and justice, reinforcing the need for systemic change to eliminate disparities in health outcomes and foundational knowledge for subsequent sessions in the series.
The first session of the webinar series (Table 1) was highly rated by participants, with 69.3% of the respondents rating it as excellent. Qualitative feedback reinforced this finding, with participants highlighting the practical utility of accessible screening tools and the importance of presented resources. Many respondents noted that the session provided a “great reminder” and was “well done,” suggesting that the content successfully reinforced prior knowledge while introducing new, actionable strategies. A recurring theme was the value placed on the integration of tools that could be immediately applied in clinical practice, particularly in resource-limited settings. These findings suggest that the session effectively laid the groundwork for deeper engagement in subsequent webinars by offering foundational insights into how SDOH can be addressed through structured screening.
Webinar 1 Survey Results.
Webinar 2—Integrating Social Determinants of Health in Nurse Practitioner Education
The second webinar expanded on the content offered from the first session by focusing on the integration of SDOH into NP curricula. The session objectives focused on understanding how SDOH shapes clinical decision-making and patient care outcomes, describing instructional frameworks that enhance students’ knowledge of health disparities, and recognizing the importance of SDOH in the evaluation of clinical competencies and academic progression. Strategies for embedding SDOH into coursework, clinical training, and competency assessments to better prepare NP students for addressing health disparities in practice were provided. Through clinical examples, the webinar highlighted how NP students can integrate SDOH factors into clinical reasoning, enhancing culturally responsive and equitable patient care. Clinical learning strategies included incorporating SDOH considerations into advanced pathophysiology and pharmacology, tracking patient cases using Z codes, and engaging students in reflective exercises on how SDOH influences care delivery. The session concluded by emphasizing the necessity of threading SDOH throughout NP curricula to meet national accreditation standards and core competency requirements while fostering advocacy, leadership, and lifelong learning in NP education.
The second webinar (Table 2) had 85.4% of respondents rating it as excellent. Qualitative responses reflected enthusiasm and a sense of empowerment. One participant stated, “Loved this session! So many great ideas to incorporate into practice,” while another respondent expressed their appreciation of the SDOH toolkit that was shared. Several respondents commented on the review of material and found value in the session’s ability to frame existing knowledge within a practical, toolkit-based context. Overall, the data reflects a well-received session that was educationally sound, practically oriented, and aligned with the learning needs of professionals committed to addressing SDOH.
Webinar 2 Survey Results.
Webinar 3—Social Determinants of Health in Nurse Practitioner Education
The final webinar focused on the practical application of SDOH principles using case studies and real-world exemplars from the toolkit. The session emphasized how faculty could map SDOH content to NP competencies, including the NONPF NP Role Core Competencies 28 and AACN Essentials, 29 and accreditation standards ensuring that SDOH concepts are threaded throughout NP curricula. The presenters discussed strategies for integrating SDOH exemplars into curriculum development, clinical training, and assessments to provide students with hands-on experience addressing social determinants in patient care. The session also explored methods for incorporating SDOH into research projects and clinical competencies, with examples such as patient assessments, structured screenings using validated tools, and case-based learning. Assignments such as sociograms, care plans, and interprofessional collaboration activities were highlighted as ways to encourage students to critically analyze social determinants and their impact on health outcomes.
A significant component of the session focused on fostering interprofessional collaboration, cultural competency training, and experiential learning. The presenters examined how NP students could engage with other healthcare professionals to develop strategies for managing patients experiencing housing instability, food insecurity, or financial constraints. Assignment exemplars provided frameworks for students to apply their knowledge in real-world settings while developing advocacy and leadership skills. The webinar concluded with a discussion on integrating SDOH into doctoral-level projects, reinforcing the importance of research-driven interventions to address social needs in clinical practice.
The third and final webinar (Table 3) continued the trend of high satisfaction, with 76.7% respondents rating it as excellent. This session deepened the exploration of SDOH by engaging respondents in the identification of specific determinants and how they influence patient outcomes. Responses included detailed examples such as transportation, food insecurity, housing instability, economic stability, education, and health literacy. Respondents noted that these factors play a pivotal role in access to care, medication adherence, and health behaviors. Comments also reflected a deep appreciation for the session’s clinical applicability. For instance, one respondent shared, “This webinar was the most helpful for me personally,” while another praised its use in curriculum development. This final session appears to have effectively closed the loop by connecting SDOH to both clinical application and educational practice with 93% of respondents stating that they intend to integrate resources from the NONPF SDOH Toolkit into their NP curriculum. The data affirm that a progressive, multi-part educational approach can enhance provider understanding and motivation to act on SDOH across multiple domains of healthcare and education.
Webinar 3 Survey Results.
Conclusion
The development of a faculty toolkit and webinar series offers NP educators a practical, evidence-based method for embedding SDOH content into curricula in ways that translate directly to clinical application. Designed for ease of use and adaptability, these resources equip faculty with ready-to-implement teaching strategies, case examples, and evaluation tools that streamline integration across courses and clinical training. By pairing the toolkit with an accessible webinar series, the initiative supports both immediate adoption and ongoing faculty development, fostering consistent, competency-based SDOH instruction. This dual-resource model is scalable, adaptable across diverse academic settings, and positioned to prepare future NPs with the skills and confidence to address SDOH in practice—to ultimately advance health equity and improve patient outcomes.
Footnotes
Acknowledgements
The authors would like to acknowledge the support of this work from the National Organization of Nurse Practitioner Faculties (NONPF) Board of Directors and Faculty Institute.
Ethical Considerations
This project did not constitute human subjects research and therefore did not require Institutional Review Board (IRB) approval. The faculty enrichment initiative focused solely on educational development and evaluation activities. No identifiable personal information or sensitive data were collected or analyzed.
Consent to Participate
Participation in the faculty enrichment initiative was voluntary. Participants were informed of the project’s purpose and educational objectives, and engagement in the activities or submission of feedback indicated consent to participate.
Funding
The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The open access publication fee for this article was supported through a scholarship provided by the Guest Editor of this issue. The funding source had no involvement in the study design, data collection, analysis, interpretation, or manuscript preparation.
Declaration of Conflicting Interests
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.