Nurs Outlook. 2026 Mar 31;74(3):102749. doi: 10.1016/j.outlook.2026.102749. Online ahead of print.
ABSTRACT
BACKGROUND: National nursing organizations and policy frameworks call for incorporating social determinants of health (SDOH) into nursing curricula to improve workforce readiness and promote health equity. Although providers acknowledge the importance of SDOH, gaps remain in preparing prelicensure nursing students to address systemic and community health factors.
PURPOSE: This project assessed the effectiveness of the Toward Health Equity and Literacy (2HEAL) program’s online modules in improving BSN students’ perceived competence in addressing SDOH.
METHODS: The 2HEAL team created a series of asynchronous, interactive modules covering various SDOH topics. BSN students (n= 346) completed the modules between August 2023 and March 2025. A retrospective self-assessment survey measured changes in students’ perceived competence. Data from 1,131 surveys compared pre- and post-module scores. Net Promoter Scores (NPS) evaluated module acceptability.
FINDINGS: Students reported a statistically significant increase in perceived competency across all SDOH topics appearing in more than one module, with an overall average increase of +0.50 points. Post-module scores showed students self-reported proficiency in 68% of assessed SDOH domains. The greatest gains were in civic engagement (+0.63), while environmental health showed the smallest increase (+0.26). Modules achieved an average NPS of +36, indicating high learner satisfaction.
DISCUSSION: This project demonstrates that structured, competency-based digital modules can improve BSN students’ perceived competence in addressing SDOH. Results highlight improvement in addressing civic engagement, immigrant health, and health literacy, and reveal ongoing gaps in climate and environmental health education. The 2HEAL model provides a scalable way to incorporate SDOH training into pre-licensure programs.
PMID:41924837 | DOI:10.1016/j.outlook.2026.102749
