Provider and staff perspectives on screening and referral for social determinants of health during perinatal care: Implications using the consolidated framework for implementation research

BACKGROUND: New federal mandates require universal screening and referral for social determinants of health (SDOHs), and evidence exists supporting its integration into primary care practice. However, implementation in maternity care remains understudied and underfunded. To inform maternal health practice, we studied clinical stakeholders' perspectives on SDOH screening and referral knowledge, priority, challenges, and opportunities across four hospital-affiliated obstetrics and gynecology clinics in New Hampshire. 

METHODS: We conducted 15 semistructured interviews and four focus groups (with 20 total group participants) to explore clinical providers' and staff perspectives regarding the implementation of SDOH screening at their obstetrics clinics. We used the updated Consolidated Framework for Implementation Research to inform our interview and focus group guides. We identified our themes inductively using Practical Thematic Analysis. 

RESULTS: Participants represented nine different clinical and administrative roles. Four major themes culminated from the interviews and focus groups: 1) clinic staff identified clinic-specific workflows as critical to implementing the SDOH screening intervention; 2) clinical staff's workload and lack of training in SDOHs informed their level of commitment to SDOH screening and referral; 3) given many patients' extensive psychosocial needs, clinical staff wanted dedicated resources and time to respond to screening results; and 4) clinical staff perceived that SDOH screening impacts the patient experience, with the potential to decrease stigma depending on how screening results are discussed. 

CONCLUSIONS: Despite unanimous support for addressing SDOHs within maternity care, participants perceived persistent challenges to effectively implementing SDOH screening and providing adequate referrals. They recommended that screening for SDOHs in vulnerable populations be accompanied by clear guidance and leadership, equitable distribution of resources and staff time between implementing clinics, and continuous quality improvement efforts.