Unpacking patient perspectives on social needs screening: A mixed methods study in primary care practices

Background: Recognizing that health-related social needs drive health inequities, healthcare settings are increasingly beginning to screen and refer patients for social needs. Yet, many patients who screen positive for social needs decline to be referred to resources or do not have their needs resolved. This raises the question of whether screening and assistance processes are serving patients.

Objective: To explore factors influencing patient perspectives on screening for health-related social needs.

Methods: In a parallel secondary mixed-methods analysis of data from three western Colorado primary care clinics, we used logistic regression to examine effects of practice- and patient-level factors on comfort with and perceived helpfulness of social needs screening. We applied narrative analysis to 20 patient interviews to further understand how patients’ lived experiences influenced their perceptions of screening.

Results: Among 511 patients, receiving an explanation about screening was associated with increased odds of comfort (OR 2.1, 95% CI [1.1-4.30]) and perceived helpfulness (OR 4.7 [2.8-7.8]). Those experiencing more needs were less likely to report comfort (3+ needs vs. 0: OR 0.2 [0.1-0.5]). Narratives elucidated how a history of stigmatizing experiences increased discomfort disclosing needs and captured how relationship quality with healthcare teams influenced perceptions of screening for patients with extensive needs.

Conclusion: Practice-level (screening explanation and therapeutic rapport) and patient-level factors (history and extent of needs) are key influences on comfort with and perceived helpfulness of screening. Good communication about screening benefits all patients. Patients with extensive social needs may require additional sensitivity to their past experiences.

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