“What do I do about it?”: Perspectives about conducting health-related social needs screening and response from pediatricians working at Federally Qualified Health Centers in the United States

Background and Objectives: Adverse and structural drivers of health (SDOH) create conditions whereby health-related social needs (HRSNs) substantially influence child health outcomes in the U.S. Federally Qualified Health Centers (FQHCs) serve U.S. populations with high social need, yet pediatric HRSN screening and response models are not standardized. We aimed to gain some understanding from pediatricians about their perspectives on HRSN screening and response at FQHCs in the U.S.

Methods: We developed and conducted a qualitative interview study. Pediatricians practicing in FQHCs were recruited through convenience sampling via phone and email outreach to more than 100 FQHCs. Due to low response, recruitment efforts were expanded to include contacting state and county medical societies. After providing informed consent, study participants were interviewed and recorded virtually using a standardized script of questions developed and refined by our research team. Using a constructivist grounded theory approach, interview transcripts were iteratively coded to identify emerging themes. Findings were reported following the COnsolidated criteria for REporting Qualitative research (COREQ).

Results: We conducted seven structured qualitative interviews between January 2023-March 2023 with pediatricians practicing in seven different states representing geographically and culturally diverse U.S.-based FQHCs. Despite a very small sample size, the coding team reached consensus that the analysis achieved thematic saturation. Three themes emerged after coding the interview transcripts: (1) perceived support for HRSN screening and response including dedicated staff, community partnerships, and funding; (2) barriers to effective implementation including time constraints, language barriers, and limited social services; and (3) perceived impact on patients including improving wellbeing and strengthening the physician-patient relationship, and on providers including moral distress when social needs could not be met.

Conclusions: Pediatricians working within FQHCs view HRSN screening as essential but insufficient without a robust response infrastructure. Investment in team-based response systems and partnerships with community organizations are critical in addressing HRSNs. These findings from a small sample of pediatric providers working at FQHCs in the U.S., though preliminary insights rather than generalizable conclusions, support the need for larger, more inclusive studies designed to understand patient, staff, and community perspectives to advance identification and response to social needs among patient families. This study highlights opportunities for advocacy by both health systems and pediatric providers to advance policies and practices to effectively address the adverse social and structural SDOH that influence HRSNs.