"Why do they want to know?": A qualitative assessment of caregiver perspectives on social drivers of health screening in pediatric primary care

Despite strong evidence that social factors have a large influence on child health, systematic screening for social needs is not performed universally in pediatric primary care. This is due to multiple barriers, including concerns about acceptability to families. This study sought to assess family acceptability of social needs screening in pediatric primary care. METHODS: Eight semi-structured focus groups were performed with English and Spanish-speaking caregivers of pediatric patients from a diverse, academic medical center. Focus groups explored the acceptability of social domains including housing, education, finances, food access, and safety. Focus group transcripts were qualitatively analyzed to identify themes. RESULTS: Four salient themes emerged 1) The acceptability of social determinants of health screening questions was tied to participants' understanding of the connection between the topic and child health 2) Families preferred a warm handoff to community services 3) Families feared child protective services intervention as a result of sharing unmet social needs and 4) Positive provider rapport was an important factor in choosing to share social needs. CONCLUSIONS: Pediatric primary care providers should feel comfortable implementing social needs screening when they can clearly explain the connection to child health. They should become knowledgeable about organizations and partners within their communities and feel empowered to connect patients to these resources.