It’s About Trust: Low-Income Parents’ Perspectives on How Pediatricians Can Screen for Social Determinants of Health

Publication Year: 2019
Patient Need Addressed: Behavioral health, Food insecurity, Homelessness/housing, Patient satisfaction/engagement, Trauma
Population Focus: Low income
Demographic Group: Adult
Intervention Type: Best practices
Type of Literature: Grey
link: https://www.publicagenda.org/wp-content/uploads/2019/08/itsAboutTrust_UHF_Final.pdf
Abstract

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Insights Results

Overview of article

  • Attempts to integrate social determinants of health screenings into pediatric primary care are more likely to succeed if they are grounded in an understanding of parents’ receptivity to discussing social needs and responsive to their concerns about doing so.
  • Researchers conducted qualitative research with low-income parents in New York City in an effort to obtain answers to three main questions: 1) What are these parents’ perspectives on social determinants of health?; 2) How receptive are they to discussing social needs with pediatricians?; and 3) What are their ideas for making social determinants of health screenings work well? This report summarizes findings from 8 focus groups with low-income parents of children ages 5 years and younger in New York City, conducted in English and Spanish by Public Agenda in July and August 2018

Methods of article

  • This report summarizes findings from 8 focus groups with low-income parents of children ages five years and younger in New York City, conducted in English and Spanish by Public Agenda in July and August 2018
  • Among all 8 focus groups, 88 parents participated. Specifically, in the 4 focus groups Public Agenda conducted at the professional market research facility, all participants were low-income parents who had taken their children to pediatricians during the previous twelve months. In total, 40 parents participated in the groups at the facility. In the 4 focus groups Public Agenda conducted at community organizations, all participants were low-income parents of children ages five years and younger, were clients of one or another of those organizations and had taken their children to pediatricians in
    the previous 12 months. In total, 48 parents participated in these 4 focus groups

Results

  • Parents in the focus groups cited a broad range of social stressors that affected their children’s health and well-being, including some that screening tools for social determinants of health may not currently include. Parents identified the many stressors that affect their children. The following are examples of some of these stressors that merit attention: 1) single parenthood and shared custody; 2) neighborhood safety and violence; 3) bullying and acceptance by other children; and 4) environmental hazards (e.g., pollution)
  • The parents did not immediately identify pediatricians as sources of help with social stressors. Their reactions to the idea of pediatricians discussing these stressors were mixed. They saw some topics, such as nutrition, education and minor behavioral issues, as appropriate to discuss with pediatricians, but others, such as domestic violence, parents’ mental health and legal issues, as more sensitive
  • Parents’ concerns about discussing sensitive social needs with pediatricians included worries about being judged and discriminated against, fear of intervention by a child welfare agency, lack of time during appointments and frustration at the prospect of disclosing sensitive information without getting help
  • Parents’ recommendations for pediatricians about discussing social determinants of health included building trust, choosing the right moment and making clear that screening is standard protocol
  • In addition, parents’ fear of child welfare agencies may be a particularly difficult challenge for pediatricians who want to screen for social determinants of health, given the high stakes involved. Parents in these groups worried about losing custody of their children if they disclosed information about some of the very social needs that can be most important for health and well-being. Parents’ suggestion that pediatricians should be transparent about what does and does not trigger reporting, however, could help allay at least some of their fears and could help build trust between them and pediatricians. Making clear that screening is standard protocol might begin to address low-income parents’ feelings of being discriminated against and judged. Lastly, attempts to screen for social determinants of health may be more successful if pediatricians develop partnerships with the community organizations and other social service providers that low-income families already trust and turn to for information and help

Key takeaways/implications

  • As a follow-up, a survey of low-income parents could explore how they rate the relative importance of various stressors and how widespread the fear of child welfare agencies is. A survey could also explore whether low-income parents’ views vary by factors such as race and ethnicity, the quality of their relationships with their children’s pediatricians, parents’ and children’s health status, and parents’ previous experiences with healthcare and social service systems
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