Original Article| Volume 23, ISSUE 2, P329-335, March 2023

“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.


      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.


      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.


      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.


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        • Chen E
        • Matthews KA
        • Boyce WT.
        Socioeconomic differences in children's health: how and why do these relationships change with age?.
        Psychol Bull. 2002; 128: 295-329
        • Chen E
        • Martin AD
        • Matthews KA.
        Understanding health disparities: the role of race and socioeconomic status in children's health.
        Am J Public Health. 2006; 96: 702-708
        • Currie J
        • Lin W
        Chipping away at health: more on the relationship between income and child health.
        Health Aff. 2007; 26: 331-344
        • Shah CP
        • Kahan M
        • Krauser J.
        The health of children of low-income families.
        Can Med Assoc J. 1987; 137: 485-490
        • Hood CM
        • Gennuso KP
        • Swain GR
        • et al.
        County health rankings: relationships between determinant factors and health outcomes.
        Am J Prev Med. 2016; 50: 129-135
      1. Children below 200 percent poverty. Kids Count Data Center. Available at: Accessed August 30, 2020.

        • Thornton RL
        • Glover CM
        • Cené CW
        • et al.
        Evaluating strategies for reducing health disparities by addressing the social determinants of health.
        Health Aff (Millwood). 2016; 35: 1416-1423
        • Garg A
        • Butz AM
        • Dworkin PH
        • et al.
        Improving the management of family psychosocial problems at low-income children's well-child care visits: the we care project.
        Pediatrics. 2007; 120: 547-558
        • Garg A
        • Cull W
        • Olson L
        • et al.
        Screening and referral for low-income families' social determinants of health by US pediatricians.
        Acad Pediatr. 2019; 19: 875-883
        • Cartier Y
        • Gottlieb L.
        The prevalence of social care in US health care settings depends on how and whom you ask.
        BMC Health Serv Res. 2020; 20481
        • Rogers AJ
        • Hamity C
        • Sharp AL
        • et al.
        Patients’ attitudes and perceptions regarding social needs screening and navigation: multi-site survey in a large integrated health system.
        J Gen Intern Med. 2020; 35: 1389-1395
        • De Marchis EH
        • Hessler D
        • Fichtenberg C
        • et al.
        Assessment of social risk factors and interest in receiving health care-based social assistance among adult patients and adult caregivers of pediatric patients.
        JAMA Netw Open. 2020; 3e2021201
        • Colvin JD
        • Bettenhausen JL
        • Anderson-Carpenter KD
        • et al.
        Caregiver opinion of in-hospital screening for unmet social needs by pediatric residents.
        Acad Pediatr. 2016; 16: 161-167
        • Cottrell EK
        • Hendricks M
        • Dambrun K
        • et al.
        Comparison of community-level and patient-level social risk data in a network of community health centers.
        JAMA Netw Open. 2020; 3e2016852
        • Vasan A
        • Kenyon CC
        • Palakshappa D.
        Differences in pediatric residents’ social needs screening practices across health care settings.
        Hosp Pediatr. 2020; 10: 443-446
        • Swamy P
        • Monterrey AC
        • Wood MS
        • et al.
        Caregiver and pediatric health care provider views on social needs identification.
        J Prim Care Community Health. 2020; 112150132720923085
        • Chung EK
        • Siegel BS
        • Garg A
        • et al.
        Screening for social determinants of health among children and families living in poverty: a guide for clinicians.
        Curr Probl Pediatr Adolesc Health Care. 2016; 46: 135-153
        • Sokol R
        • Austin A
        • Chandler C
        • et al.
        Screening children for social determinants of health: a systematic review.
        Pediatrics. 2019; 144e20191622
        • Garg A
        • Sarkar S
        • Marino M
        • et al.
        Linking urban families to community resources in the context of pediatric primary care.
        Patient Educ Couns. 2010; 79: 251-254
        • Garg A
        • Brochier A
        • Messmer E
        • et al.
        Clinical approaches to reducing material hardship due to poverty: social risks/needs identification and interventions.
        Acad Pediatr. 2021; 21: S154-S160
        • Morone J.
        An integrative review of social determinants of health assessment and screening tools used in pediatrics.
        J Pediatr Nurs. 2017; 37: 22-28
        • Schleifer D.
        It's about trust: low-income parents’ perspectives on how pediatricians can screen for social determinants of health.
        Health Serv Res. 2020; 55: 134-135
        • Byhoff E
        • De Marchis EH
        • Hessler D
        • et al.
        Part II: a qualitative study of social risk screening acceptability in patients and caregivers.
        Am J Prev Med. 2019; 57: S38-S46
        • Palakshappa D
        • Doupnik S
        • Vasan A
        • et al.
        Suburban families' experience with food insecurity screening in primary care practices.
        Pediatrics. 2017; 140e20170320
        • American Academy of Pediatrics
        Integrating Social Determinants of Health Into Health Supervision Visits.
        April. 2019;
        • Emengo VN
        • Williams MS
        • Odusanya R
        • et al.
        Qualitative program evaluation of social determinants of health screening and referral program.
        PLoS One. 2020; 15e0242964
        • Harris PA
        • Taylor R
        • Thielke R
        • et al.
        Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support.
        J Biomed Inform. 2009; 42: 377-381
        • Harris PA
        • Taylor R
        • Minor BL
        • et al.
        The REDCap consortium: building an international community of software partners.
        J Biomed Inform. 2019; 95103208
        • Crabtree BF
        • Miller WL.
        Doing Qualitative Research: Multiple Strategies.
        SAGE, Thousand Oaks, Calif1992
        • Ryan G
        • Bernard H.
        Techniques to identify themes.
        Field Methods. 2003; 15: 85-109
        • Benjamin A.
        • et al.
        • Council on Community Pediatrics, Council on Nutrition
        Promoting food security for all children.
        Pediatrics. 2015; 136: e1431-e1438
        • Jenssen BP
        • Bryant-Stephens T
        • Leone FT
        • et al.
        Clinical decision support tool for parental tobacco treatment in primary care.
        Pediatrics. 2016; 137e20154185
        • De Marchis EH
        • Ettinger de Cuba SA
        • Chang L
        • et al.
        Screening discordance and characteristics of patients with housing-related social risks.
        Am J Prev Med. 2021; 61: e1-e12
        • Sandel M
        • Phelan K
        • Wright R
        • et al.
        The effects of housing interventions on child health.
        Pediatr Ann. 2004; 33: 474-481
        • Pierse N
        • White M
        • Ombler J
        • et al.
        Well homes initiative: a home-based intervention to address housing-related Ill health.
        Health Educ Behav. 2020; 47: 836-844
        • Purkey E
        • Bayoumi I
        • Coo H
        • et al.
        Exploratory study of "real world" implementation of a clinical poverty tool in diverse family medicine and pediatric care settings.
        Int J Equity Health. 2019; 18: 200
      2. Wilson-Hall L, McPeak K, Constant B, et al. Screening for social needs in pediatrics: how can we ensure it is family-centered and effective? PolicyLab at Children's Hospital of Philadelphia; 2020. Available at: Accessed May 4, 2020.

        • Gottlieb LM
        • Hessler D
        • Long D
        • et al.
        Effects of social needs screening and in-person service navigation on child health: a randomized clinical trial.
        JAMA Pediatr. 2016; 170e162521
        • Garg A
        • Toy S
        • Tripodis Y
        • et al.
        Addressing social determinants of health at well child care visits: a cluster RCT.
        Pediatrics. 2015; 135: e296-e304
        • Peretz PJ
        • Matiz LA
        • Findley S
        • et al.
        Community health workers as drivers of a successful community-based disease management initiative.
        Am J Public Health. 2012; 102: 1443-1446
        • Gibbons MC
        • Tyus NC.
        Systematic review of U.S.-based randomized controlled trials using community health workers.
        Prog Community Health Partnersh. 2007; 1: 371-381
        • Garg A
        • Toy S
        • Tripodis Y
        • et al.
        Addressing social determinants of health at well child care visits: a cluster RCT.
        Pediatrics. 2015; 135: e296-e304
        • Liljenquist K
        • Coker TR.
        Transforming well-child care to meet the needs of families at the intersection of racism and poverty.
        Acad Pediatr. 2021; 21: S102-S107
        • Wight V
        • Thampi K
        • Chau M.
        Poor Children by Parents' Nativity: What Do We Know?.
        National Center for Children in Poverty, New York, NY2011
        • Uwemedimo OT
        • May H.
        Disparities in utilization of social determinants of health referrals among children in immigrant families.
        Front Pediatr. 2018; 6: 207