Pediatricians, along with other health care providers, are increasingly being asked to identify and help address social determinants of health. These efforts represent a transition for both the pediatricians and for parents. It is crucial for pediatricians to understand parents’ needs, concerns and goals as both parties adjust to this expanded vision of pediatric care. Pediatricians and their staffs must work with parents to build their comfort with disclosing information about social stressors, particularly those that are most sensitive.
The low-income parents in our focus groups understood their children were affected by the social determinants of health for which some pediatricians are screening. But they did not immediately identify pediatricians as sources of help with social needs—perhaps because few of them indicated having experienced pediatric care that attempted to address those needs. Parents’ frustration at the prospect of disclosing sensitive information without getting help may stem in part from their not expecting pediatricians to be able to help with those issues.
Many of these parents’ ideas for pediatricians about how to discuss social needs would likely strengthen the quality of pediatric primary care more generally—in particular, building long-term trusting relationships between parents and pediatricians. Addressing short appointments and long waits could also promote higher quality care if doing so created more time to discuss social needs and freed parents to take care of priorities like work or school rather than waiting for appointments to start.
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.
This qualitative research provides rich insight into low-income parents’ views on social needs and screenings. These findings should inform future research and interventions focused on making sure screenings for social determinants of health meet the needs of parents and children. 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 health care and social service systems.
As social determinants of health screenings become more common in pediatric primary care, qualitative and quantitative research can help us understand parents’ experiences of those screenings and can continue to engage parents in conversations about how to promote their children’s health and well-being by addressing social needs.