JMIR Publications

ABSTRACT

Background:

Mounting evidence clearly demonstrates social determinants of health (SDoH) impact health outcomes. Provider consideration of patient SDoH in prevention and treatment planning is critical for improved health care quality and health equity. Despite awareness of the connections between SDoH and improved population health, research demonstrates few providers document patient SDoH.

Objective:

This qualitative study aimed to better understand the barriers and facilitators of SDoH assessment, documentation, and referral in different health care settings and roles.

Methods:

Individual semi-structured interviews were conducted with practicing health care providers in South Carolina between August 25, 2022 and September 2, 2022. Participants were recruited via community partners’ online newsletters or listservs using a purposive sampling design. An interview guide with 25 questions was used to explore the following research question: How do SDoH impact patient health and what are the facilitators and barriers experienced by multi-disciplinary health care providers assessing and documenting patient SDoH?

Results:

Participants (n=5) included a neonatal intensive care unit registered nurse, a nurse practitioner, a certified nurse midwife, a family and preventive medicine physician, and a counselor (Licensed Clinical Social Worker), with careers spanning 12-32 years. Participant responses are presented according to the following six themes: participant definitions of SDoH as they pertain to their patient population, participant assessment and documentation practices, perceived barriers and facilitators to assessment and documentation of SDoH, and participant training preferences regarding SDoH assessment and documentation. Overall, participants were aware of the importance of including patient SDoH in assessment and intervention but noted a variety of institutional and interpersonal barriers to assessment and documentation, including time constraints, perceptions of stigma around discussion of SDoH, and limited referral protocols.

Conclusions:

Incentivizing inclusion of patient SDoH in health care must be facilitated from the top down, so assessment and documentation can be universally implemented in a pragmatic way that works for providers in a variety of roles and settings for the betterment of health care quality, health equity, and improved population health outcomes. Partnering with community organizations can serve to augment health care organizations’ resource and referral availability for addressing patients’ social needs.