Implementation of social needs screening in primary care: a qualitative study using the health equity implementation...

Area of Science:

• Implementation Science
• Health Equity
• Primary Care Research

Background:

• Screening for social needs (e.g., housing instability, food insecurity) in primary care is crucial for improving patient health outcomes.
• This study is the first to use an implementation science framework to examine social needs screening and response.

Purpose of the Study:

• To identify barriers and facilitators to implementing the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) in a federally qualified health center.
• To evaluate implementation factors and best practices for social needs screening and response using the Health Equity Implementation Framework (HEIF).

Main Methods:

• Qualitative data collection through semi-structured interviews with patients and focus groups with clinicians.
• Utilized the Health Equity Implementation Framework (HEIF) to guide data collection and directed content analysis.
• Evaluated the implementation of the PRAPARE protocol in a federally qualified health center.

Main Results:

• Patients and clinicians identified barriers and facilitators across multiple domains, including structural determinants, resource availability, discrimination, and administrative burden.
• Facilitators included evidence-based techniques like motivational interviewing, team-based staffing, and alignment with patient-centered care.
• High patient acceptability was observed, with opportunities for adaptation to enhance equitable adoption and reach.

Conclusions:

• Findings offer practical insights for implementing social needs screening and response protocols (e.g., PRAPARE) at multiple levels: individual, organizational, community, and societal.
• Future research should focus on developing discrete implementation strategies and multisector care coordination to improve health outcomes and equity for vulnerable populations.