Implementation context for addressing social needs in a learning health system: a qualitative study

Area of Science:

• Health Services Research
• Implementation Science
• Digital Health

Background:

• Unmet social needs exacerbate health disparities and increase healthcare costs.
• Integrating social needs data into electronic health records (EHRs) can link patients to community resources.
• Contextual factors influencing the implementation of such interventions in clinical settings require further investigation.

Purpose of the Study:

• To explore patient and provider perspectives on implementing a module for collecting and integrating patient-reported social needs into EHRs.
• To identify facilitators and barriers to the acceptability and feasibility of social needs screening in primary care.

Main Methods:

• Qualitative interviews with 40 patients and focus groups with 12 providers across two primary care clinics.
• Data collection focused on constructs from the Theoretical Framework for Acceptability and Consolidated Framework for Implementation Research.
• Framework analysis involving deductive and inductive coding and matrix analyses.

Main Results:

• Patient concerns included discomfort with sensitive questions, privacy, module readability, and technological literacy.
• Provider rapport facilitated patient disclosure of social needs.
• Providers identified limited patient time and lack of community resources as significant barriers.

Conclusions:

• Flexible approaches are needed for assessing and discussing patient social needs.
• Health system support is essential for the feasibility of social needs interventions.
• The availability of community resources must be studied to ensure intervention effectiveness.