School-Based Health Providers' Approaches to Social Risk Screening for Pediatric Asthma: A Qualitative Study

Asthma has a high prevalence among children and is associated with negative outcomes and extreme costs. Asthma exacerbations, often preventable, have been associated with social determinants of health and social risk factors. It is unclear whether school-based health providers consider social information for asthma, possibly related to a lack of knowledge or data availability.

Describe the information-gathering behaviors and approaches for social risk screening for patients with asthma exacerbations performed by school-based health center providers.

We conducted a qualitative descriptive study with a purposive sample of school-based health center medical providers. We conducted four focus group sessions (total participants = 16 nurse practitioners) and employed thematic analysis to generate themes.

We identified four major themes: (1) Information-gathering tactics, (2) diligence, (3) challenges accessing and assessing social determinants of health information, and (4) uncertainty. Major findings include: (1) There is a variety of information-gathering tactics used; (2) there are missed opportunities for social risk screenings in schools; (3) social risk screening is feasibly challenging; and (4) there is continued need for resources and increased awareness of screening.

This study highlights the lived experiences of school-based health center providers in gathering information about social determinants of health and social risk factors. Challenges limit the ability to provide effective screening and referral to resources, particularly for school-age children with asthma. Our findings can be used for further research and development of informatics resources to promote effective social risk screening in school-based health centers.