Patients' perspectives about sharing information with providers on social needs during pregnancy: a qualitative study

There is increasing interest in addressing adverse social determinants of health (SDoH) as a part of clinical care, yet there is limited understanding about the perspectives of patients, including pregnant and postpartum individuals from marginalized groups, that can be used to inform collection and use of information about patients' social needs. This study examines the perceptions of patients regarding barriers to and facilitators of sharing information about social needs during pregnancy with their obstetric providers.

In this qualitative study, we conducted exploratory semi-structured telephone and in-person interviews with pregnant and postpartum patients of an ambulatory obstetrics and gynecology clinic serving a large and racially diverse population primarily covered by Medicaid. Researchers recruited English-speaking pregnant and postpartum individuals 18 years or older during their clinic visits. We asked about experiences of and preferences for sharing social needs information with healthcare providers and receiving support to address those needs. We used deductive and reflective thematic analysis to categorize verbatim transcripts of the patients' interviews into codes and themes.

Twenty-two pregnant (6 to 37 weeks of gestation) and 4 postpartum (1 to 1.5 months postpartum) patients participated in interviews. Their median age was 28 years (range: 18 to 38); 54% identified as Black, 19% White, 12% Latinx, 8% Asian, and 8% multiracial. We delineated two subthemes relating to perceived barriers to sharing information about social needs with providers: process barriers (never/inconsistently asked; limited time during appointments; inadequate ways to capture information about pregnancy-related social needs); and expectation discordancy barriers (skepticism about providers' intentions to help; perceiving the clinician role as limited to physical health). Additionally, we defined two subthemes that facilitate patients' sharing social needs information with providers: relational facilitators (good relationships with providers; providers demonstrate effective interpersonal skills; pregnancy as opportune time to build relationships with providers); and process facilitators (ensured privacy and confidentiality; receiving more than a list of resources).

Health systems should consider the perspectives of patients to inform processes around the collection and use of information about SDoH to increase equity, improve patient-centered care during pregnancy, and improve maternal and infant outcomes.