Nonresponse to Health-Related Social Needs Screening Items Within Pediatric Primary Care

Health-related social needs (HRSN) screening has become standard in pediatric health care. HRSN screening may connect families with resources; however, the rates at which families decline screening in pediatric primary care may limit the impact of screening. We aimed to quantify the frequency of nonresponse to HRSN items and assess patient characteristics associated with nonresponse.

We completed a cross-sectional analysis of electronic health record data of an 8-item HRSN questionnaire from 54 pediatric practices. Participants were categorized as nonresponse if they marked "decline" or skipped an HRSN item. We examined nonresponse to each item and examined factors associated with nonresponse to 1 or more items through multilevel logistic regression models with practice-level random effects.

Caregivers of 177 094 children receiving an HRSN questionnaire between 2021 and 2024 were included; nonresponse to 1 or more HRSN items occurred for 9.6% of caregivers. In adjusted analyses, nonresponse was higher for questionnaires of children with public insurance (13.7%; 95% CI, 13.3-14.1) compared with those of commercially insured children (6.7%; 95% CI, 6.4%-6.9%). Similarly, nonresponse was higher for children identified as non-Hispanic Black (11.8%; 95% CI, 11.3%-12.3%), Hispanic (13.3%; 95% CI, 12.1%-14.5%), or another non-white, non-Black, and non-Hispanic race and ethnicity (17.0%; 95% CI, 16.0%-17.9%), compared with non-Hispanic white children (8.4%; 95% CI, 8.1%-8.6%).

Study results suggest overall high completion of HRSN screening but higher nonresponse rates for those within sociodemographic groups that may have higher unmet HRSN. Developing HRSN interventions with families that are adaptive to family and neighborhood contexts may improve trustworthiness of screening and increase resource connection.