"It doesn't feel as much like my downfall for needing help": patient perspectives on pathways for improving health...

Social health integration (SHI) consists of health care systems' efforts to identify and address patient social circumstances, such as housing instability, food insecurity, or limited transportation. Gottlieb et al. published a revised logic model in 2024 describing multiple pathways for SHI programs to achieve the goals of improving health and reducing avoidable utilization. Previous qualitative studies have described patient attitudes towards and experiences of SHI programs, but there are limited insights into how patient perspectives align with the newly proposed pathways described in the revised logic model. These perspectives are critical for shaping patient-centered implementation and evaluation of future SHI programs.

We conducted semi-structured qualitative interviews with 50 patients who participated in a pragmatic randomized evaluation of an SHI program in two primary care clinics. The program consisted of universal screening and randomized follow-up by either a local, clinic-based community resource specialist or a resource specialist operating out of Kaiser Permanente's nationally-run, centralized Connections Call Center. We elicited patient perspectives on their general experience with SHI, perceived usefulness of SHI, if their needs had been met, and the impact of SHI on their overall health care experience. We analyzed the qualitative data using a Rapid Analysis Procedure to identify overarching themes, and organized the results using the pathways proposed in the revised logic model.

Few patients reported being successfully connected to resources, enhanced engagement with outpatient services, or receiving tailored care plans as a result of participating in the SHI program. Patient perspectives most strongly aligned with emotional support and healing relationships as the value-driver for SHI.

Although few patients reported successful connection to social services as a result of participating in the SHI program, many more patients reported that their positive interactions with a resource specialist regarding their social circumstances led to an improved perception of their health care system, and the perception that their needs had been met. This mismatch emphasizes the value that health care organizations can offer by providing emotional support to patients who are facing stressful social circumstances, even when the need for social services outstrips the supply.