Screening for financial vulnerability in a paediatric hospital setting: a pilot study of the Financial Risk Questionnaire (FRIQuest)

Growing up in poverty can significantly influence child health and access to healthcare. Paediatric healthcare providers can play an important role in identifying families experiencing financial vulnerability. However, various barriers prevent standard poverty screening in paediatric care. To support this, we developed a digital financial vulnerability screening questionnaire: the Financial Risk Questionnaire (FRIQuest). This study describes its development and evaluates its implementation, perceived usefulness, acceptability, and user friendliness. This mixed-methods implementation study was conducted in a tertiary paediatric hospital in Rotterdam, the Netherlands. Quantitative data included response rates, FRIQuest item responses, parent evaluation survey data, and healthcare provider compliance rates. Qualitative data were obtained through interviews with parents and paediatric healthcare providers. The FRIQuest was sent out to parents of 1206 unique patients. A total of 485 (40.2%) completed the FRIQuest, of whom 22.0% reported (sometimes) experiencing financial vulnerability. Parents generally found the questionnaire easy to complete and felt comfortable answering its questions. They considered it appropriate for healthcare providers to address financial vulnerability, preferably as part of a broader conversation about family wellbeing rather than as a stand-alone topic. Healthcare providers reported that the questionnaire was useful for identifying families in need and was feasible in clinical practice. However, various barriers affected response rates, healthcare compliance, and initiation of conversations.

FRIQuest is a feasible, generally acceptable, and potentially useful digital questionnaire to support the identification of financial vulnerability in paediatric hospital care. This study highlights that successful implementation requires not only suitable questionnaires, but also inclusive implementation strategies, provider engagement and support, and access to social support. Future research should evaluate its impact on referrals to support services and socioeconomic inequalities in child health.

• Growing up in poverty is associated with poorer health and reduced access to healthcare. • Paediatricians can contribute to improving child health outcomes by addressing financial vulnerability within clinical care. However, various barriers prevent standard financial vulnerability screening.

• The Financial Risk Questionnaire is a feasible and generally acceptable digital questionnaire to support identification of financial vulnerability in paediatric hospital care. • Besides suitable questionnaires, successful financial vulnerability screening requires inclusive implementation strategies, provider support, and organisational embedding.