Understanding Caregiver Perspective on Social Determinants of Health Interventions in Pediatric Primary Care.

Abstract

Comprehensive social risk screening has become standard practice in primary care. Evidence is lacking, however, on whether and how interventions provided for positive screens are being utilized. This study aimed to create a standardized follow-up process to evaluate caregiver perspective and usage of community resources provided during well-child visits. Follow-up calls were made to families with positive screens for food insecurity (FI) and/or utility insecurity (UI) (nn=n347). Phone interviews assessed resource usage, effectiveness, influence on stress level, and current insecurity status. Caregiver responses regarding barriers to resource usage were inductively analyzed and developed into major themes. The sample included 228 (65.7%) families with positive screens for FI and 166 (47.8%) families screening positive for UI. Of those who completed interviews (nn=n108), 77 (71.3%) caregivers recalled being provided resources during their child's visit with only 33 (42.9%) reporting use of those resources. Twelve (36.4%) of those caregivers who used the resources confirmed that their insecurity was still a concern. Five major themes for barriers to resource usage emerged: (1) improved situation, (2) perception, (3) access barriers, (4) conflicting priorities, and (5) too busy/overwhelmed. The majority of caregivers (95.7% of asked) noted that their insecurity caused increased stress with 70.5% acknowledging decreased stress levels after discussion with a provider. Integrating caregiver input through a standardized follow-up protocol into provided interventions for screened social risks can improve not only the quality and effectiveness of provided resources, but also provide insight into the impact of those interventions on insecurity from the caregiver perspective.