It’s about Trust: Low‐Income Parents’ Perspectives on How Pediatricians Can Screen for Social Determinants of Health
Authors: Schleifer D. 
Published: August 2020

Attempts to screen for social determinants of health in pediatrics should be grounded in an understanding of parents’ receptivity to discussing social needs and should be responsive to their concerns about doing so. Yet little research has asked parents, particularly low‐income parents, for their perspectives about social determinants of health and how screenings can be implemented successfully. This research seeks to explore questions including which social stressors concern low‐income parents; what roles these parents think pediatricians could play in addressing social needs; and how these parents think pediatricians should discuss social determinants of health with them.

Eight focus groups in New York City with low‐income parents of children ages five years and younger. Each focus group lasted two hours. Two of the groups were conducted in Spanish and six in English. Focus groups were audio recorded and professionally transcribed and translated. The research team collaboratively developed a coding scheme and coded the transcripts using Dedoose software.

Low‐income parents of children ages five years and younger in New York City.

First, parents in the focus groups cited a broad range of social stressors that affected their children’s health and well‐being, including some that screening tools for social determinants of health may not currently include. Second, the parents did not immediately identify pediatricians as sources of help with social stressors. They saw some topics, such as nutrition, education, and minor behavioral issues, as appropriate to discuss with pediatricians, but others, such as domestic violence, parents’ mental health, and legal issues, as more sensitive. Third, parents’ concerns about discussing sensitive social needs with pediatricians included worries about being judged and discriminated against, fear of intervention by a child welfare agency, lack of time during appointments, and frustration at the prospect of disclosing sensitive information without getting help.

Parents’ recommendations for pediatricians about discussing social determinants of health included building trust, choosing the right moment, and making clear that screening is standard protocol. Parents recommended that screening should not take place in front of children. They emphasized that pediatricians should be transparent about what triggers reporting to child welfare. Parents said that if pediatricians ask about sensitive issues, they should be able to offer or suggest help.

As social determinants of health screenings become more common in pediatric primary care, pediatricians and their staffs must work with parents to build parents' comfort with disclosing information about social stressors by creating long‐term trusting relationships with them. Attempts to screen for social determinants of health may be more successful if pediatricians develop partnerships with the community organizations and other social service providers that low‐income families may already trust and turn to for information and services for social needs. Further qualitative and quantitative research can explore parents’ experiences of those screenings and can continue to engage parents in conversations about how to promote their children’s health and well‐being by addressing social needs.

United Hospital Fund.