Department of Anthropology, Rhode Island College, Providence, Rhode Island.
Providence Community Health Centers, Providence, Rhode Island.
Am J Prev Med. 2022 Sep;63(3 Suppl 2):S116-S121. doi: 10.1016/j.amepre.2022.03.035. Epub 2022 Aug 17.
Despite efforts to identify and address the social needs of patients in U.S. healthcare settings, researchers consistently find high rates of patients who decline social interventions after reporting that they have unmet social needs. It is an open question as to why people who screen positive for social risks decline assistance. This question was qualitatively explored in a community health center in Rhode Island.
From 2020 to 2021, a total of 26 patients with a positive screen for social risks were telephonically interviewed. Zoom focus groups with clinic staff and Community Advisory Board members were also conducted. Interviews were audio recorded and transcribed. Transcripts were read and analyzed by 4 investigators using an open-coding framework to identify themes emerging from the data and across interviews.
A total of 6 dominant themes related to why patients decline social assistance emerged from the data and were identified across interviews and study populations. Participants explained that the wording of screening questions, along with voluminous paperwork and time constraints of the clinic sometimes resulted in inaccurate reporting. Patients' knowledge of limited resources from previous experiences of requesting social support but not receiving help was a theme. Shame/pride, stigma/discrimination, beliefs and lack of understanding, and fear/mistrust were also described.
Barriers to patients' acceptance of services to support social needs were influenced by multiple factors, both internal and external to the health center. These findings can inform best practices related to and the reliability of social risk screening processes in clinic settings to promote social justice and ensure health equity.
尽管美国医疗保健环境中努力识别和满足患者的社会需求，但研究人员仍一致发现，许多报告存在未满足的社会需求的患者在接受社会干预后拒绝接受。人们为什么在筛查出社会风险后拒绝帮助，这是一个悬而未决的问题。罗得岛州的一个社区卫生中心对此进行了定性研究。
在 2020 年至 2021 年期间，对 26 名筛查出社会风险阳性的患者进行了电话访谈。还对诊所工作人员和社区咨询委员会成员进行了 Zoom 焦点小组讨论。访谈进行了录音并转录。4 名研究人员阅读和分析了转录本，使用开放式编码框架识别数据和访谈中出现的主题。
共有 6 个与患者拒绝社会援助的原因相关的主要主题从数据中浮现出来，并在访谈和研究人群中得到了确认。参与者解释说，筛查问题的措辞、大量的文书工作以及诊所的时间限制有时会导致不准确的报告。患者对以前请求社会支持但未获得帮助的有限资源的了解是一个主题。羞耻/自豪、耻辱/歧视、信念和缺乏理解以及恐惧/不信任也有所描述。
患者接受支持社会需求的服务的障碍受到健康中心内外多种因素的影响。这些发现可以为诊所环境中的社会风险筛查流程提供最佳实践和可靠性信息，以促进社会公正和确保健康公平。
