Center for Healthful Behavior Change, Institute for Excellence in Health Equity, NYU Grossman School of Medicine, New York, New York.
Family Support Services, Family Health Centers at NYU Langone Health, New York, New York.
Am J Prev Med. 2022 Sep;63(3 Suppl 2):S144-S151. doi: 10.1016/j.amepre.2022.03.033. Epub 2022 Aug 17.
Research has focused on developing methods to facilitate screening and tracking data on social risk factors in healthcare settings. Less is known about the multiple factors that shape patients' acceptance of healthcare-based social risk programs. This qualitative study sought to elucidate the multilevel (individual, interpersonal, family/community, system, policy) factors that influence patients' acceptance of a healthcare-based social risk program within a Federally Qualified Health Center in New York City.
Participants included 5 patients receiving care at the Federally Qualified Health Center who screened positive for social risks, 4 nurses who are responsible for conducting social risk screenings, and 5 Family Support Services counselors who conduct outreach to patients who screened positive. Interviews were conducted from March to June 2021 and analyzed from July to September 2021 using the constant comparative method.
Analyses of the transcripts identified the following 3 themes: (1) Patients appreciated being asked about social risk factors, but there was a mismatch between their understanding of the screening process, their desire for assistance, and the support received. Although nurses and counselors described relationship-centered approaches to involve patients in the process, patients reported feeling initial discomfort and confusion; (2) Multilevel barriers inhibit patients' acceptance of assistance; and (3) Patient trust in the physician and healthcare organization serves as facilitators to acceptance.
Patients' views about the purpose of a healthcare-based social risk program differed from nurses' and counselors' perspectives of the process. Although patients face multilevel challenges, strong trust in the physician and Family Health Centers served as facilitators to accepting healthcare-based assistance.
研究重点是开发方法，以促进在医疗保健环境中筛选和跟踪社会风险因素的数据。对于影响患者接受基于医疗保健的社会风险计划的多种因素知之甚少。这项定性研究旨在阐明影响患者接受位于纽约市的联邦合格健康中心的基于医疗保健的社会风险计划的多层次（个人、人际、家庭/社区、系统、政策）因素。
参与者包括在联邦合格健康中心接受护理且社会风险筛查呈阳性的 5 名患者、负责进行社会风险筛查的 4 名护士以及对筛查呈阳性的患者进行外展的 5 名家庭支持服务顾问。访谈于 2021 年 3 月至 6 月进行，并于 2021 年 7 月至 9 月使用恒定性比较方法进行分析。
对转录本的分析确定了以下 3 个主题：（1）患者对询问社会风险因素表示赞赏，但他们对筛查过程的理解、对援助的渴望与所获得的支持之间存在不匹配。尽管护士和顾问描述了以关系为中心的方法来让患者参与该过程，但患者报告说他们最初感到不适和困惑；（2）多层次的障碍阻碍了患者接受援助；（3）患者对医生和医疗保健组织的信任是接受的促进因素。
患者对基于医疗保健的社会风险计划目的的看法与护士和顾问对该过程的看法不同。尽管患者面临多层次的挑战，但对医生和家庭健康中心的强烈信任是接受基于医疗保健的援助的促进因素。
