Center of Innovation in Long Term Services and Supports (LTSS-COIN), VA Providence Healthcare System, Providence, Rhode Island; Department of Family Medicine, Warren Alpert Medical School, Brown University, Providence, Rhode Island; Department of Health Services, Policy, & Practice, School of Public Health, Brown University, Providence, Rhode Island.
Department of Health Behavior & Health Education, School of Public Health, University of Michigan, Ann Arbor, Michigan.
Am J Prev Med. 2022 Sep;63(3 Suppl 2):S152-S163. doi: 10.1016/j.amepre.2022.02.022. Epub 2022 Aug 17.
A substantial proportion of patients screening positive for social risks either decline assistance or do not follow-up with offered resources. This study examined patient interest in and engagement with offered social care assistance among adults with poorly controlled diabetes at an academic medical center.
Surveys (n=307) and purposively sampled follow-up interviews (n=40) were conducted 6 months after randomization to receive guided online self-navigation or in-person assistance to address unmet social needs. Integrated mixed methods (data collected in 2019-2021) explored the motivators, barriers, and preferences regarding the uptake of offered assistance. Results were analyzed in 2021 using descriptive statistics, rapid qualitative analysis, and joint display models.
A total of 77% of people randomized to online self-navigation and 14% randomized to in-person assistance engaged with offered assistance. Motivators for engagement were similar across groups and included ease of use, anticipating assistance that could address 1 or more needs, and interest in learning more about available resources. Barriers to engagement included not needing or desiring assistance, participants perceiving that offered assistance was not relevant to their needs or that they would not qualify, competing priorities/forgetting, previous negative experiences or stigma, and technology or access challenges (online self-navigation group). Preferences around offered assistance that directly addressed barriers to uptake included changing messaging and framing around offered help and the ability to tailor modalities.
There are key barriers to the use of social care assistance that may directly reflect the process by which individuals are screened and offered assistance. Strategies to increase uptake should be patient centered and ideally provide multiple options for type of assistance and mode of engagement.
相当一部分社会风险筛查呈阳性的患者要么拒绝接受帮助，要么不跟进提供的资源。本研究考察了学术医疗中心的糖尿病控制不佳的成年人对提供的社会护理援助的兴趣和参与度。
在随机分配后 6 个月，进行了调查（n=307）和有针对性的抽样随访访谈（n=40），以接受指导的在线自我导航或面对面帮助来满足未满足的社会需求。综合混合方法（2019-2021 年收集的数据）探讨了接受提供的援助的动机、障碍和偏好。2021 年使用描述性统计、快速定性分析和联合展示模型进行分析。
随机分配到在线自我导航的人中，有 77%的人参与了提供的援助，而随机分配到面对面帮助的人中，有 14%的人参与了提供的援助。参与的动机在各小组中相似，包括使用方便、预期可以满足 1 个或多个需求的帮助，以及对了解更多可用资源的兴趣。参与的障碍包括不需要或不想要帮助、参与者认为提供的帮助与他们的需求无关或他们没有资格、优先事项/忘记、以前的负面经历或耻辱感、技术或获取障碍（在线自我导航小组）。直接解决接受障碍的提供援助的偏好包括改变提供帮助的信息传递和框架，以及调整模式的能力。
使用社会护理援助存在关键障碍，这些障碍可能直接反映了筛选和提供帮助的过程。增加接受度的策略应该以患者为中心，理想情况下应为患者提供多种类型的援助和参与模式。
