Long Kristin A, Paredes Molina Alix A, Blakey Ariel O, Oliveira Dara R, Barahona Paz Katherine, Mateo Camila M, Cazorla-Garcia Illari, Abramson Mathena A, Drainoni Mari-Lynn, McKee M Diane, Rudel Rebecca K, Trivedi Michelle K, Garg Arvin
Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts.
Department of Psychology and Behavioral Health, Children's National Hospital, Washington, DC.
JAMA Netw Open. 2025 Aug 1;8(8):e2529538. doi: 10.1001/jamanetworkopen.2025.29538.
Screening for health-related social needs (HRSNs) has become the standard of care, but little is known about patients' perceptions of whether and how screening and referral should be conducted, particularly among Black and Latine populations, who have variable rates of screening and resource receipt. Limited consideration of racism within HRSN frameworks and research underlies concerns that HRSN screening and referral systems may paradoxically exacerbate inequities.
To characterize Black and Latine patients' perspectives regarding (1) the suitability of HRSN screening and referral systems within primary care, (2) decision-making regarding HRSN disclosure, (3) contextual barriers and facilitators of equitable screening and referral, including processes underlying inequitable outcomes, and (4) implementation recommendations.
DESIGN, SETTING, AND PARTICIPANTS: In this qualitative study, data collected from April to August 2023 were audio-recorded, transcribed, systematically coded, and analyzed using applied thematic analysis. The study was conducted at 4 urban family medicine clinics in Worcester, Massachusetts. Participants self-identified as Black or African American and/or Latine and spoke English, Spanish, and/or Portuguese. Enrollment ceased upon reaching thematic saturation.
Grounded in the Health Equity Implementation Framework, semistructured interviews probed implementation barriers and facilitators to HRSN screening and referrals. Qualitative data were stratified by race and ethnicity and language.
The study included 32 participants (mean [SD] age, 43 [23] years; 23 women [72%]; 9 [28%] Black; 22 [69%] Latine; 1 [3%] both), who emphasized the importance of HRSN screening and referral systems. However, mistrust in health care systems fueled reservations about disclosing HRSNs. Participants described needing to actively weigh high perceived risks (eg, loss of privacy, judgment, or government agency involvement) with low expectations of receiving resources, ultimately limiting disclosure. Within clinics, participants explained that achieving equitable screening and referrals would require transparent, bidirectional patient-practitioner communication, systematic HRSN screening protocols and accountability, and mitigation of systemic barriers that disproportionately affect minoritized patients (eg, staff shortages, time constraints, and biases).
In this qualitative study, Black and Latine patients described their perceptions of HRSN screening and referral systems, emphasizing compounding barriers across screening, referral, and resource receipt and underscoring how fears of negative consequences may limit disclosure of HRSNs. Together, these findings highlight how interpersonal and structural racism influence the likelihood of Black and Latine patients' needs being recognized or addressed. An intentional approach is necessary to enhance patient trust and to implement systematic, universal, patient-centered social care systems.
筛查与健康相关的社会需求（HRSNs）已成为医疗护理的标准，但对于患者对筛查和转诊是否以及应如何进行的看法知之甚少，尤其是在黑人和拉丁裔人群中，他们的筛查率和资源获取率各不相同。HRSN框架和研究中对种族主义的考虑有限，这引发了人们对HRSN筛查和转诊系统可能反而加剧不平等的担忧。
描述黑人和拉丁裔患者对于（1）HRSN筛查和转诊系统在初级保健中的适用性，（2）关于HRSN披露的决策，（3）公平筛查和转诊的背景障碍及促进因素，包括不平等结果背后的过程，以及（4）实施建议的看法。
设计、背景和参与者：在这项定性研究中，2023年4月至8月收集的数据进行了录音、转录、系统编码，并采用应用主题分析法进行分析。该研究在马萨诸塞州伍斯特的4家城市家庭医学诊所进行。参与者自我认定为黑人或非裔美国人及/或拉丁裔，会说英语、西班牙语和/或葡萄牙语。达到主题饱和后停止招募。
基于健康公平实施框架，半结构化访谈探讨了HRSN筛查和转诊的实施障碍及促进因素。定性数据按种族、族裔和语言进行分层。
该研究纳入了32名参与者（平均[标准差]年龄为43[23]岁；23名女性[72%]；9名[28%]黑人；22名[69%]拉丁裔；1名[3%]两者皆是），他们强调了HRSN筛查和转诊系统的重要性。然而，对医疗保健系统的不信任加剧了对披露HRSNs的保留态度。参与者表示需要积极权衡高感知风险（如隐私丧失、评判或政府机构介入）与获得资源的低期望，最终限制了披露。在诊所内部，参与者解释说，要实现公平的筛查和转诊，需要透明、双向的医患沟通、系统的HRSN筛查方案和问责制，以及减轻对少数族裔患者影响过大的系统性障碍（如人员短缺、时间限制和偏见）。
在这项定性研究中，黑人和拉丁裔患者描述了他们对HRSN筛查和转诊系统的看法，强调了筛查、转诊和资源获取方面的多重障碍，并强调了对负面后果的恐惧可能如何限制HRSNs的披露。这些发现共同凸显了人际和结构性种族主义如何影响黑人和拉丁裔患者的需求被识别或解决的可能性。需要采取有意为之的方法来增强患者信任，并实施系统、全面、以患者为中心的社会护理系统。
