Addressing Social Determinants of Health (SDOH) in perinatal care settings: Implementation, acceptability, and preliminary findings
研究了在产科诊所实施社会健康决定因素筛查和转诊的可接受性，发现患者和临床人员普遍支持，但资源不足导致实施困难，且筛查阳性者不良围产结局风险更高。
Background: Despite evidence on the effects of social determinants of health (SDOH) in maternal health, there is a dearth of research on operationalizing SDOH interventions in maternity care.Objective: To determine the (1) acceptability of SDOH screening and referral among patients and clinical staff and (2) association between SDOH and adverse perinatal outcomes across four obstetrics clinics in NH.Methods: Using the Consolidated Framework for Implementation Research, we evaluated three domains of SDOH screening and referral implementation: the intervention, healthcare professionals' perspectives, and patients' perspectives.We performed qualitative descriptive and retrospective electronic medical record analyses (2022)(2023).Results: We conducted interviews with patients (n = 14) and clinical staff (n = 15) and focus groups with patients (1 group, 5 participants) and clinical staff (4 groups, 20 participants).Patients cited caring and unjudgmental interactions with their care team and expressed satisfaction with available resources; however, most described persistent challenges, including the overlap and complexity of food and other insecurities.Clinical staff were supportive of SDOH screening and referral, with varying levels of priority.Notably, staff experienced distress when they were unable to effectively respond to a positive SDOH screen, citing limited capacity, knowledge, or resources.From Jan 2022 -Dec 2023, the most common SDOH needs across sites included social isolation (14.5%), financial insecurity (12.7%), food insecurity (8.1%), and housing instability (7.6%).Those who screened positive for 1+ SDOH (n = 409) were more likely to be non-White, and have Medicaid/Medicare insurance compared to those who screened negative (n = 1813; p < 0.001); and more likely to deliver preterm and deliver a low-birthweight infant (p < 0.001).Additionally, there was a moderate, positive relationship between experiencing food and financial insecurity (r = 0.529), housing and food insecurity (r = 0.514), and housing and financial insecurity (r = 0.482; all p < 0.01).Conclusions: Unmet SDOH needs to magnify inequities in adverse perinatal outcomes.While patients and clinical teams alike support SDOH screening and referrals, persistent and intersecting social needs require ample resources to ensure the effective implementation of SDOH interventions.