ABSTRACT
INTRODUCTION: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.
