Social Determinants Screening with Social History: Pediatrician and Resident Perspectives from a Middle-Income Country.

Abstract

Social history (SH) makes it possible to learn the social environment of children in pediatric practice and enables interventions into social risks such as poverty. While SH has been evolving in use as an advocacy practice in high-income countries, that seems not to be the case in low- and middle-income countries. We explored pediatricians' and pediatric residents' opinions and experiences of SH with an aim to promote advocacy-based SH practices in Turkey. A qualitative study conducted involving interviews with pediatrics residents, pediatricians and educators, and a focus group with residents. Interviews and the focus group were transcribed and reviewed for themes using qualitative content analysis. The principal objective of SH wasfound to be diagnosis rather than advocacy. Although all participants expressed opinions about socioeconomic conditions' vital influence on child health, most reported limited use of SH. When asked about social needs screening with SH, most participants opposed with various reasons, primarily time concerns and doubts about the necessity for each child. Lack of time was reported as the leading barrier to SH by participants. Other barriers were identified as lack of structured SH education, problems regarding referrals and interdisciplinary work, and the biomedical health approach which defines the physician's role within the physical health domain. To achieve an advocacy-based SH practice, the biomedical health approach should be questioned. Action is needed to implement a social determinants of health approach and equity focus to health policies and to medical and residency education.