(PS6-95) Where's My Information Going? Understanding Black and Latine Patients’ Concerns Underlying Engagement with Health-related Social Needs Screening

Introduction: Adverse health-related social needs (e.g. housing/food insecurity) exacerbate persistent health disparities among individuals from racially/ethnically marginalized backgrounds. These unmet social needs pose significant barriers to both physical and mental healthcare engagement. Health-related social needs (HRSN) screening in integrated care settings is well-documented as an effective approach for informing clinical care and facilitating community resource referrals to address patients’ unmet needs, ultimately improving holistic well-being. Yet, available literature documents mistrust in healthcare systems as a key barrier yielding low engagement amongst individuals with social needs. This qualitative study explores Black and Latine patients’/caregivers’ perspectives on HRSN screening, aiming to understand the underlying mechanisms driving patient decision-making in disclosing sensitive needs-related information in family-medicine clinics.

Methods: Participants (N=33) were patients/caregivers of patients from four community-based family-medicine primary healthcare clinics; self-identified as Black/African American or Latino/x/e; and spoke English, Spanish, or Portuguese. Participants were purposively sampled by race, ethnicity and primary language. Semi-structured qualitative interviews explored perceived barriers to engaging with HRSN screening and experiences of racism and discrimination in family-medicine primary healthcare clinics. Data were transcribed verbatim, cleaned, systematically coded, and analyzed using applied thematic analysis.

Results: While participants emphasized the importance of HRSN screening, mistrust in healthcare systems fueled reservations about openly disclosing intimate needs-related information. Participants described concerns regarding: 1) breaches in privacy to their sensitive responses, 2) involvement from child welfare institutions (e.g. CPS, DCF) or immigration agencies (e.g. ICE), and 3) potential judgment after disclosing often stigmatized unmet social needs. Participants’ fears were informed by personal experiences and observations of racism and discrimination in healthcare and social services settings. These fear-driven apprehensions limited participants' feelings of security in openly sharing information about their unmet social needs, overall impacting willingness to engage in screening.

Discussion: HRSN screening holds promise to addressing root causes for racial/ethnic physical and mental health disparities within the context of healthcare delivery. Effective implementation of HRSN screening, however, must address patient apprehensions, aiming to encourage transparent disclosure of unmet needs, in order to equitably enhance patient health outcomes and limit the pervasiveness and detrimental consequences of unmet social needs.