Parent perspectives on electronic health record-based social needs screening and documentation: A qualitative study

Abstract

Objective:

Social needs interventions in clinical settings can improve child health outcomes; however, they are not routinely delivered in routine pediatric care. The electronic health record (EHR) can support these interventions, but parent engagement in the development of EHR-based social needs interventions is lacking. The aim of this study was to assess parent perspectives on EHR-based social needs screening and documentation and identify family-centered approaches for screening design and implementation.

Methods:

We enrolled 20 parents from four pediatric primary care clinics. Parents completed a social risk questionnaire from an existing EHR module and participated in qualitative interviews. Parents were asked about the acceptability of EHR-based social needs screening and documentation and preferences for screening administration. A hybrid deductive-inductive approach was used to analyze qualitative data.

Results:

Parents identified benefits of social needs screening and documentation, but expressed concerns related to privacy, fear of negative outcomes, and use of outdated documentation. Some felt self-administered electronic questionnaires would mitigate parent discomfort and encourage disclosure of social needs, while others felt face-to-face screening would be more effective. Parents stressed the importance of transparency on the purpose of social needs screening and use of data.

Conclusions:

This work can inform the design and implementation of EHR-based social needs interventions that are acceptable and feasible for parents. Findings suggest strategies such as clear communication and multi-modal delivery methods may enhance intervention uptake. Future work should integrate feedback from multiple stakeholders to design and evaluate interventions that are family-centered and feasible to implement in clinical settings.

Introduction

Evidence strongly supports the association between unmet social needs in childhood and increased risk of behavioral and developmental problems, chronic diseases, poorer mental and physical health, higher healthcare utilization and costs, and mortality.^1–5 A growing body of research has examined interventions targeting social needs (e.g., screening and connecting families to community resources). While the evidence is mixed, studies have shown such interventions may improve social and health outcomes for children and families.^{6, 7} Although the American Academy of Pediatrics recommends addressing patients’ social needs, only half of pediatricians routinely screen for any social needs and systematic screening for multiple needs remains uncommon.^8–10

The electronic health record (EHR) can support the adoption of social needs interventions into routine clinical practice.^{11, 12} Documentation of social determinants of health (SDoH) is typically captured in free-text narratives which are not easily accessible during subsequent clinical encounters and make research on aggregate SDoH data difficult.¹³ A growing number of EHR systems offer tools such as centralized modules for SDoH documentation and dashboards that highlight social risks. Other available EHR tools, such as patient portal questionnaire administration and electronic referrals, may help streamline social needs interventions. Unfortunately, although these modules are available, they are not widely used. Promoting uptake of the modules to support interventions in pediatric settings requires consideration of issues such as adolescent privacy and parental roles in consent and decision-making. Therefore, tailored strategies are needed for designing and implementing social needs interventions in pediatric settings.

Stakeholder acceptability is a key driver of implementation success.¹⁴ Given the importance of developing interventions and implementation plans that are acceptable to participants, stakeholder engagement is a key component of implementation research.¹⁵ Much of the existing research specific to EHR-based social needs interventions has elicited perspectives of healthcare providers and IT specialists, with less attention to the needs and preferences of patients or families.¹⁶ Engaging patients and parents is especially important for developing EHR-based interventions because attitudes and preferences toward interventions may change when the EHR is involved.¹⁷ Eliciting these perspectives may also help understand why disclosure of social needs is less frequent than expected in large-scale EHR-based screening efforts.¹⁸

The overall goal of this research was to identify strategies for implementing technology-based social needs interventions that are patient-centered, clinically relevant, and compatible with current clinical practice. This qualitative study aimed to assess the acceptability of and preferences for the design and implementation of EHR-based social needs screening and documentation through interviews with parents.

Methods

Setting

This study was conducted from February to August 2022 at a large academic health system in the Southeast United States. The study was approved by the local Institutional Review Board. We recruited parents from four pediatric primary care clinics which serve a population with varying levels of poverty and rurality. Pediatric patients seen at these clinics are 52% White, 25% Black, 15% other race, 4% Multiracial, 10% Hispanic, and 75% have patient portal accounts. Approximately 47% of patients at these clinics are enrolled in Medicaid, with rates by clinic ranging from 28–55%. About 3% of these patients have a preferred language other than English identified in their medical record.

All health system clinics use the Epic^® EHR platform and associated patient portal. Epic^® has introduced a module that offers a single location for documentation of SDoH data. The module questions for patients under age 12 are intended to be answered by the parent and include the following domains: physical activity, food insecurity, housing, transportation needs, caregiver education and work, caregiver health, child education, and safety and environment. Module domains and risk classification are evidence-based and follow recommendations from the National Academy of Medicine.^{19, 20} Once responses are entered, healthcare providers can identify areas of risk through a color-coded visual display (see Appendix A). The pediatric questionnaire was not a component of standard care or available through the patient portal during the study period.

Theoretical Framework

We used the Theoretical Framework of Acceptability (TFA) to guide this research.²¹ Acceptability is a multi-faceted construct, defined as the extent to which stakeholders “consider an intervention to be appropriate, based on anticipated or experienced cognitive and emotional responses to the intervention.”²¹ We chose the TFA because it is a comprehensive framework that can be applied during the intervention development phase. Selected TFA domains are described in Table 1.

Table 1.

Theoretical Framework of Acceptability Domains²¹

Domain	Description
Affective Attitude	How an individual feels about taking part in an intervention
Burden	The perceived amount of effort that is required to participate in the intervention
Self-Efficacy	Participant’s confidence that they can perform the behaviors required to participate in the intervention
Perceived Effectiveness	The extent to which the intervention is perceived as likely to achieve its purpose

Participants and Recruitment

We set a target sample size of 20 parents based on published guidance for qualitative research and previous work on this topic.^22–24 English-speaking parents or legal guardians of current pediatric patients with the ability to complete interviews via videoconference or telephone were eligible. Due to COVID-19 precautions, remote recruitment methods were used. We identified potential participants through a registry of patients who previously provided consent to be contacted about research studies. Registry enrollment is offered as part of the standard check-in procedures for new patients. Approximately 7% of patients seen in the four clinics participate in the registry. Demographics of the pediatric registry patients are similar to the general patient population (55% White, 27% Black, 6% Multiracial, 9% other race, and 12% Hispanic). We obtained a random sample of patients in this registry who were seen in the four clinics in the preceding year. We contacted the parent via email and placed a follow-up telephone call if no response was received after five days. After confirming eligibility, we conducted the informed consent process using REDCap. We performed recruitment until five participants from each clinic completed interviews.

Procedures

A research team member trained in qualitative methods conducted interviews via videoconference. Before the interview, parents completed the Brief Health Literacy Screening Tool (BRIEF) to identify participants who may require assistance completing the questionnaire.²⁵ Immediately before the interview, parents completed the 20-item Epic^® SDoH module pediatric questionnaire (see Appendix B). The purpose of administering the questionnaire was to familiarize the parent with the content rather than to identify and address their personal social needs. The study was not conducted as a part of clinical care and responses were not recorded in their child’s EHR. We offered all parents the option to have the questions read to them, regardless of BRIEF score.

The interview guide was structured by TFA constructs. We asked parents about their impressions of the social risk questionnaire, preferences for screening location (home or clinic), screening administration (e.g., patient portal, verbal, paper), attitudes toward EHR social needs documentation, comfort discussing their responses with a member of the healthcare team, the type of provider or staff member they would prefer to talk to, and how they would like social needs to be addressed (see Appendix C). We also asked about suggested strategies for supporting social needs screening and documentation. Interviews lasted approximately 30 minutes and were audio-recorded and transcribed. Parents received a $25 incentive to participate in interviews.

Data Analysis

We used a hybrid deductive-inductive qualitative analysis approach conducted in two phases. Two team members performed the analysis. In the first phase of analysis we used a template analysis approach.²⁶ We developed an initial data extraction template based on framework constructs and the interview guide. We included fields for comments that were relevant to the study aims but fell outside of the structured template. We piloted the template on the first three interviews and revised it using an iterative process. One team member used the template to extract pertinent data and quotations from all transcripts. A second team member performed audits on 30% of transcripts to identify any missing or irrelevant content. We then entered the summarized content into a participant-by-domain matrix. This matrix provided a reduced dataset containing only information specific to our study aims for further analysis. This stage of analysis was performed concurrently with data collection

In the second stage of analysis, two team members conducted inductive coding of content in the matrix. We developed a preliminary codebook informed by observations from the first analysis phase and organized by TFA domains. Two team members performed independent coding to identify emerging themes within specific domains. Using the constant comparison method, the team compared coding, reconciled differences, and updated the codebook using an iterative process.²⁷ Two team members independently coded data from half of the participants and one team member coded the remaining data. Intercoder reliability, calculated as the number of coding agreements divided by all coding decisions, reached >0.80 for the final two rounds of coding by both team members. No new codes were identified after eight summaries were reviewed, suggesting thematic saturation was reached. Data were managed in Microsoft Excel and an audit trail detailing dates and descriptions of all decisions relating to analysis was maintained.

Results

All parents were sent recruitment emails except 11 parents with missing email data in the registry (n=8) or whose recruitment email was undeliverable (n=3). These parents were only contacted by telephone. Of the 183 potential participants we attempted to contact, we enrolled 20 (10.9%), 148 (80.9%) did not respond, 13 (7.1%) declined to participate, and two (1.1%) were ineligible because their child no longer received care from the health system.

Participant characteristics are presented in Table 2. Most participants identified as female, White, and non-Hispanic. Parent ages ranged from 31 to 56 years and the majority (70%) had multiple children. Most parents lived in areas in the third and fourth Social Vulnerability Index (SVI) quartiles, indicating higher vulnerability.²⁸ Compared to overall pediatric patient demographics, the parent sample had a higher proportion of individuals identifying as White (60% vs. 52%) and a lower proportion identifying as Hispanic (5% vs. 10%). Questionnaire responses indicated one or more social risks for 85% of the sample. Risks identified by the screener fell under the domains of physical activity (n=13, 65%), safety and environment (n=6, 30%), child education (n=6, 30%), food security (n=4, 20%), housing (n=3, 15%), caregiver health (n=2, 10%), and transportation (n=1, 5%). All but one participant had used the patient portal. All parents scored ≥13 on the BRIEF assessment, indicating adequate health literacy. Seven parents completed the questionnaire verbally. All parents completed the questionnaire in less than five minutes, regardless of the administration method. Themes organized by TFA construct along with illustrative quotes are presented in Table 3.

Table 2.

Parent participant characteristics (n=20)

Characteristic	n	%
Age in years
30–39	9	45.0
40–49	7	35.0
50–59	4	20.0
Gender
Female	19	95.0
Male	1	5.0
Race
White/Caucasian	12	60.0
Black/African American	5	25.0
Asian	1	5.0
Other	1	5.0
Declined to answer	1	5.0
Ethnicity
Hispanic	1	5.0
Non-Hispanic	18	90.0
Declined to answer	1	5.0
Social Vulnerability Quartile1
1	2	10.0
2	6	30.0
3	5	25.0
4	7	35.0
Patient portal account
Yes	19	95.0
No	1	5.0
Age of children2
<5	9	45.0
5–12	14	70.0
13–18	9	45.0
≥19	3	15.0
Number of social risks
0	3	15.0
1	9	45.0
2	3	15.0
3	2	10.0
4	3	15.0

¹Higher quartile indicates greater social vulnerability

²Count of parents with at least one child in age range. Totals exceed 100% due to parents with multiple children

Table 3.

Themes by TFA construct

TFA Construct	Code	Theme	Illustrative Quotes
Affective Attitude	Privacy concerns	Concerns related to the confidentiality and privacy of social needs disclosures affect screening preferences	“In the privacy of the room I think would be okay to ask, but if it was something outside where there were other people, people might not answer as truthfully.”
			“When people are feeling awkward about answering things in front of people, email by might be a little bit more secure than receiving a text message over your phone. People pick up phones all the time, you know.”
			“At least on paper or by the link your kids aren’t knowing everything. Because my kids don’t know financial stuff or anything like that... That’s too much of a stress that they don’t need to know, they just need to be kids. I don’t think it would be appropriate to do it verbally.”
Burden	Negative outcomes	Disclosure and documentation of social needs may lead to involvement of child protective services or elicit negative feelings	“I would be a little concerned about if they’re looking at those things and saying, ‘Well because you’re experiencing these things, and because you’re poor, or you don’t have education, that you’re not fit parents, so you shouldn’t have your child.’”
			“Well, if anything were to ever happen, like DCF were to get involved, and they get a hold of that chart. They can [say] well, ‘three years ago, you had a problem with this, that, and the other.’”
			“Somebody might not feel comfortable wanting a permanent record of a time...that may not be the most the greatest point of their life. I just think that no parent wants to not be able to provide for their child. That has that has to be a gut-wrenching feeling.”
	Convenience	Parents’ willingness to participate in and preferences for social needs screening is strongly influenced by how easy the intervention is to fit within their lives	“It’s a lot about convenience so being able to access [the questionnaire], not necessarily during my work hours – being able to have an avenue that I can do it online after I get off work and I’m not trying to make sure my child is eating or sleeping or taking a bath, all of that stuff – when I kind of have the downtime so concentrate on other things outside of you know, making sure that they’re okay.”
			“We do a lot of stuff before the visit online. There’s still one of the questionnaires that we start to fill out in person at each visit, which is always fun when you have a toddler or an infant all over the place...Anything that can reduce the amount of paperwork that you have to do at a visit while you’ve got a little one to entertain, I’m all for.”
			“I can say that some people may have more of an issue with [portal screening] considering access to the Internet in rural areas. Like where I live, it’s a very rural area and not everybody has Internet access out here, and if they do it’s really spotty.
Self-efficacy	Honesty	The likelihood of parents providing accurate responses on the social needs screening is influenced by screening administration method	“It’s a little harder like when you’re facing somebody to answer [that] we don’t have food all the time, or you know I am having a hard time paying my bills.”
			“Maybe [self-administered screening] would also feel a little less invasive than having to like, physically speak to somebody in the moment and kind of answer them. You may feel like you’re being grilled a little bit... I personally would feel more comfortable just answering the questions written than maybe talking about it.”
			“If you had somebody sitting down and asking, you could see that, as you know, here’s my opportunity to actually get help. Someone’s asking me those questions, so I could see that as. a lifeline, like a resource for aid.”
Perceived Effectiveness	Changing circumstances	Knowledge of social needs can help providers better understand families and monitor or explain changes over time; however, outdated information could give providers an inaccurate perception of current family circumstances	“[EHR documentation of the screening] gives a baseline for your doctor...how your situation may have changed, and that’s something that might alert him to ask some deeper questions for you and your child.”
			“I wouldn’t want that [information] sticking around, you know. Because like I said situations change...if somebody came across a survey that I did five or ten years ago, where it says I’m struggling to feed my kids, I wouldn’t want them to think that it’s still an ongoing problem if it’s no longer an ongoing problem.”

Themes by TFA Construct

Affective attitude

Although parents discussed privacy protections for medical records as an assurance the healthcare team would keep their information confidential, they also expressed privacy concerns related to screening methods. Most were comfortable completing the screening in the clinic waiting room, but others felt the exam room would offer more privacy. For pre-visit screening, parents raised concerns about others in the home overhearing a phone screening or viewing responses on a smartphone. Parents also emphasized the importance of protecting their children from stress by not verbally screening or discussing social needs in their presence. One parent noted that this would also be a concern if previous questionnaire responses were visible in the patient portal because children in the health system are eligible for their own account at age 12. One parent noted that some parents might not know patient portal questionnaires are stored in the EHR. This statement was supported by the fact that four of the parents who expressed comfort and willingness to complete the questionnaire via the patient portal explicitly stated they would not want their responses saved in their child’s medical record.

Burden

Parents expressed apprehension about providing honest answers to the questionnaire due to fear of negative consequences, such as being reported to the Department of Children and Families (DCF) and experiencing distressing emotions. Parents discussed these concerns in the context of the entire questionnaire rather than individual questions. This barrier was especially salient when parents were asked about their comfort with documentation of the questionnaire responses in their child’s EHR. One parent described the potential for the documentation to be used “as evidence that parents are negligent, whereas they simply just tried to say like, ‘look, I need help raising my kid.’” Another parent acknowledged the importance of recording social needs that impact a child’s health; however, they worried documentation would serve as a “permanent record” of a difficult time and raise feelings of vulnerability and inadequacy.

Convenience strongly influenced parents’ preferred screening administration method. All but one parent had experience using the patient portal and many stated it was their preferred screening method. For some, this was a welcome alternative to completing questionnaires in the clinic waiting room while trying to manage young children. Some parents noted portal-based screening might be difficult due to technology barriers, especially in rural areas with limited internet connectivity. Parents advised against telephone-based screening, in part because many parents would not answer calls from unknown numbers or during work hours.

Self-efficacy

In addition to convenience, parents often discussed their recommendations for screening administration in terms of which method would elicit honest answers. Parents described how providing self-administered social risk questionnaires would elicit more disclosures by feeling “less invasive” and providing a sense of anonymity. While these parents thought self-administered questionnaires would mitigate feelings of discomfort associated with in-person screening, others felt that if a trusted provider asked directly about social needs, they would be more willing to share information. Parents expressed confidence in their ability to use the patient portal, but some stated they would need to be reminded to complete questionnaires.

Perceived effectiveness

Parents saw screening and documentation of social needs as a way for healthcare providers to better understand children and families; however, potential unintended consequences were also identified. One benefit of EHR documentation identified by parents was the ability to record a “baseline” for healthcare providers to assess changes in the child’s social risks and health. This particular use of EHR documentation was seen as a tool to help providers understand causes of changes in the child and serve as a trigger to initiate in-depth conversations about changes in the family and environment. On the other hand, parents discussed how documentation of social needs could backfire if the information were not updated. Parents expressed concerns that outdated information could lead providers to have an inaccurate perception of the current family situation.

Suggested Strategies

Table 4 presents strategies suggested by parents to support social needs screening and documentation. Parents discussed the importance of transparency in the screening process so parents would feel comfortable disclosing social needs. They stressed the need to communicate why questions were being asked, how their responses would be used, who the information would be shared with, and what type of follow-up would be offered. This related to both being clear about the services the clinic could offer as well as assuring parents their answers would not “be held against them.” Other strategies related to increasing accessibility and convenience. Parents suggested offering parents multiple methods for completing the screening pre-visit (e.g., patient portal, text message) and including in-clinic options if the screening was not completed before the visit. Parents noted reminders to complete the screening via the patient portal would be helpful and often cited text messaging as the best method of contact. Another parent noted audio options for electronic screening could help parents with low literacy complete the questionnaire.

Table 4.

Strategies to support social needs screening and documentation identified by participants

Strategy	Illustrative Quotes
Be transparent about the reason for screening, how information is stored, and the potential outcomes of sharing social needs information	“I would also be clear about what help is available, and what I mean by that is, are you going to share my name with some agency or...are you going to help me access that information?”
	“Explaining to them why they’re filling out the questionnaire, because a lot of people, you know they look at it as the government’s invading privacy. But if they explained, we’re trying to help you...and see what areas you need help in, I think people would be more willing to open up and talk.”
	“It’s not easy to answer yes to a number of these questions, so there’s a risk involved. If I take the risk of doing that, what’s the potential benefit? Because otherwise I’m either not going to answer them or I’m not going to answer them truthfully.”
Increase screening accessibility and convenience by offering multiple screening options	“Just have a variety of ways that they can choose to answer, whatever works best for their lifestyle. So, it may be phone. Phone is not my preferred method, you know I’d rather text or email. Even though my personal preference isn’t phone, giving them options for how they can answer it.”
	“Someone who don’t really care about surveys, they’re not gonna fill them out anyway, unless you at the doctor’s office. You [can] send it through email or via text. They may not even [do it] if they’re not a survey person.”
Implement reminders for pre-visit questionnaires	“I think the same way that we get appointment reminders to confirm that we have gotten the appointment. So if I got reminders hey you haven’t gone in and answer these questions, it’s kind of like the insurance – we need it pre filled out before you get here. Just kind of give us the nudge to remind us.”
	“Like I said I don’t go on [the patient portal] often...That’s not one of the places I go check for an upcoming appointment even though it’s recorded in there. So that’s just me, I’m one of those people that probably wouldn’t go to [the portal] first but, unless I know ahead of time to check for a survey something. If a text says please check your [portal account] for the survey that’s the only way I would remember to do it, truthfully.”

Discussion

This study identified factors influencing the acceptability and feasibility of EHR-based social needs screening and documentation along with strategies to enhance screening uptake among parents. Most parents viewed social needs screening as acceptable and many expressed support for EHR documentation; however, they also identified barriers that need to be addressed in implementation efforts. This feedback is essential to developing family-centered social needs interventions and implementation strategies for pediatric primary care.

Administering social needs questionnaires using the patient portal offers the advantages of easily accessible structured data and increased clinical efficiency; however, for social needs interventions to be effective, patients with social needs must be able and willing to complete questionnaires in this manner. Parents in this study often identified the patient portal as a preferred screening administration method. Some felt this approach would elicit more honest screening responses, which aligns with previous research supporting the acceptability and effectiveness of electronic social risk screening.^{17, 24, 29} Unfortunately, significant disparities in pediatric patient portal activation and use exist.^{30, 31} Health systems must therefore be cautious when relying on patient portal-based screening delivery, which may disproportionately reach and benefit less vulnerable populations and exacerbate disparities. Multi-modal screening options to enhance the reach of social needs screening should be considered in conjunction with promoting universal patient portal activation and use.

Previous quantitative research found that only 60% of caregivers of pediatric patients are comfortable with EHR social needs documentation.¹⁷ Our study provides insight into some reasons for discomfort with documentation. Parents described apprehension that EHR documentation of social needs may be used as evidence of parental mistreatment or neglect, both at the time of the screening and in subsequent years. This concern may also be relevant to parents completing social needs screening at their own healthcare visits.³² Parents in this study recommended providing assurances that their responses would not be shared or used against them; however, it should be noted that the questionnaire contained topics that are subject to mandatory reporting requirements (e.g., physical and sexual abuse). When developing social needs screening procedures, healthcare systems should consider the appropriateness of including these sensitive items on a self-administered questionnaire. For example, previous pediatric screening initiatives in this health system omitted sensitive questions due to the questionable reliability of screening in this format.³³ If potentially urgent social needs are included in self-administered screening, EHR alerts and other mechanisms must be implemented to ensure a timely response if screening is administered independently from a visit or if a scheduled visit is missed.

Another concern related to documentation of social needs centered on the potential for outdated information to be stored in the EHR. The ability to review social needs data in the EHR may enhance healthcare providers’ understanding of their patients and help tailor care plans,^{6, 24} but social needs can change rapidly and data will quickly become outdated. One solution is to institute consistent screening schedules; however, health systems must guard against parents being inundated with social needs screening and associated feelings of vulnerability when receiving care at multiple clinics. Similarly, if parents are asked to undergo the distressing process of disclosing social needs, health systems must ensure appropriate resources are available to help address these needs.³⁴

One issue raised by our findings is the extent to which parents understand and have control over how EHR social needs data are stored and shared. Similar to diagnostic codes and problem lists, social needs data stored in a centralized EHR module can be easily accessed by healthcare providers and staff outside of the clinic that administered the screening. This provides many benefits including data standardization and tracking; however, parents may not want social needs information shared with a trusted healthcare provider to be viewed by others due to concerns around stigma and bias.²⁴ Further, there is the potential for other family members with access to the child’s patient portal account, or even the child themselves, to access screening responses. Some institutions have implemented workarounds to store social needs data outside the EHR, but this approach requires additional workflow steps and can make communication among relevant team members inefficient.³⁵ Addressing these privacy and confidentiality issues will depend on the EHR system in use and healthcare system policies. Until EHR systems can provide appropriate privacy protections, parents need to be clearly informed about how the information they provide is managed and shared.

Strengths of this research include the specific focus on EHR-based social needs screening and documentation in pediatric settings and elicitation of stakeholder perspectives to inform implementation. This research also has some limitations. This study was conducted in a single healthcare system and findings may not be transferrable to other settings. The use of a research registry for recruitment may have introduced selection bias. Although the demographic characteristics of patients enrolled in the registry are similar to those of the general patient population, there may be other differences that could influence our results. For example, parents who do not participate in the registry may hold less trust in the healthcare system or have lower technological literacy, which would likely influence their views on EHR-based social needs screening and documentation. Another limitation of our sampling approach was the restriction to English-speaking parents. Future work should explore barriers related to patient portal use and social needs screening for parents who do not speak English. Additionally, our sample was largely White non-Hispanic and all parents were over age 30; a younger, more diverse sample may have provided additional insight into topics related to social needs. Finally, all but one participant had an active portal account and findings may not reflect the experiences of parents facing barriers to portal access.

Conclusion

This study provides important insight into parent perceptions of EHR-based social needs screening and documentation. Findings offer several strategies for designing and implementing EHR-based social needs interventions in pediatric settings that are acceptable and feasible for parents. Future work should focus on integrating feedback from multiple stakeholders to design interventions that are both family-centered and feasible to implement in clinical settings.

What’s New.

This study provides parent perspectives on the design and implementation of EHR-based social needs screening and documentation in pediatric primary care. Our findings highlight potential challenges to intervention uptake and offer intervention design and implementation strategies to overcome these barriers.