Table 3.

Patient interviews − acceptability of the social needs intervention, themes by TFA construct

TFA Construct	Theme definition	Example quotation
Affective attitude
Rapport with provider (n = 21)	Acceptability of social needs interventions depends on the interaction and relationship that patients have with their provider.	“It just depends on who your doctor is. You got to have a relationship or a rapport with your doctor. And if you're not able to trust your doctor, it doesn't matter, if you have to do the questionnaire or not. People are not going to be truthful.” [Clinic, F, AA; ID #3]
Life changes (n = 13)	Assessing social needs more frequently is important because a patient’s life condition can change.	“A lot can change in six months… You do not have any updates if you just do it once a year. You're still relying on what the questionnaire said at the beginning of the year. Your situation might have changed in a couple of months.” [Home, F, AA; ID #21]
Privacy (n = 9)	Acceptability of social needs interventions depends on the privacy and confidentiality of answers to social needs questions or discussions about social needs.	“That’s something that once it’s on [the portal]… someone can see it. This is between me and my doctor. You do it on the Internet, there’s a chance that that can get out there to somebody else. You got billing department. You got every doctor I see on that portal. [Clinic, M, W; ID #7]
Burden
Discomfort (n = 12)	Patients may be less likely to disclose social needs because the questions or assessment cause discomfort (are personal, sensitive, or trigger emotions).	“My daughter’s 20, and we still struggle… I know if you ask my daughter, she would decline because she wouldn't want to be honest and truthful when it would hurt. Hurts when you answer the questions sometimes… You're like oh, wait, that makes me feel like failing as a parent and stuff.” [Clinic, F, NR; ID #8]
Time limitations (n = 9)	Having meaningful social needs assessment or discussion is difficult if the process takes too much time, or if done in a context where the patient or provider feels rushed for time.	“There’s a lot of times depending on when you arrive at your appointment… I do not have time to answer questionnaires. I do not want the stress of trying to answer this and bring it back here… so I can give it to her on time. Those little things.” [Clinic, M, AA; ID #9]
Stigma (n = 8)	Patients may be less likely to disclose social needs due to concerns about being judged by providers or other patients.	“I’m at a point where I may need more [medication] but I am afraid to ask, so I don't ask for more… I do not want them to judge me…” [Home, F, AA; ID #21]
Perceived effectiveness
Positive outcomes (n = 16)	Assessing and addressing social needs will lead to positive outcomes, such as "help", referrals, or positive health outcomes.	“If you hadn't had food, maybe they could say, okay, she could be suffering from you know being hungry… If you're behind on your mortgage and bills or something - could be related to stress, high blood pressure, stuff like that.” [Home, F, AA; ID #33]
Important for routine care (n = 15)	Assessing and/or acting on social needs is important for a patient’s normal or routine health care.	“Well, [the questions] were more about living, and that was important… I do not know why a doctor wouldn't be concerned about those questions.” [Clinic, F, W; ID #11]
Trust building (n = 13)	Assessing social needs builds trust or understanding between patient and provider, and may improve their relationship.	“The physicians will know exactly what you're going through, exactly what you're feeling, and then… they can be able to relate to you.” [Clinic, F, AA; ID #20]
Encouraging disclosure (n = 11)	Answering social needs questions or discussing social needs will encourage patients to disclose personal information they might otherwise withhold.	“Because [the provider] can get more out of it if he’s talking… person-to-person. And [patients will] tell you more how they feel about it, if questions was asked to them. [Home, F, AA; ID #29]
Self-efficacy
Honesty (n = 14)	Patients will answer social needs questions meaningfully if they have a personal commitment to being honest or truthful.	“I'm not afraid to tell anything to my doctor because I'm an open book. And I'm [on] short time anyhow… So the more information they have the better can help me, you know.” [Home, M, W; ID #27]
Technology literacy (n = 13)	Patients may not use technical applications for social needs assessment because they don't understand or can't use the technology (e.g., computers, tablets).	“No, [I would not be comfortable with the technology] because I don't know about anything about a computer or a phone. Only thing I know is how to say ‘Hello’ and ‘Goodbye’.” [Home, F, AA; ID #21]
Difficult to read/understand (n = 10)	Patients may have difficulty reading or understanding social needs questions and/or understanding social needs discussion with providers.	“[Completing questions in the waiting room] would suck… My eyes are really bad and it’s hard for me to see…. I do not like to strain my eyes.” [Home, M, W; ID #40]

Abbreviations: AA, African-American; F, female; ID, respondent identification number; M, male; NR, not reported; TFA, Theoretical Framework of Acceptability; W, White.