Table 5.
Provider focus groups − acceptability/feasibility of the social needs intervention, themes by CFIR domain
| CFIR domain | Theme definition | Example quotation |
|---|---|---|
| Intervention characteristics | ||
| Evidence strength/quality | ||
|
Effect that social determinants have on patients’ access to care | "When they don't have the basic needs of life, it’s hard to get into the clinic, it’s hard for us to take care of medical problems." [Clinic 1, Physician; ID #1 |
|
Positive effect that social needs intervention has on health and service outcomes | “[If patients] were able to get help towards [affordability of medications], and they start taking their medications regularly. Of course, you see an immediate improvement in the blood pressure." [Clinic 1, Nurse; ID #5] |
| Complexity | ||
|
Overlap of module social needs questions with current patient care practices | "I often ask some of the questions when they're relevant, but if I then had to go and like click over to the other section and fill it in… I do not know if it would be worth my while.” [Clinic 2, Physician; ID #8] |
|
Disruptions in clinical workflow resulting from social needs intervention | “[Patients] already have different issues that they are coming to see you with… Then you get behind and then everyone… gets upset of you because of your own clinic flow… I do not know, it just creates a lot for you." [Clinic 2, Physician; ID #8] |
| Outer setting | ||
| Patient needs/resources | ||
|
Patient needs for privacy that affect disclosure of social needs | "If we’re going to talk about child abuse or domestic violence, there’s like a reluctance to report out of fear… and DCF involvement." [Clinic 1, Social worker; ID #2] |
|
Patient needs for comfort that are impacted by social needs intervention questions or timing | "Some questions even just by asking the question, you can offend somebody… ‘Do you have trouble affording your medications?’ ‘What do you mean? Do I look like I have trouble affording my medications?'" [Clinic 1, Clinical pharmacist; ID #7] |
|
Availability of community resources to address patients’ social needs | “There’s a lot of children programs out there for like schools and connecting them… And for elderly adults, I know there’s also programs for them too especially if [they have]… complex medical conditions.” [Clinic 2, Physician; ID #8] |
| Inner setting | ||
| Implementation climate (compatibility) | ||
|
Capacity of clinicians to administer social needs questions | "Maybe the LPNs could sit down during a nurse visit and make time for those questions. I mean, we all can take turns, all of us can do it. It’s just a lot of patients. I don't see how one person can be responsible for those questions." [Clinic 1, Nurse; ID #5] |
|
Limited time available to assess or discuss social needs with patients | “Time is the number one [barrier]… There’s a fear among physicians of… opening up a can of worms… So many of our patients have multiple of these issues that you would end up just kind of taking a lot of the whole visit." [Clinic 2, Physician; ID #11] |
| Individual characteristics | ||
| Individual knowledge/beliefs | ||
|
Provider belief that solutions for addressing social needs are limited | “[If you're] opening this up… there’s not really a lot you can do right then and [patients] also already have different issues that they are coming to see you with.” [Clinic 2, Physician; ID #8] |
|
Provider belief that social needs intervention can prompt patients to discuss issues | "Just having it there and if they answer it, it’s probably the starting point for you to go into the conversation. And you’ll feel a little more comfortable going and talking about it if there’s already something there." [Clinic 1, Physician; ID #4] |
|
Provider belief that social needs intervention can build trust/rapport with patients | "When you talk to them one-on-one and you really develop a relationship, they do tend to tell you more information than they might tell the physician when the physician goes in." [Clinic 1, Nurse; ID #5] |
Abbreviations: CFIR, Consolidated Framework for Implementation Research; DCF, Department of Children and Families; LPN, licensed practical nurse; SDoH, social determinants of health.