Perspectives on Health-Related Social Needs Screening in Primary Care Among Black and Latine Patients.

Importance: Screening for health-related social needs (HRSNs) has become the standard of care, but little is known about patients' perceptions of whether and how screening and referral should be conducted, particularly among Black and Latine populations, who have variable rates of screening and resource receipt. Limited consideration of racism within HRSN frameworks and research underlies concerns that HRSN screening and referral systems may paradoxically exacerbate inequities. Objective: To characterize Black and Latine patients' perspectives regarding (1) the suitability of HRSN screening and referral systems within primary care, (2) decision-making regarding HRSN disclosure, (3) contextual barriers and facilitators of equitable screening and referral, including processes underlying inequitable outcomes, and (4) implementation recommendations. Design, Setting, and Participants: In this qualitative study, data collected from April to August 2023 were audio-recorded, transcribed, systematically coded, and analyzed using applied thematic analysis. The study was conducted at 4 urban family medicine clinics in Worcester, Massachusetts. Participants self-identified as Black or African American and/or Latine and spoke English, Spanish, and/or Portuguese. Enrollment ceased upon reaching thematic saturation. Main Outcomes and Measures: Grounded in the Health Equity Implementation Framework, semistructured interviews probed implementation barriers and facilitators to HRSN screening and referrals. Qualitative data were stratified by race and ethnicity and language. Results: The study included 32 participants (mean [SD] age, 43 [23] years; 23 women [72%]; 9 [28%] Black; 22 [69%] Latine; 1 [3%] both), who emphasized the importance of HRSN screening and referral systems. However, mistrust in health care systems fueled reservations about disclosing HRSNs. Participants described needing to actively weigh high perceived risks (eg, loss of privacy, judgment, or government agency involvement) with low expectations of receiving resources, ultimately limiting disclosure. Within clinics, participants explained that achieving equitable screening and referrals would require transparent, bidirectional patient-practitioner communication, systematic HRSN screening protocols and accountability, and mitigation of systemic barriers that disproportionately affect minoritized patients (eg, staff shortages, time constraints, and biases). Conclusions and Relevance: In this qualitative study, Black and Latine patients described their perceptions of HRSN screening and referral systems, emphasizing compounding barriers across screening, referral, and resource receipt and underscoring how fears of negative consequences may limit disclosure of HRSNs. Together, these findings highlight how interpersonal and structural racism influence the likelihood of Black and Latine patients' needs being recognized or addressed. An intentional approach is necessary to enhance patient trust and to implement systematic, universal, patient-centered social care systems.