Elsevier

Academic Pediatrics

Volume 11, Issue 5, September–October 2011, Pages 387-393
Academic Pediatrics

Education
Training in Social Determinants of Health in Primary Care: Does it Change Resident Behavior?

Presented at the Pediatric Academic Societies Annual Meeting, Vancouver, British Columbia, May 2010.
https://doi.org/10.1016/j.acap.2011.04.004Get rights and content

Abstract

Objective

The aim of this study was to examine the effects of a new social determinants of health curriculum on pediatric interns’ attitudes, knowledge, documentation, and clinical practice.

Methods

A nonrandomized mixed-methods study of an educational intervention conducted over a 1-year period was performed. The 2008–2009 pediatric interns (intervention group) participated in a new social determinants of health curriculum; prior year interns were controls. An anonymous online survey at the end of internship to both groups (post-tests) and the beginning of internship to the intervention group (pretest) assessed attitudes and knowledge. Documentation from the electronic medical record of social history questions was audited during the same 3-month period in successive years. Medical-legal partnership (MLP) referrals from both groups were compared.

Results

Intervention interns (n = 20) were more comfortable discussing issues (100% vs 71%; P < .01) and felt more knowledgeable regarding issues (100% vs 64%; P = .005), community resources (94% vs 29%; P < .001), and housing (39% vs 6%; P = .04) than control group interns (n = 18). No differences regarding the importance of social hardships or screening for food security or education issues were found. Knowledge was greater in the intervention group post-test in all domains: benefits (72% vs 52%), housing (48% vs 21%), and education (52% vs 33%; P < .001 for all). Intervention interns were more likely to document each issue (benefits 98% vs 60%, housing 93% vs 57%, food 74% vs 56%; P < .001 for all). The intervention group had a slightly higher rate of referral to MLP, although the difference did not reach statistical significance.

Conclusion

The educational intervention increased interns’ comfort and knowledge of social determinants of health and community resources. Documentation of social questions also increased.

Section snippets

Methods

This was a nonrandomized mixed-methods study of an educational intervention. It was approved by the Institutional Review Board of the CCHMC. The study was conducted from June 2008 to June 2009 (Figure 1).

Participant Demographics

A comparison of the intervention and control groups demonstrated no significant differences in gender, age, or prior work/volunteer experience in a legal aid or social work office.

Attitude Survey Questions

The postsurvey was completed by 17 of 18 (94%) control subjects. The preintervention and postintervention surveys were completed by 18 of 20 (90%) intervention subjects.

Attitude and comfort assessing families, evaluated by preintervention and postintervention surveys, changed positively on multiple issues: comfort

Discussion

Pediatric residents in continuity clinic often treat children from underserved populations with unmet basic needs that may impact their health, yet traditional medical education does not address these issues. The new interdisciplinary social determinants of health curriculum developed for this study successfully improved resident comfort and knowledge of social determinants of health and community resources, and increased their EMR documentation of social questions and referrals to Child HeLP.

Conclusion

Continuity clinic patients are frequently from underserved backgrounds and may have a variety of unmet social and legal needs that can impact health, yet traditional medical training does not address these issues. Our new social determinants of health curriculum focuses on these issues and the community resources available to help resolve them. This curriculum improved pediatric residents’ comfort with screening and both knowledge of issues and community resources, and increased their

Acknowledgments

We would like to thank the PPCC continuity clinic residents for their interest in learning and in improving patient care.

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