Abstract
Background
Social history (SH) makes it possible to learn the social environment of children in pediatric practice and enables interventions into social risks such as poverty. While SH has been evolving in use as an advocacy practice in high-income countries, that seems not to be the case in low- and middle-income countries. We explored pediatricians’ and pediatric residents’ opinions and experiences of SH with an aim to promote advocacy-based SH practices in Turkey.
Methods
A qualitative study conducted involving interviews with pediatrics residents, pediatricians and educators, and a focus group with residents. Interviews and the focus group were transcribed and reviewed for themes using qualitative content analysis.
Results
The principal objective of SH was found to be diagnosis rather than advocacy. Although all participants expressed opinions about socioeconomic conditions’ vital influence on child health, most reported limited use of SH. When asked about social needs screening with SH, most participants opposed with various reasons, primarily time concerns and doubts about the necessity for each child. Lack of time was reported as the leading barrier to SH by participants. Other barriers were identified as lack of structured SH education, problems regarding referrals and interdisciplinary work, and the biomedical health approach which defines the physician’s role within the physical health domain.
Conclusions for Practice
To achieve an advocacy-based SH practice, the biomedical health approach should be questioned. Action is needed to implement a social determinants of health approach and equity focus to health policies and to medical and residency education.
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Availability of data and material
Quotes from participants are provided in Table 3 to support analyzed data. Otherwise whole transcripts are not available for sharing in order to maintain confidentiality.
Code availability
Not applicable.
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Acknowledgements
We are grateful to the physicians who participated in this study for their contributions. We thank Engin Fırat, MSW (Hacettepe University, Ankara) for his help during data collection process. We also thank Meta van de Heuvel, MD, PhD (The Hospital for Sick Children, Toronto), Assoc. Prof. İlknur Yüksel Kaptanoğlu (Institute of Population Studies, Ankara) and team members at Ankara University School of Medicine, Department of Pediatrics, Developmental-Behavioral Pediatrics Division for their critical review and invaluable comments on the manuscript.
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The study was conceived and designed by MÇK and SSY. MÇK collected the data. MÇK and SSY analyzed the data. The paper was drafted by MÇK; both authors read and approved the final manuscript.
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This study was approved by the Ethics Committee of Hacettepe University (35853172/433_254).
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Kanatlı, M.Ç., Yalcin, S.S. Social Determinants Screening with Social History: Pediatrician and Resident Perspectives from a Middle-Income Country. Matern Child Health J 25, 1426–1436 (2021). https://doi.org/10.1007/s10995-021-03191-7
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DOI: https://doi.org/10.1007/s10995-021-03191-7