Should we screen for poverty in primary care?

Gopal, Dipesh P; Beardon, Sarah; Caraher, Martin; Woodhead, Charlotte; Taylor, Stephanie J C

doi:10.3399/bjgp21x717317

Cited by 5 publications

(3 citation statements)

References 18 publications

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“…Therefore, to identify families experiencing multiple and interacting adversities who may benefit from social and practical support, it is important for practitioners to understand and assess family’s experiences of poverty. Parents within this study highlighted that issues surrounding poverty would need to be approached in a non-threatening way, yet poverty issues are not currently routinely asked in health-care appointments within the UK [ 75 ]. Due to the focus upon families in this study and from parents’ insights, there may be potential to pilot an initial assessment question around poverty within midwifery services for expectant parents and their families, to identify need for additional support.…”

Section: Discussionmentioning

confidence: 99%

“…A single question approach has been developed in Canada for primary-care practitioners, mainly using the question “Do you ever have difficulty making ends meet at the end of the month?” , which identifies patients that would benefit from accessing resources and benefits for which they are eligible [ 76 ]. However, this screening tool is not without some implementation barriers, including escalating high workload of practitioners, fear of awkwardness in consultations, and a fear of helplessness without an adequate intervention to help patients out of poverty [ 75 , 76 ]. Further research would need to address, pilot and test whether such an approach would be acceptable and feasible within midwife appointments with parents.…”

Section: Discussionmentioning

confidence: 99%

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Co-design workshops with families experiencing multiple and interacting adversities including parental mental health, substance use, domestic violence, and poverty: intervention principles and insights from mothers, fathers, and young people

Muir,

Kedzior,

Barrett

et al. 2024

Res Involv Engagem

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Background Clustering and co-occurring of family adversities, including mental health problems, substance use, domestic violence and abuse, as well as poverty can increase health and behavioural risks for children, which persist throughout the life course. Yet, interventions that acknowledge and account for the complex interactive nature of such risks are limited. This study aimed to develop intervention principles based on reflections from mothers, fathers, and young people who experience multiple and interacting adversities. These principles will show how family members perceive an intervention may bring about positive change and highlight key insights into design and delivery. Methods A series of six co-design workshops with mothers, fathers, and young people who experienced multiple and interacting adversities (n = 41) were iteratively conducted across two regions in England (London and North-East) by four researchers. Workshop content and co-design activities were informed by advisory groups. Data from facilitator notes and activities were analysed thematically, resulting in a set of intervention principles. Results The intervention principles highlighted that: (1) to reduce isolation and loneliness parents and young people wanted to be connected to services, resources, and peer support networks within their local community, particularly by a knowledgeable and friendly community worker; (2) to address feelings of being misunderstood, parents and young people wanted the development of specialised trauma informed training for practitioners and to have the space to build trusting, gradual, and non-stigmatising relationships with practitioners; and (3) to address the needs and strengths of individual family members, mothers, fathers, and young people wanted separate, tailored, and confidential support. Conclusions The current study has important implications for practice in supporting families that experience multiple and interacting adversities. The intervention principles from this study share common characteristics with other intervention models currently on offer in the United Kingdom, including social prescribing, but go beyond these to holistically consider the whole families’ needs, environments, and circumstances. There should be particular focus on the child’s as well as the mothers’ and fathers’ needs, independently of the family unit. Further refinement and piloting of the developing intervention are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Co-design workshops with families experiencing multiple and interacting adversities including parental mental health, substance use, domestic violence, and poverty: intervention principles and insights from mothers, fathers, and young people

Muir,

Kedzior,

Barrett

et al. 2024

Res Involv Engagem

View full text Add to dashboard Cite

show abstract

“…[21][22][23] Second, newly-detected patient social needs could lead to excessive medicalization and impose additional work on busy professionals. 24,25 Third, dealing with SDoH is rarely associated with financial rewards for primary care professionals, 24 except for some innovative approaches. 26,27 Fourth, there is little current evidence that clinicians can play effective roles in SDoH in primary care practice, 28,29 particularly in small practice settings.…”

Section: Introductionmentioning

confidence: 99%

Primary care physicians’ perceptions of social determinants of health recommendations: a qualitative study

et al. 2022

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BackgroundSeveral organizations have called for primary care professionals to address social determinants of health (SDoH) in clinical settings. For primary care physicians to fulfill their community health responsibilities, the implications of the SDoH recommendations need to be clarified.AimTo describe primary care physicians’ views about being asked to address SDoH in clinical settings, from both positive and negative perspectives.Design & settingA qualitative study in Japan. Twenty-one physicians were purposively recruited.MethodLove and breakup letter methodology was used to collect qualitative data that contained both positive and negative feelings. Participants wrote love and breakup letters about being asked to address SDoH in a clinical setting, then undertook an in-depth online interview. Data were analyzed via thematic analysis using the framework approach.ResultsThe following themes were identified: (i) primary care physicians take pride in being expected to address SDoH; (ii) primary care physicians rely on the recommendations as a partner, even in difficult situations; (iii) primary care physicians consider the recommendations to be bothersome, with unreasonable demands and challenges, especially when supportive surroundings are lacking; (iv) primary care physicians reconstruct the recommendations on the basis of their experience.ConclusionPrimary care physicians felt sympathy and antipathy toward recommendations asking them to address SDoH in their clinical practice. The recommendations were not followed literally, and contributed to physicians’ clinical mindlines. Professional organisations that plan to develop and publish recommendations about SDoH should consider how their recommendations might be perceived by their targets.

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Is it possible to identify populations experiencing material disadvantage in primary care? A feasibility study using the Clinical Practice Research Database

Davies,

Sinclair,

Kingston

et al. 2024

J Epidemiol Community Health

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BackgroundMaterial disadvantage is associated with poor health, but commonly available area-based metrics provide a poor proxy for it. We investigate if a measure of material disadvantage could be constructed from UK primary care electronic health records.MethodsUsing data from Clinical Practice Research Datalink Aurum (May 2022) linked to the 2019 English Index of Multiple Deprivation (IMD), we sought to (1) identify codes that signified material disadvantage, (2) aggregate these codes into a binary measure of material disadvantage and (3) compare the proportion of people with this binary measure against IMD quintiles for validation purposes.ResultsWe identified 491 codes related to benefits, employment, housing, income, environment, neglect, support services and transport. Participants with one or more of these codes were defined as being materially disadvantaged. Among 30,897,729 research-acceptable patients aged ≥18 with complete data, only 6.1% (n=1,894,225) were classified as disadvantaged using our binary measure, whereas 42.2% (n=13,038,085) belonged to the two most deprived IMD quintiles.ConclusionData in a major primary care research database do not currently contain a useful measure of individual-level material disadvantage. This represents an omission of one of the most important health determinants. Consideration should be given to creating codes for use by primary care practitioners.

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Should we screen for poverty in primary care?

Cited by 5 publications

References 18 publications

Co-design workshops with families experiencing multiple and interacting adversities including parental mental health, substance use, domestic violence, and poverty: intervention principles and insights from mothers, fathers, and young people

Co-design workshops with families experiencing multiple and interacting adversities including parental mental health, substance use, domestic violence, and poverty: intervention principles and insights from mothers, fathers, and young people

Primary care physicians’ perceptions of social determinants of health recommendations: a qualitative study

Is it possible to identify populations experiencing material disadvantage in primary care? A feasibility study using the Clinical Practice Research Database

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