"Why Do They Want to Know?": A Qualitative Assessment of Caregiver Perspectives on Social Drivers of Health Screening in Pediatric Primary Care.

OBJECTIVE: Despite strong evidence that social factors have a large influence on child health, systematic screening for social needs is not performed universally in pediatric primary care. This is due to multiple barriers, including concerns about acceptability to families. This study sought to assess family acceptability of social needs screening in pediatric primary care. METHODS: Eight semi-structured focus groups were performed with English and Spanish-speaking caregivers of pediatric patients from a diverse academic medical center. Focus groups explored the acceptability of social domains including housing, education, finances, food access, and safety. Focus group transcripts were qualitatively analyzed to identify themes. RESULTS: Four salient themes emerged: 1) the acceptability of social determinants of health screening questions was tied to participants' understanding of the connection between the topic and child health, 2) families preferred a warm handoff to community services, 3) families feared child protective services intervention as a result of sharing unmet social needs, and 4) positive provider rapport was an important factor in choosing to share social needs. CONCLUSIONS: Pediatric primary care providers should feel comfortable implementing social needs screening when they can clearly explain the connection to child health. They should become knowledgeable about organizations and partners within their communities and feel empowered to connect patients to these resources.

Awareness of obesity and diabetes: a survey of a subset of British male drivers.

UNLABELLED: Behavior modification necessary to tackle obesity and type 2 diabetes mellitus (T2DM) requires individual awareness of the existing problem. OBJECTIVES: This study aimed to assess body weight perception, awareness of the relation between adiposity and T2DM, and the relation between adiposity and weight loss attempts. METHODS: Male drivers were recruited randomly from motorway service stations between May and July 2007, completed a questionnaire and had body mass index (BMI), waist circumference (WC), and body composition. RESULTS: Participants included 266 men, median age 52 years, and BMI 28.25 kg/m2. Obesity prevalence was 46% based on BMI and 73% based on WC. Participants underestimated their WC (94.3 ± 10.2 vs. 102.9 ± 11.41 cm, estimated vs. actual, p < .001). Of participants with normal BMI, 18% thought they were overweight, whereas 26% of overweight thought they were "just right" and 19% of obese recognized their obesity. Based on WC, 30% of participants with normal WC thought they were obese and 9% of obese realized they were obese. Only 25% and 42% of participants recognized that T2DM is associated with large waist and obesity, respectively. A total of 81% of overweight and 62% of obese participants (based on BMI) believed that they were not at increased risk of T2DM. Self-perception of adiposity weakly predicted weight loss attempts (λ = 0.28, p = .008). CONCLUSION: Male drivers significantly underestimate their adiposity and risk of T2DM. Further public education regarding obesity, its associated health risks, and the benefits of weight loss is needed.

A sociotechnical method for designing work systems.

The paper describes a new method for allocating work between and among humans and machines. The method consists of a series of stages, which cover how the overall work system should be organized and designed; how tasks within the work system should be allocated (human-human allocations); and how tasks involving the use of technology should be allocated (human-machine allocations). The method makes use of a series of decision criteria that allow end users to consider a range of factors relevant to function allocation, including aspects of job, organizational, and technological design. The method is described in detail using an example drawn from a workshop involving the redesign of a naval command and control (C2) subsystem. We also report preliminary details of the evaluation of the method, based on the views of participants at the workshop. A final section outlines the contribution of the work in terms of current theoretical developments within the domain of function allocation. The method has been applied to the domain of naval C2 systems; however, it is also designed for generic use within function allocation and sociotechnical work systems.