Frequency and nature of discussing social influences on health in urban safety-net clinics: A qualitative analysis

Objective: Chronic social isolation is a risk factor for all-cause mortality and disease progression, but is not routinely screened for in clinical settings. This study analyzed provider-patient communication patterns about social influences during primary care encounters, to identify opportunities to screen for objective or perceived social isolation. Methods: Content analysis was conducted on transcripts of 97 audiotaped, English-speaking patient encounters with 27 primary care providers at 3 safety-net primary care centers in New York City. Conversations were first coded for specific social isolation screening, then more broadly to quantify and qualify how social influences were discussed in relation to health. Results: Transcripts included no explicit examples of social isolation screening. Social influences on health were discussed meaningfully in only 28 % of transcripts, compared to medication adherence (93 %) and diet (64 %). Patients initiated conversations about social influences on health twice as often as providers, however providers did not acknowledge 67% of these prompts. Conclusion: Social influences on health, including social isolation, were uncommonly discussed in this sample of primary care visits. When social influences were discussed meaningfully, providers utilized relationship-centered communication strategies. Practice implications: Strategic conversations about social influences, even when brief and informal, can effectively screen patients for social isolation.