Training in social determinants of health in primary care: does it change resident behavior?

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.