Clinical intervention directed at social risks does not increase experiences of discrimination

Image of doctor talking about medical results to a patient
Providing resources that help address social risks can help not only the families who come into the clinic but also the friends, neighbors and family members with whom they frequently share information.

A growing recognition of the health impact of social risks – such as food insecurity and homelessness – has prompted researchers, healthcare providers and policymakers to consider ways to address these risk factors as part of holistic clinical care. However, some healthcare providers worry the same interventions designed to help patients and families with social risks might also make them feel singled out or like they are otherwise stigmatized.

Now, new results of a rigorous study from the University of Chicago Medicine published October 2023 in JAMA Pediatrics suggest well-designed interventions that address social risks can be provided to parents of hospitalized children without increasing self-reported experiences of discrimination.

The researchers said they hope these new findings will have the potential to remove a roadblock that has been holding back the field of social care research.

“What encouraged us to conduct this study is the combination of data from other studies showing that addressing social risks in clinical care can improve health and wellness, and patients and their families are amenable to receiving these kinds of interventions. However, studies also find clinicians consistently express concerns about compromising satisfaction and engendering feelings of discrimination when addressing social risks in clinical practice,” said Nathaniel Glasser, MD, an internist, pediatrician and health researcher at UChicago Medicine and lead author of the paper.

In the study, caregivers of pediatric patients were randomized to receive either usual care or usual care plus CommunityRx: a low-intensity, universally-delivered program that involves providing personalized information about local resources that help address social risks, such as food insecurity or transportation difficulties. After children were discharged from inpatient units, their parents filled out standardized surveys designed to assess their satisfaction with medical care and whether or not they experienced discrimination of any kind, such as being treated with less courtesy than others, during their child’s most recent hospital stay.

The researchers were able to conclude that CommunityRx did not increase experiences of discrimination, although some caregivers did report experiencing at least one form of discrimination during a hospital visit.

The team emphasized that discrimination in healthcare settings is a pervasive and well-documented issue that must be addressed, but clarified that this particular study focused on addressing social risks with root causes that lie outside the clinical setting, but to do so without making families feel stigmatized.

“Our intervention was not specifically designed to reduce experiences of discrimination that might happen during a child’s hospitalization; it was designed to reduce social risks families had when their child was admitted to the hospital,” said senior author