Healthcare systems are investing more in addressing social determinants of health (SDoH) to improve patient outcomes, yet gaps exist in linking clinical and community-based health resources. We sought to understand 1) how individuals communicate with their healthcare providers about SDoH, and 2) the types of community-based health resources people use to inform our design of a digital tool linking patients in a safety-net delivery system (SFHN) to resources in their neighborhoods.

Materials & Methods

Using participant observation, in-depth interviews, and participant-led neighborhood tours, we recruited and interviewed SFHN primary care patients (n=10) and community leaders (n=11) working in these patients’ neighborhoods.

We entered location-based data into the Streetwyze platform and analyzed the interview, tour, and observational data through deductive and inductive coding with ATLAS.ti 8. Codebook and major themes were established through consensus meetings.

Results

Patient participants were 67% female, 44% Black, half college graduates, and on average 65 years old. We interviewed community leaders serving the Mission (n=4), Tenderloin (3), Bayview-Hunters Point (1), Ingleside (1), and San Francisco broadly (2). Primary concerns that emerged included food insecurity, psychosocial needs, lack of spirituality-focused spaces, and feeling unwelcome at resource locations. One patient referred to their closest grocery store as “the store that you have to pay twice the amount for your basic items, your veggies.” The need to build upon existing trusting relationships between patients and healthcare providers and to strengthen ties between community-based organizations and healthcare settings were also key findings.

Discussion and Conclusions

Diverse patients are interested in sharing information about their neighborhood health resources through digital tools, but tools must reflect the types of belonging and wellbeing resources that matter to them. New tools should harness existing linkages between patients and community-based organizations as well as between patients and healthcare providers (physicians, nurses, and social workers) to generate trust in a new online resource.