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.