“It Made Me Feel like Things Are Starting to Change in Society:” A Qualitative Study to Foster Positive Patient Experiences during Phone-Based Social Needs Interventions
Abstract
:1. Introduction
2. Materials and Methods
2.1. Qualitative Approach
2.2. Context, Setting, and Intervention
2.3. Sampling Strategy
2.4. Ethical Issues Pertaining to Human Subjects
2.5. Recruitment and Data Collection
2.6. Data Processing and Analysis
3. Results
“Some people will take that as a straight up scam, like you’re trying to track them or some shit, you know what I mean?”<25-year-old White male (a)
“I’m very inquisitive when it comes to that … At first [I ask], ‘Where are you calling me from? Why are you calling me?’ Not just anyone is going to be helping a person. Sometimes they just do it to grab your information.” (“Yo soy muy preguntona para eso … Al principio [yo digo], ‘¿De dónde me llamas? ¿Por qué me llamas?’ … No cualquiera va a estar ayudando a una persona. A veces nomás hacen por agarrar información.”)45 to 54 year-old Hispanic female
“There are people out there that need help but don’t wanna be a bother … People my age and older, you don’t take handouts, that’s embarrassing.”45 to 54-year-old White female
“[She] didn’t want things to come down to her, like, because I’m applying for assistance then they would come and look at her, like, ‘Why aren’t you giving more money or why aren’t you doing something?’ … I think [there was a concern around something like Department of Human Services (DHS) involvement] … With my daughter’s disability there was DHS involved quite a bit in our household … Maybe it would cause her more problems to admit to some of this stuff.”65 to 74-year-old White female
“It seemed like a scam at first, but because I know [the healthcare organization] and I’ve been going there since I was like two years old, I was like, ‘No, there’s no way it’s a scam.’”<25-year-old White female (a)
Interviewer: “To make sure I’m getting this right, being prepared for when the person answers to give a clear description of who you are and where you’re coming from?” Interviewee: “Right. You got it. A plus.”65 to 74-year-old Black male
“She mentioned there was going to be some personal questions and I didn’t have to answer if I didn’t want to … I appreciated that a lot.”<25-year-old White female (b)
“I mean, I don’t want to be hassled if I tell them that everything is good … If I’m not in a good place, I’ll ask them. I don’t want to be pressured or hassled.”45 to 54-year-old Black male
“It’s pretty straightforward … We all know good customer service. Be nice to people. Treat others how you’d want to be treated.”35 to 44-year-old Black male
“The tone of voice she maintained the whole time was also really helpful … Just maintaining maybe a soft, it doesn’t always have to be soft, but just like a calming [voice] … It’s very stereotypical, but it does work.”<25-year-old Hispanic female (a)
Interviewer: “How did you feel during the call?” Interviewee: “Supported.” Interviewer: “Supported. Was that because of the questions they were asking you or because of the tone of their voice or both?” Interviewee: “Because of both things.” (Entrevistadora: “¿Cómo se sintió durante esta llamada?” Entrevistada: “Apoyada.” Entrevistadora: “Apoyada. ¿Es por las preguntas que le hicieron o por el tono de voz o ambas? Entrevistada: “Por ambas.”)55 to 64-year-old Hispanic female
“She wasn’t very kind, too. Just quick and short … The tone in her voice, it seemed like she was in a big hurry … I had the feeling she didn’t have her morning coffee … There was just no life and no concern, no personal interest in what she was saying.”55 to 64-year-old White female
“As long as I think it’s gonna help me and not hurt me, I’m willing to answer questions.”45 to 54-year-old American Indian or Alaska Native female
Interviewer: “Is it okay to ask [about social needs], even when help or resources cannot be guaranteed?” Interviewee: “It depends on the person. Look, there are times when, if they are going to help you, that’s fine! But if they are one of those people who doesn’t want to help, they will not explain it to you. Interviewer: “So, more like what are the intentions [of the person]?” Interviewee: “Yes.” (Entrevistadora: “¿Está bien que se hagan este tipo de preguntas, aun cuando no es posible garantizar la ayuda o los recursos?” Entrevistado: “Depende de la persona. Mira que hay veces que, si te van a ayudar, ¡está bien! Pero si son de esas personas que no quieren ayudar, no te van a explicar. Entrevistadora: “O sea, más bien ¿cómo son las intenciones?” Entrevistado: “Ajá.”)45 to 54-year-old Hispanic male
Interviewee: “It was just very helpful … One of those things where it’s like I point out a problem [and they say] ‘Oh, there’s an issue, let’s get that taken care of.’” … Interviewer: “It sounds like you appreciated that … she had an optimistic outlook on it, but she also explained that it couldn’t be guaranteed. Like, she tried to do both of those things?” Interviewee: “Exactly. That feels more honest because you can still be optimistic without knowing that there’s a guarantee.”<25-year-old White male (b)
“If you had gotten me, say, seven months ago … it would have been significantly more difficult because I was delusional … If [a person] is so far gone that they can’t actually answer the questions, [you] just need to contact them at a later date because it’s a day-to-day thing.”—35 to 44-year-old male (the participant did not respond to the questions about race or ethnicity)
“I think [the process to try to connect me with resources] was very easy and thoughtful … She gave me a choice to do it online or by mail … So, when I was able to get it through the mail, like I requested, I could use it for future reference if I ever needed it.”55 to 64-year-old Black female
Interviewee: “Oh yeah, [having someone walk me through the paperwork was helpful]. For people like me, I have a hard time with reading and things that are pretty basic … Interviewer: “Do you think that had you not had that help, you may have not applied for the bus passes, for example?” Interviewee: “Yeah, probably, because I’m just really anxious about stuff like that, especially in regards to paperwork and legal stuff, I would have been too afraid of doing it wrong.”<25-year-old Hispanic female (b)
“Well, I told him, ‘I live in [County A], so do you [have] anything in [County A]?’ But they gave me the [number for] [County B] … That’s the problem … I don’t need [County B].”45 to 54-year-old Asian male
“I told him over and over again, ‘I don’t need all of the other stuff, the dot coms and all that crap.’ … [The resources were sent] as texts on my phone, but there weren’t phone numbers on any of them, and I don’t have a computer, or a laptop, or [know] how to do that.”55 to 64-year-old Native Hawaiian or Other Pacific Islander female
“It’s giving so much hope and kindness … Because of COVID … because of my heart condition and health condition … I have to stay away from people, I don’t have the vaccine yet because of my heart and everything. So I’m not as social as I used to be. And some people, their lights go dim. And you guys are like the lighthouse on the beach, saying, ‘Here’s the light, I’m trying to shine it to you.’”45 to 54-year-old Multiracial female
“I was happy because it made me feel like things are starting to change in society … I really felt important and like things are starting to change.”25 to 34-year-old Hispanic female
“I don’t remember exactly, but when someone isn’t very nice to you, you would remember it … I think the person was nice. They were nice because of that, because I don’t really remember.” (“No recuerdo con exactitud, pero cuando alguien no es muy amable con uno, uno sí lo recuerda … Yo pienso que la persona fue amable. Fue amable por eso, [porque] no tengo mucho recuerdo.”)65 to 74-year-old Hispanic male
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Appendix A. Interview Guide
- How is your health status in general? Would you say it is very good, good, relatively good, bad, or very bad?
- How would you describe your health over the last six to twelve months?
- Do you remember that call?
- What do you remember about the questions?
- How did the interaction feel to you?
- Did the questions seem relevant to your health?
- Were you surprised to get questions about these topics from [clinical delivery site]?
- What do you think about healthcare organizations asking these types of questions, in general?
- Do you have recommendations about how to ask these questions? For example, do you have a preference for being asked these questions in person or over the phone?
- That is totally fine. The questions were about things that may affect your health, like food, housing, and access to transportation.
- What do you think about healthcare organizations asking these types of questions, in general?
- Do you have recommendations about how to ask these questions?
- Did anyone follow up with you about this? If so, what do you remember about that conversation? Probes, if needed: For example, how the conversation went, what the person asked, how you felt?
- If no one followed up, do you have thoughts about that?
- If your healthcare provider offered to help you identify resources for things like food and housing, do you think you would accept their support? Why or why not?
- Were you able to access any resources through the person who followed up with you or through your own outreach?
- If so, please share a bit about the resources you received. Did you receive the resource information through the mail or electronically?
- If not, do you have thoughts about that?
- Are you still facing any of the same problems you were experiencing before?
- Are you okay with healthcare organizations asking about these types of things, even if they are not able to resolve the problem?
- Do you have any recommendations for how to make community resource referrals smoother for patients?
- Have you tried to access community resources like these before? Why or why not?
- Are you okay with healthcare organizations asking about these types of things, even if they are not able to resolve the problem?
- Do you have any recommendations for how to make community resource referrals smoother for patients?
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Demographics | N (%) |
---|---|
Sex | |
Female | 20 (59%) |
Male | 14 (41%) |
“What is your race?” (Select all that apply) * | |
American Indian or Alaska Native | 2 (6%) |
Asian | 1 (3%) |
Black or African American | 5 (15%) |
Native Hawaiian or Other Pacific Islander | 1 (3%) |
White | 17 (50%) |
Other | 7 (21%) |
No Response | 3 (9%) |
“Are you Hispanic, Latino/a, or Spanish Origin?” | |
Yes | 10 (29%) |
Spanish Language Interview | |
Yes | 5 (15%) |
Age | |
<25 | 7 (21%) |
25–34 | 3 (9%) |
35–44 | 2 (6%) |
45–54 | 9 (26%) |
55–64 | 7 (21%) |
65–74 | 6 (18%) |
“What is your highest grade or year of school you completed?” | |
Never attended school or only kindergarten | 0 (0%) |
Grades 1–8 (Elementary) | 4 (12%) |
Grades 9–11 (Some High School) | 4 (12%) |
Grade 12 or GED (High School) | 11 (32%) |
College, 1–3 Years (Some College) | 11 (32%) |
College, 4 Years or more (College Graduate) | 4 (12%) |
HRSN | |
Type(s) * | |
Food | 27 (79%) |
Housing | 26 (76%) |
Transportation | 16 (47%) |
Utilities | 8 (24%) |
Interpersonal Safety | 3 (9%) |
Quantity | |
1 | 8 (24%) |
2 | 10 (29%) |
3 | 12 (35%) |
4 | 4 (12%) |
5 | 0 (0%) |
AHC Model Intervention & Interview Timing | |
Clinical Delivery Site | |
ED | 16 (47%) |
FQHC | 18 (53%) |
Months from AHC Model Intervention to Interview | |
1 | 2 (6%) |
2 | 18 (53%) |
3 | 9 (26%) |
4 | 2 (6%) |
5 | 3 (9%) |
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Share and Cite
Steeves-Reece, A.L.; Nicolaidis, C.; Richardson, D.M.; Frangie, M.; Gomez-Arboleda, K.; Barnes, C.; Kang, M.; Goldberg, B.; Lindner, S.R.; Davis, M.M. “It Made Me Feel like Things Are Starting to Change in Society:” A Qualitative Study to Foster Positive Patient Experiences during Phone-Based Social Needs Interventions. Int. J. Environ. Res. Public Health 2022, 19, 12668. https://doi.org/10.3390/ijerph191912668
Steeves-Reece AL, Nicolaidis C, Richardson DM, Frangie M, Gomez-Arboleda K, Barnes C, Kang M, Goldberg B, Lindner SR, Davis MM. “It Made Me Feel like Things Are Starting to Change in Society:” A Qualitative Study to Foster Positive Patient Experiences during Phone-Based Social Needs Interventions. International Journal of Environmental Research and Public Health. 2022; 19(19):12668. https://doi.org/10.3390/ijerph191912668
Chicago/Turabian StyleSteeves-Reece, Anna L., Christina Nicolaidis, Dawn M. Richardson, Melissa Frangie, Katherin Gomez-Arboleda, Chrystal Barnes, Minnie Kang, Bruce Goldberg, Stephan R. Lindner, and Melinda M. Davis. 2022. "“It Made Me Feel like Things Are Starting to Change in Society:” A Qualitative Study to Foster Positive Patient Experiences during Phone-Based Social Needs Interventions" International Journal of Environmental Research and Public Health 19, no. 19: 12668. https://doi.org/10.3390/ijerph191912668