Objective
The COVID-19 pandemic has exacerbated socioeconomic barriers to health among people seeking obstetrical and gynecologic care, including cisgender women and transgender patients. , Increased socioeconomic vulnerability in these populations is associated with alarmingly high rates of mental health problems observed during the pandemic. , The American College of Obstetricians and Gynecologists (ACOG) recommends that healthcare providers screen and refer for health-related socioeconomic risk factors (HRSRs) as a means to provide more effective care, improve individual health outcomes, and reduce population-level inequities in reproductive health. Previous studies have established the appropriateness of HRSR screening among primary care patients and caregivers of pediatric patients. To complement the ACOG recommendation, this study examined how obstetrical and gynecologic patients perceive HRSR screening and documentation.
Study Design
A cross-sectional convenience sample of patients was recruited from urban, academic obstetrical and gynecologic clinics between April 2019 and June 2019. Eligible participants were English- or Spanish-speaking patients aged ≥18 years and able to provide informed consent. Potential participants were approached in clinic waiting areas, provided with information about the study, and screened for eligibility if interested. Eligible participants completed a self-administered survey assessing sociodemographic characteristics, HRSR status, and attitudes toward HRSR screening and documentation in electronic health records (EHRs). All participants provided verbal confirmation of the informed consent process. The protocol was approved by the institutional review board. Descriptive statistics were used to summarize survey responses across all patients and stratified by HRSR status (no HRSR or ≥1 HRSR).
Results
Of the 133 patients who expressed interest when approached, 79 met eligibility criteria and were included in the sample. Moreover, 47% of patients reported ≥1 HRSR, including food insecurity (33%), housing instability (25%), transportation difficulties (22%), utilities difficulties (13%), and interpersonal violence (1%) ( Table ). The desire for assistance with HRSRs was endorsed by 90% of patients with utilities difficulties (n=9), 65% of patients with housing instability (n=13), and 73% of patients with food insecurity (n=19). Among all patients with ≥1 HRSR, 60% desired assistance with HRSRs (32% overall), 72% were comfortable with EHR documentation (66% overall), and 92% felt it was appropriate to assess for HRSRs in clinical settings (82% overall).
| Characteristics | Total (N=79) | |
|---|---|---|
| N | % | |
| Age (n=77) | ||
| 18–44 y | 64 | 83 |
| 45–64 y | 12 | 16 |
| ≥65 y | 1 | 1 |
| Gender | ||
| Cisgender woman | 78 | 99 |
| Transgender man | 1 | 1 |
| Race | ||
| Black | 48 | 62 |
| White | 22 | 28 |
| Other a | 8 | 10 |
| Education | ||
| Less than high school or high school | 20 | 25 |
| Greater than high school | 49 | 75 |
| Income (n=67) | ||
| ≤$25,000 | 26 | 39 |
| >$25,000 | 41 | 61 |
| HRSRs | ||
| Food insecurity | 26 | 33 |
| Transportation difficulties | 17 | 22 |
| Utilities difficulties | 10 | 13 |
| Housing instability | 20 | 25 |
| Interpersonal violence | 1 | 1 |
| Number of HRSRs | ||
| No HRSR | 42 | 53 |
| ≥1 HRSR | 37 | 47 |
| Desiring HRSR assistance | ||
| No | 54 | 68 |
| Yes | 65 | 32 |
| Appropriateness of HRSR screening | ||
| Inappropriate | 14 | 18 |
| Appropriate | 65 | 82 |
| Comfort with EHR documentation (n=77) | ||
| Uncomfortable | 26 | 34 |
| Comfortable | 51 | 66 |
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