Addressing Social Determinants of Health Service Gaps in Chinese American Caregivers During the COVID-19 Pandemic

Abstract

Highlights: What are the main findings? Caregiver and provider perspectives are both needed to understand how patients navigate addressing social determinants of health for their children and families. Patient cultural values and beliefs are integral to understanding how they contribute to patient behaviors and when designing interventions to address social determinants of health. What are the implications of the main findings? Adaptations in health services settings need to consider cultural diversity and language concordance among Chinese American immigrant populations based on their region of origin. Structural limitations in health services workflow (e.g., reduced staff, digital tools not in the patient’s primary language) may inhibit caregivers’ ability to address social determinants of health needs efficiently. Background/Objectives: This study aims to understand gaps and strategies in Chinese Americans’ utilization of SDOH services in the pediatric primary care context in Sunset Park, Brooklyn, from a patient–provider partnership perspective. Methods: The study was guided by an integrated Patient–Provider Partnership, Engagement, and Collaboration (PEC) framework that influenced patient–provider interaction during the provision of SDOH services. A qualitative study design was applied, and eight quality improvement interviews with healthcare providers were conducted to understand the existing community and health service system context. Six in-depth interviews were conducted with Mandarin-speaking Chinese American caregivers. Interviews were transcribed and coded in Mandarin and then translated into English. Results: Consistent with the PEC framework, we identified cognitive, affective, and communication gaps from both the patient and provider. Caregivers reported unaddressed needs in food, financial security, and mental health. Providers identified gaps in patient workflow, staffing, and the intake form process. Conclusions: Addressing social determinants of health among Chinese American immigrant populations is crucial for mitigating poor health outcomes in children and families. Multi-level community-engaged strategies are needed to alleviate the challenges facing this community. Recommendations for future research should consider the importance of language and cultural affinity, digital intake forms translated into the patient’s language, and regular on-site staffing during SDOH screenings.