Photo Caption: Kristen Ray (left), senior author and associate professor of pediatrics, and Maya Ragavan, associate professor of pediatrics, both School of Medicine.
In pediatric offices, screenings for health-related social needs (HRSN), the nonmedical factors in a person’s life that influence overall health and well-being, are standard. Unmet social needs, like access to food, housing and financial security, are associated with worse health outcomes and are more prevalent in families with marginalized or multiply marginalized identities or experiences.
Health care providers use these screenings to connect families with resources like food assistance programs or transportation services. But some families may not always answer.
Researchers from the University of Pittsburgh School of Medicine analyzed screening responses from 54 pediatric practices. They found that, while HRSN screenings generally have high completion rates, response rates tend to be lower among sociodemographic groups that are more likely to have unmet HRSN.
“What we wanted to understand was who’s indicating that they don’t want to answer these questions in some way or another,” said Kristin Ray, senior author and associate professor of pediatrics, School of Medicine. “What do we need to learn from people who are making the active choice not to respond? If we’re only offering resources to those indicating that they have a need, we might not be meeting all the needs of the families we see. Is there a way we can interpret that nonresponse to guide action that meet family needs while still respecting the family decision not to respond?”
The study’s findings also highlighted the importance of primary care to serve as a trusted and safe place for families to engage in these conversations. Noting that approximately 16% of children in the United States live below the poverty threshold, according to the U.S. Census Bureau, the researchers said that discussing HRSN in primary care settings is essential for identifying the root causes of many health concerns.
"Bringing this work into primary care is essential,” said Maya Ragavan, associate professor of pediatrics, School of Medicine. “It may help us recognize that a child losing weight might not be a medical issue, but a sign of something like food insecurity. And then we can support the family and connect them to resources.”
Ragavan added that understanding family needs and questionnaire responses may have broader impact, like garnering support and resources for different organizations and programs that doctors refer families to.
“Health care systems must invest not only in screening but also in supporting the services these patients and their families can rely on,” Ragavan said.
The paper, “Non-response to Health-Related Social Needs Screening Items within Pediatric Primary Care,” was published in the journal Pediatrics on June 25, 2025.