{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T14:08:42Z","timestamp":1790690922336,"version":"4.1.0"},"reference-count":49,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Dermatol"],"published-print":{"date-parts":[[2023,12,1]]},"abstract":"Importance<\/jats:title>Providing person-centered dermatologic care includes consideration of social risk factors, such as housing instability and unreliable transportation, that may affect clinical management. Patients\u2019 perspectives on social risk screening and documentation in dermatology clinics have not yet been evaluated.<\/jats:p><\/jats:sec>Objective<\/jats:title>To understand patients\u2019 perspectives on social risk screening and documentation in a dermatology clinic.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This mixed-methods study used a survey and semistructured interviews and was conducted in a general dermatology clinic at a large urban public hospital. Patients at the clinic were eligible to complete the survey if they were 18 years or older; able to speak and read English, Spanish, or Cantonese; and comfortable using a computer tablet. Survey participants who preferred to use English were eligible for interviews. The survey included social risk screening questions, measures of acceptability, and questions on social risk factors associated with patient acceptability. Semistructured interviews were conducted to explore attitudes and beliefs about social risk screening and documentation. Survey and interview findings were integrated during data analysis through development of themes and joint display. Data were analyzed from December 2021 to April 2023.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>There were 2 outcome measures of acceptability: appropriateness of screening in a dermatology clinic and comfort with documentation of social risk in the electronic health record (EHR).<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 135 participants (including 73 males [54.1%]) answered both measures of acceptability in the survey. Of these participants, 116 (85.9%) reported that social risk screening in their dermatology clinic was very or somewhat appropriate and 85 (63.0%) reported being completely or somewhat comfortable with having their social risks documented in the EHR. Themes that were developed from surveys and interviews were the (1) role of interpersonal factors in willingness to disclose social risks, (2) implications of institutional trust for willingness to disclose and comfort with documentation, and (3) relevance of screening in a dermatology clinic.<\/jats:p><\/jats:sec>Conclusions and Relevance<\/jats:title>Results of this study showed that most participants found social risk screening to be appropriate in a dermatology clinic, although a smaller proportion of participants were comfortable with EHR documentation of their social risks. Optimizing patients\u2019 trust in their physicians and the medical system, while addressing privacy and discrimination concerns, may help facilitate disclosure of social risks.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamadermatol.2023.3887","type":"journal-article","created":{"date-parts":[[2023,10,25]],"date-time":"2023-10-25T15:33:41Z","timestamp":1698248021000},"page":"1346","source":"Crossref","is-referenced-by-count":7,"title":["Patient Perspectives on Social Risk Screening and Documentation in a Dermatology Clinic"],"prefix":"10.1001","volume":"159","author":[{"given":"Kamina","family":"Wilkerson","sequence":"first","affiliation":[{"name":"University of California, San Francisco School of Medicine, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emilia","family":"De Marchis","sequence":"additional","affiliation":[{"name":"Department of Family and Community Medicine, University of California, San Francisco School of Medicine, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nora","family":"Rudd","sequence":"additional","affiliation":[{"name":"University of California, San Francisco School of Medicine, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jazzmin C.","family":"Williams","sequence":"additional","affiliation":[{"name":"University of California, San Francisco School of Medicine, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matt","family":"Pantell","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of California, San Francisco School of Medicine, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara L.","family":"Ackerman","sequence":"additional","affiliation":[{"name":"Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erin H.","family":"Amerson","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco"},{"name":"Department of Dermatology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aileen Y.","family":"Chang","sequence":"additional","affiliation":[{"name":"Department of Dermatology, University of California, San Francisco School of Medicine, San Francisco"},{"name":"Department of Dermatology, Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"10","reference":[{"issue":"suppl 1","key":"doi230051r1","doi-asserted-by":"publisher","first-page":"S33","DOI":"10.1097\/PHH.0000000000000373","article-title":"Measurement of health disparities, health inequities, and social determinants of health to support the advancement of health equity.","volume":"22","author":"Penman-Aguilar","year":"2016","journal-title":"J Public Health Manag Pract"},{"issue":"1","key":"doi230051r2","doi-asserted-by":"publisher","first-page":"381","DOI":"10.1146\/publhealth.2011.32.issue-1","article-title":"The social determinants of health: coming of age.","volume":"32","author":"Braveman","year":"2011","journal-title":"Annu Rev Public Health"},{"issue":"2","key":"doi230051r5","doi-asserted-by":"publisher","first-page":"407","DOI":"10.1111\/milq.2019.97.issue-2","article-title":"Meanings and misunderstandings: a social determinants of health lexicon for health care systems.","volume":"97","author":"Alderwick","year":"2019","journal-title":"Milbank Q"},{"issue":"5","key":"doi230051r12","doi-asserted-by":"publisher","first-page":"976","DOI":"10.1007\/s10900-013-9681-1","article-title":"Traveling towards disease: transportation barriers to health care access.","volume":"38","author":"Syed","year":"2013","journal-title":"J Community Health"},{"issue":"6","key":"doi230051r13","doi-asserted-by":"publisher","first-page":"7438","DOI":"10.1002\/cam4.v12.6","article-title":"Melanoma awareness and prevention among Latinx and non-Latinx White adults in urban and rural California: a qualitative exploration.","volume":"12","author":"Mesia","year":"2023","journal-title":"Cancer Med"},{"issue":"1","key":"doi230051r14","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1016\/j.jaad.2022.04.023","article-title":"Prevalence and predictors of transportation barriers to health care among US adults with a history of skin cancer.","volume":"88","author":"Zheng","year":"2023","journal-title":"J Am Acad Dermatol"},{"issue":"6","key":"doi230051r15","doi-asserted-by":"publisher","first-page":"760","DOI":"10.1093\/bjd\/ljad040","article-title":"Association of homelessness and skin conditions: a Danish population-based cohort study.","volume":"188","author":"Nilsson","year":"2023","journal-title":"Br J Dermatol"},{"issue":"3","key":"doi230051r16","doi-asserted-by":"publisher","first-page":"107","DOI":"10.1097\/DER.0000000000000034","article-title":"Associations of childhood eczema severity: a US population-based study.","volume":"25","author":"Silverberg","year":"2014","journal-title":"Dermatitis"},{"issue":"9","key":"doi230051r17","doi-asserted-by":"publisher","first-page":"945","DOI":"10.1001\/jamadermatol.2020.0902","article-title":"Dermatologic care of persons experiencing homelessness: key concepts in an era of housing instability.","volume":"156","author":"Coates","year":"2020","journal-title":"JAMA Dermatol"},{"issue":"4","key":"doi230051r18","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1001\/jamadermatol.2021.5925","article-title":"How dermatologists can address the structural and social determinants of health\u2014from awareness to action.","volume":"158","author":"Williams","year":"2022","journal-title":"JAMA Dermatol"},{"issue":"3","key":"doi230051r19","doi-asserted-by":"publisher","first-page":"334","DOI":"10.1177\/1203475418803077","article-title":"African American patients with hidradenitis suppurativa have significant health care disparities: a retrospective study.","volume":"23","author":"Soliman","year":"2019","journal-title":"J Cutan Med Surg"},{"issue":"3","key":"doi230051r20","doi-asserted-by":"publisher","first-page":"560","DOI":"10.1016\/j.jaad.2022.10.004","article-title":"Disparities in melanoma-specific mortality by race\/ethnicity, socioeconomic status, and health care systems.","volume":"88","author":"Rosenthal","year":"2023","journal-title":"J Am Acad Dermatol"},{"issue":"2","key":"doi230051r21","doi-asserted-by":"publisher","first-page":"379","DOI":"10.1016\/j.jaad.2021.07.049","article-title":"Survival differences in acral lentiginous melanoma according to socioeconomic status and race.","volume":"86","author":"Yan","year":"2022","journal-title":"J Am Acad Dermatol"},{"issue":"11","key":"doi230051r22","doi-asserted-by":"publisher","first-page":"1758","DOI":"10.1111\/jgs.2006.54.issue-11","article-title":"Socioeconomic status and survival in older patients with melanoma.","volume":"54","author":"Reyes-Ortiz","year":"2006","journal-title":"J Am Geriatr Soc"},{"key":"doi230051r23","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.jdin.2020.10.010","article-title":"Use of primary care services among patients with chronic skin disease seen by dermatologists.","volume":"2","author":"Barbieri","year":"2020","journal-title":"JAAD Int"},{"issue":"4","key":"doi230051r25","doi-asserted-by":"publisher","first-page":"964","DOI":"10.5811\/westjem","article-title":"Patient and community organization perspectives on accessing social resources from the emergency department: a qualitative study.","volume":"21","author":"Samuels-Kalow","year":"2020","journal-title":"West J Emerg Med"},{"issue":"1","key":"doi230051r26","doi-asserted-by":"publisher","first-page":"101","DOI":"10.1007\/s10995-019-02785-6","article-title":"Food insecurity screening in pediatric clinical settings: a caregivers\u2019 perspective.","volume":"24","author":"Barnidge","year":"2020","journal-title":"Matern Child Health J"},{"issue":"1","key":"doi230051r27","doi-asserted-by":"publisher","first-page":"181","DOI":"10.1353\/hpu.2018.0012","article-title":"Successes, challenges, and considerations for integrating referral into food insecurity screening in pediatric settings.","volume":"29","author":"Knowles","year":"2018","journal-title":"J Health Care Poor Underserved"},{"key":"doi230051r28","doi-asserted-by":"publisher","first-page":"S25","DOI":"10.1016\/j.amepre.2019.07.010","article-title":"Part I: a quantitative study of social risk screening acceptability in patients and caregivers.","volume":"57","author":"De Marchis","year":"2019","journal-title":"Am J Prev Med"},{"issue":"2","key":"doi230051r29","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1016\/j.jadohealth.2013.02.024","article-title":"Youths\u2019 health-related social problems: concerns often overlooked during the medical visit.","volume":"53","author":"Hassan","year":"2013","journal-title":"J Adolesc Health"},{"issue":"6","key":"doi230051r30","doi-asserted-by":"publisher","first-page":"e1332","DOI":"10.1542\/peds.2006-1505","article-title":"Families\u2019 health-related social problems and missed referral opportunities.","volume":"119","author":"Fleegler","year":"2007","journal-title":"Pediatrics"},{"issue":"7","key":"doi230051r31","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1258\/jtt.2012.120214","article-title":"Assessing and referring adolescents\u2019 health-related social problems: qualitative evaluation of a novel web-based approach.","volume":"18","author":"Wylie","year":"2012","journal-title":"J Telemed Telecare"},{"key":"doi230051r32","doi-asserted-by":"publisher","first-page":"244","DOI":"10.1016\/j.jpeds.2018.09.004","article-title":"Screening for toxic stress risk factors at well-child visits: the Addressing Social Key Questions for Health Study.","volume":"205","author":"Selvaraj","year":"2019","journal-title":"J Pediatr"},{"issue":"5","key":"doi230051r33","doi-asserted-by":"publisher","first-page":"1389","DOI":"10.1007\/s11606-019-05588-1","article-title":"Patients\u2019 attitudes and perceptions regarding social needs screening and navigation: multi-site survey in a large integrated health system.","volume":"35","author":"Rogers","year":"2020","journal-title":"J Gen Intern Med"},{"issue":"2","key":"doi230051r34","doi-asserted-by":"publisher","first-page":"161","DOI":"10.1016\/j.acap.2015.06.002","article-title":"Caregiver opinion of in-hospital screening for unmet social needs by pediatric residents.","volume":"16","author":"Colvin","year":"2016","journal-title":"Acad Pediatr"},{"issue":"1","key":"doi230051r35","doi-asserted-by":"publisher","first-page":"32","DOI":"10.1177\/0009922808320602","article-title":"Screening for basic social needs at a medical home for low-income children.","volume":"48","author":"Garg","year":"2009","journal-title":"Clin Pediatr (Phila)"},{"issue":"6, pt 2","key":"doi230051r36","doi-asserted-by":"publisher","first-page":"2134","DOI":"10.1111\/hesr.2013.48.issue-6pt2","article-title":"Achieving integration in mixed methods designs-principles and practices.","volume":"48","author":"Fetters","year":"2013","journal-title":"Health Serv Res"},{"issue":"6","key":"doi230051r37","doi-asserted-by":"publisher","first-page":"554","DOI":"10.1370\/afm.1865","article-title":"Integrating quantitative and qualitative results in health science mixed methods research through joint displays.","volume":"13","author":"Guetterman","year":"2015","journal-title":"Ann Fam Med"},{"issue":"5","key":"doi230051r40","doi-asserted-by":"publisher","first-page":"e3075","DOI":"10.1111\/hsc.v30.5","article-title":"Implementing health-related social needs screening in western Colorado primary care practices: qualitative research to inform improved communication with patients.","volume":"30","author":"Broaddus-Shea","year":"2022","journal-title":"Health Soc Care Community"},{"issue":"3","key":"doi230051r41","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0282103","article-title":"Addressing non-medical health-related social needs through a community-based lifestyle intervention during the COVID-19 pandemic: the Black Impact Program.","volume":"18","author":"Joseph","year":"2023","journal-title":"PLoS One"},{"issue":"1","key":"doi230051r42","doi-asserted-by":"publisher","first-page":"1275","DOI":"10.1186\/s12913-022-08652-5","article-title":"Do patients want clinicians to ask about social needs and include this information in their medical record?","volume":"22","author":"Albert","year":"2022","journal-title":"BMC Health Serv Res"},{"issue":"11","key":"doi230051r43","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2022.39855","article-title":"Assessment of unmet health-related social needs among patients with mental illness enrolled in Medicare Advantage.","volume":"5","author":"Adepoju","year":"2022","journal-title":"JAMA Netw Open"},{"key":"doi230051r44","doi-asserted-by":"publisher","DOI":"10.3389\/fpubh.2021.674035","article-title":"Health related social needs among Chinese American primary care patients during the COVID-19 pandemic: implications for cancer screening and primary care.","volume":"9","author":"Tsui","year":"2021","journal-title":"Front Public Health"},{"key":"doi230051r45","doi-asserted-by":"publisher","first-page":"S38","DOI":"10.1016\/j.amepre.2019.07.016","article-title":"Part II: a qualitative study of social risk screening acceptability in patients and caregivers.","volume":"57","author":"Byhoff","year":"2019","journal-title":"Am J Prev Med"},{"issue":"4","key":"doi230051r46","doi-asserted-by":"publisher","first-page":"1893","DOI":"10.1007\/s11135-017-0574-8","article-title":"Saturation in qualitative research: exploring its conceptualization and operationalization.","volume":"52","author":"Saunders","year":"2018","journal-title":"Qual Quant"},{"issue":"2","key":"doi230051r47","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1191\/1478088706qp063oa","article-title":"Using thematic analysis in psychology.","volume":"3","author":"Braun","year":"2006","journal-title":"Qual Res Psychol"},{"issue":"12","key":"doi230051r48","first-page":"145","article-title":"An investigation of discrepancies between qualitative and quantitative findings in survey research.","volume":"15","author":"Diloreto","year":"2016","journal-title":"Int J Learn Teach Educ Res"},{"key":"doi230051r8","volume-title":"Integrating Social Care Into the Delivery of Health Care: Moving Upstream to Improve the Nation\u2019s Health","year":"2019"},{"key":"doi230051r49","volume-title":"SAMHSA\u2019s Concept of Trauma and Guidance for a Trauma-Informed Approach","author":"SAMHSA\u2019s Trauma and Justice Strategic Initiative","year":"2014"},{"key":"doi230051r3","unstructured":"Centers for Disease Control and Prevention. Social determinants of health. September 30, 2021. Accessed April 22, 2022. https:\/\/www.cdc.gov\/socialdeterminants\/index.htm"},{"key":"doi230051r4","unstructured":"Solar? O, Irwin? A. A conceptual framework for action on the social determinants of health. World Health Organization. 2010. Accessed April 23, 2022. https:\/\/www.who.int\/publications\/i\/item\/9789241500852"},{"key":"doi230051r6","unstructured":"Centers for Medicare and Medicaid Services. Accountable health communities model. Accessed April 19, 2022. https:\/\/innovation.cms.gov\/innovation-models\/ahcm"},{"key":"doi230051r7","unstructured":"American Medical Association. Expanding access to screening tools for social determinants of health\/social determinants of health in payment models H-160.896. Accessed May 2, 2022. https:\/\/policysearch.ama-assn.org\/policyfinder\/detail\/Expanding%20Access%20to%20Screening%20Tools%20for%20Social%20Determinants%20of%20Health%2FSocial%20Determinants%20of%20Health%20in%20Payment%20Models%20H-160.896?uri=%2FAMADoc%2FHOD.xml-H-160.896.xml"},{"key":"doi230051r9","unstructured":"American Medical Association, Council on Medical Service. Alternative payment models and vulnerable populations. 2019. Accessed May 2, 2022. https:\/\/www.ama-assn.org\/system\/files\/2019-07\/a19-cms-report-10.pdf"},{"key":"doi230051r10","unstructured":"Gottlieb? LM, DeSilvey? SC, Fichtenberg? C, Bernheim? S, Peltz? A. Developing national social care standards. Health Affairs Forefront. Accessed August 9, 2023. https:\/\/www.healthaffairs.org\/do\/10.1377\/forefront.20230221.857308\/full\/"},{"key":"doi230051r11","unstructured":"De Marchis? EH, Brown? E, Aceves? BA, . SCREEN report: state of the science on social screening in healthcare settings. SIREN. 2022. Accessed April 3, 2023. https:\/\/sirenetwork.ucsf.edu\/tools-resources\/resources\/screen-report-state-science-social-screening-healthcare-settings"},{"key":"doi230051r24","doi-asserted-by":"crossref","unstructured":"Hare? A, Honig? K, Cronholm? P, Shabazz-McKlaine? S, Morgan? A. Patient perspectives on technology-based approaches to social needs screening.? Am J Manag Care. 2023;29(1):e18-e23. doi:10.37765\/ajmc.2023.89309?","DOI":"10.37765\/ajmc.2023.89309"},{"key":"doi230051r38","unstructured":"Centers for Medicare & Medicaid Services. The accountable health communities health-related social needs screening tool. 2018. Accessed March 16, 2023. https:\/\/innovation.cms.gov\/files\/worksheets\/ahcm-screeningtool.pdf"},{"key":"doi230051r39","doi-asserted-by":"crossref","unstructured":"Billioux? A, Verlander? K, Anthony? S, Alley? D. Standardized screening for health-related social needs in clinical settings: the accountable health communities screening tool. NAM Perspectives. May 30, 2017. Accessed July 14, 2023. https:\/\/nam.edu\/standardized-screening-for-health-related-social-needs-in-clinical-settings-the-accountable-health-communities-screening-tool\/","DOI":"10.31478\/201705b"}],"container-title":["JAMA Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/jamanetwork.com\/journals\/jamadermatology\/articlepdf\/2811080\/jamadermatology_wilkerson_2023_oi_230051_1701809836.39435.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,12,20]],"date-time":"2023-12-20T16:04:13Z","timestamp":1703088253000},"score":1,"resource":{"primary":{"URL":"https:\/\/jamanetwork.com\/journals\/jamadermatology\/fullarticle\/2811080"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,1]]},"references-count":49,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2023,12,1]]}},"URL":"https:\/\/doi.org\/10.1001\/jamadermatol.2023.3887","relation":{},"ISSN":["2168-6068"],"issn-type":[{"value":"2168-6068","type":"print"}],"subject":[],"published":{"date-parts":[[2023,12,1]]}}}