Skip to main content

Thank you for visiting You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Approaches to addressing social determinants of health in the NICU: a mixed methods study



Examine current approaches to addressing social determinants of health (SDOH) in the NICU and perceived appropriateness of a standardized screening and referral process.

Study design

We performed a mixed methods study in two Massachusetts safety-net NICUs. We examined rates that unmet basic needs were assessed and identified among 601 families. We conducted focus groups with NICU staff to understand current methods to assess unmet basic needs and perceived appropriateness of a standardized SDOH screening and referral process.


Except employment (89%), other unmet basic needs were infrequently assessed (housing 38%, food/hunger 7%, childcare 3%, transportation 3%, utilities 0.2%). Staff believed: (1) processes to assess SDOH were not standardized and inconsistently performed/documented; (2) addressing SDOH was important; and (3) using a standardized screening and referral process would be feasible.


Current NICU assessment of SDOH is limited and use of a standardized screening and referral process could be useful.

This is a preview of subscription content, access via your institution

Access options

Buy this article

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others


  1. Social Determinants of Health. World Health Organization. (2020).

  2. Marmot M. Social determinants of health inequalities. Lancet. 2005;365:1099–104.

    Article  Google Scholar 

  3. Braveman P, Egerter S, Williams DR. The social determinants of health: coming of age. Annu Rev Public Health. 2011;32:381–98.

    Article  Google Scholar 

  4. Poverty and Child Health in the United States. Council on Community Pediatrics. Pediatrics. 2016;137:e20160339.

    Article  Google Scholar 

  5. Kaiser Family Foundation. A view from the states: key medicaid policy changes: results from a 50-State Mediciad Budget Survey for State Fiscal Years 2019 and 2020. (2020).

  6. Profit J, Gould JB, Bennett M, Goldstein BA, Draper D, Phibbs CS, et al. Racial/ethnic disparity in NICU quality of care delivery. Pediatrics. 2017;140:e20170918.

    Article  Google Scholar 

  7. Howell EA, Janevic T, Hebert PL, Egorova NN, Balbierz A, Zeitlin J. Differences in morbidity and mortality rates in Black, White, and Hispanic very preterm infants among New York City Hospitals. JAMA Pediatr. 2018;172:269–77.

    Article  Google Scholar 

  8. Janevic T, Zeitlin J, Auger N, Egorova NN, Hebert P, Balbierz A, et al. Association of race/ethnicity with very preterm neonatal morbidities. JAMA Pediatr. 2018;172:1061–9.

    Article  Google Scholar 

  9. Lewis TP, Andrews KG, Shenberger E, Betancourt TS, Fink G, Pereira S, et al. Caregiving can be costly: a qualitative study of barriers and facilitators to conducting kangaroo mother care in a US tertiary hospital neonatal intensive care unit. BMC Pregnancy Childbirth. 2019;19:227.

    Article  Google Scholar 

  10. Greene MM, Rossman B, Patra K, Kratovil A, Khan S, Meier PP. Maternal psychological distress and visitation to the neonatal intensive care unit. Acta Paediatr. 2015;104:e306–13.

    Article  Google Scholar 

  11. Parker MG, Sandel M, Frank D, Garg A. Unmet material needs among low-income families of US preterm infants. Philidelphia, PA: Pediatric Academic Societies; 2020.

  12. Ivankova NV, Creswell JW, Stick SL. Using mixed-methods sequential explanatory design: from theory to practice. Field Methods. 2006;18:3–20.

    Article  Google Scholar 

  13. Garg A, Toy S, Tripodis Y, Silverstein M, Freeman E. Addressing social determinants of health at well child care visits: a cluster RCT. Pediatrics. 2015;135:e296–304.

    Article  Google Scholar 

  14. Bernard RH. Research methods in anthropology: qualitative and quantitative approaches. Walnut Creek: Altamira Press; 2002.

    Google Scholar 

  15. DeNavas-Walt C, Proctor BD. Income and poverty in the United States: 2014. 2014. Accessed 21 Aug 2020.

  16. Sokol R, Austin A, Chandler C, Byrum E, Bousquette J, Lancaster C, et al. Screening children for social determinants of health: a systematic review. Pediatrics. 2019;144:e20191622.

    Article  Google Scholar 

  17. Vasan A, Kenyon CC, Palakshappa D. Differences in pediatric residents’ social needs screening practices across health care settings. Hosp Pediatr. 2020;10:443–6.

    Article  Google Scholar 

  18. Joseph RM, O’Shea TM, Allred EN, Heeren T, Kuban KK. Maternal educational status at birth, maternal educational advancement, and neurocognitive outcomes at age 10 years among children born extremely preterm. Pediatr Res. 2018;83:767–77.

    Article  Google Scholar 

  19. Linsell L, Malouf R, Morris J, Kurinczuk JJ, Marlow N. Prognostic factors for poor cognitive development in children born very preterm or with very low birth weight: a systematic review. JAMA Pediatr. 2015;169:1162–72.

    Article  Google Scholar 

  20. Beck AF, Edwards EM, Horbar JD, Howell EA, McCormick MC, Pursley DM. The color of health: how racism, segregation, and inequality affect the health and well-being of preterm infants and their families. Pediatr Res. 2020;87:227–34.

    Article  Google Scholar 

  21. Pursley DM, McCormick MC. Bending the arc for the extremely low gestational age newborn. Pediatr Res. 2018;83:751–3.

    Article  Google Scholar 

  22. Shapiro N, Wachtel EV, Bailey SM, Espiritu MM. Implicit physician biases in periviability counseling. J Pediatr. 2018;197:109–15 e101.

    Article  Google Scholar 

Download references


We acknowledge the NICU staff that participated in our focus groups and the families that are cared for at the BMC and UMass NICUs. We acknowledge Alyssa Fliter, Mikayla Gordon Wexler, Archana Kalyanasundaram, Jordi Negron, Stephanie Philip, Stephen Rogers, Lindsey Simoncini, and Heather White for their assistance with data collection. This work was supported by the National Institute of Minority Health and Health Disparities (R01MD007793; PI Garg).

Author information

Authors and Affiliations



MGP contributed to the conceptualization and design, analysis, and drafted and edited the manuscript. AG, LMR, and SK contributed to the conceptualization and design and edited the manuscript. AB and ESF contributed to acquisition of data, data analysis, and edited the manuscript. M-LD contributed to the conceptualization and design, analysis, and edited the manuscript. All authors approved the final manuscript.

Corresponding author

Correspondence to Margaret G. Parker.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Parker, M.G., Garg, A., Brochier, A. et al. Approaches to addressing social determinants of health in the NICU: a mixed methods study. J Perinatol 41, 1983–1991 (2021).

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:

This article is cited by


Quick links