Date of Award

January 2014

Document Type


Degree Name

Medical Doctor (MD)



First Advisor

Andrea Asnes

Subject Area(s)



Childhood psychosocial stressors are prevalent, impactful, and amenable to intervention, and the pediatric primary care setting provides an important opportunity to identify stressors. However, despite growing awareness of the importance of psychosocial stressors, pediatric primary care providers do not reliably obtain this information from families. In the absence of a detailed understanding of the parental and provider attitudes that may impede screening, attempts to improve screening practice have met with little success. To address this knowledge gap, we conducted two qualitative studies investigating key parental and provider attitudes related to screening for psychosocial stressors in the pediatric primary care setting. Data was collected via in-depth semi-structured interviews and analyzed using the constant comparative method to identify key emergent themes. Interviews with parents yielded the following five themes: (1) current state of psychosocial screening in pediatric primary care, (2) reasons for accepting or not accepting screening, (3) limitations on providers' ability to screen in an acceptable way, (4) consequences of discussing stressors with providers, and (5) conditions under which screening would be acceptable. Interviews with providers yielded six themes: (1) importance, utility, and difficulty of obtaining psychosocial information in the pediatric primary care setting, (2) ideal role of the pediatric primary care provider in obtaining psychosocial information, (3) barriers to and facilitators of obtaining psychosocial information, (4) current behaviors related to obtaining psychosocial information, (5) strategies for overcoming barriers, and (6) suggestions for improving practices. While the data highlighted the many challenges of implementing psychosocial screening in the pediatric primary care setting, they also yielded important information about several conditions that may prove necessary for implementation of effective screening: (1) favorable parent-provider relationship, (2) training to enhance provider competence and self- efficacy, (3) addressing expectations about provider role, (4) making provider interest and motives explicit, (5) time and reimbursement, and (6) access to resources.