Registered Nurses’ Perspectives on Documenting Social Determinants of Health in Electronic Health Records: A Qualitative Descriptive Study in Saudi Arabia

Abstract

Background/Objectives: Social determinants of health (SDOH) shape health outcomes, but their documentation in electronic health records (EHRs) remains inconsistent. Nurses capture social information during routine assessment, yet their perspectives on SDOH documentation are little studied outside North American and European settings. This study explored registered nurses’ perspectives on, and perceived barriers to, SDOH documentation in EHRs in Saudi Arabia. Methods: A qualitative descriptive study was conducted with 19 registered nurses purposively recruited with maximum variation from five governmental and private facilities in Saudi Arabia. Semi-structured interviews (35 to 75 min; mean 52 min) were conducted in Arabic or English between August and November 2025 and analyzed using reflexive thematic analysis in NVivo 14. Reporting follows the COREQ 32-item checklist. Results: Four themes were constructed: (1) system design and interoperability, with social history fields that were hard to locate, rigid response options, and limited data transfer across settings; (2) time as a competing resource, with social documentation deprioritized relative to medical documentation; (3) knowledge gaps and training needs, including uncertainty about what constitutes SDOH and about documentation protocols; and (4) from documentation to action, marked by a gap between recording social needs and acting on them. Conclusions: Participants valued SDOH documentation but described technological, temporal, educational, and organizational constraints. These barriers parallel those reported internationally, but in this setting, the pathway from documentation to action extends beyond the health system. Findings indicate a need for EHR design that places social data within clinical workflow, explicit protocols, targeted training, and referral pathways linking identified needs to services.

The authors' abstract, as published at the source. Healthcare, 2026 · DOI ↗