The Paradoxes of Social Care: Reframing Apparent Conflicts.

Abstract

Social care-health care that aims to understand and address patients' social needs-is increasingly recognized as a strategy for reducing disparities. However, social care literature is characterized by numerous conflicts. Paradox, the coexistence of seemingly contradictory yet simultaneously true positions, can serve as a useful lens for examining these tensions. This study aimed to identify key paradoxes in the social care literature to illuminate the resources, mindset, and approaches required for effective social care. A sub-analysis was conducted of a systematic review on facilitators and barriers to social care in adult primary care. Investigators reviewed articles iteratively to identify apparent contradictions. Findings were grouped in paradox themes, and approaches for reconciliation were explored. Of 153 full-text studies in the systematic review, 82 addressed potential paradoxes. We identified 12 recurring paradoxes and 3 overarching reconciliation strategies: de-emphasizing the ideal in favor of meaningful action, tailoring implementation approaches, and contextualizing to localized contexts. This review identifies 12 paradoxes representing conflicting social care stances. Framing these conflicts as paradoxes enables more nuanced strategies for advancing research, practice, and policy.