**Background:** Screening for social determinants of health (SDoH) in maternity care is recommended by the American College of Obstetricians and Gynecologists, but implementation faces barriers including inconsistent screening, limited clinician awareness of resources, and patient concerns about privacy and discrimination. Human-centered design (HCD) offers an empathy-driven, stakeholder-engaged approach to address these challenges. This study aimed to use HCD methods to understand the explicit and tacit needs of birthing parents and healthcare team members around SDoH screening and referral in maternity care.
**Methods:** The study was conducted from December 2018 to January 2020 at a prenatal clinic of a university teaching hospital in the southeastern United States (IRB #18-2811, deemed exempt). Three iterative phases of qualitative research were employed. Phase 1: Two non-clinical researchers shadowed two obstetricians for four hours each (eight total hours), observing seven physician-patient interactions, four nurses, one social worker, and one financial advisor. Observations were recorded using an activities-environment-interactions-objects-users taxonomy. Phase 2: Fifteen semi-structured interviews were conducted with birthing parents (9 English-speaking, 6 Spanish-speaking; all over 18, had maternity care within the last 12 months, lived in the southeastern US). A focus group was held with 11 healthcare team members (clinic manager, pregnancy care manager, social worker, midwife, maternal fetal medicine physician, nurse). Phase 3: Three participatory workshops were held—two with birthing parents (11 English-speaking at a children's museum; 4 Spanish-speaking at a community center) and one with 10 healthcare team members at the clinic. Activities included maternity care experience mapping (using sticker-based timelines) and card sorting to prioritize informational and emotional needs. Thematic analysis was conducted on field notes, transcriptions, and artefacts, with dot-voting quantification to identify priorities.
**Key Results:** Phase 1 shadowing revealed complex patient-team interactions and multiple clinic resources (financial advising, social services, transportation, food pantry), but fragmented clinician awareness of these resources. Spanish-language materials were lower quality (greyscale, office-printed) and contained inaccurate translations. Phase 2 interviews identified two high-level themes: informational needs (e.g., why SDoH data are collected, how they are used, who sees them, potential consequences) and emotional needs (e.g., feeling respected, acknowledged, trusted, included in decision-making). The healthcare team focus group revealed clinicians wanted clarity on available resources, confidence that referrals would help patients, and transparency that administrators act on SDoH data. Phase 3 workshops: Birthing parents prioritized needs including knowing how SDoH information would be used, feeling respected, and avoiding discrimination. Spanish-speaking participants additionally emphasized language-concordant care and compassion, and reported instances of procedures performed without clear explanation or interpreter presence. Healthcare team members prioritized shared accountability, workflow integration, and administrative support. In the roles and responsibilities activity, most team members identified pregnancy care managers as central for connecting patients to resources, follow-up, and affirming strengths, while clinical leadership was seen as key for resource coordination.
**Clinical Implications:** The study demonstrates that HCD methods can surface distinct informational and emotional needs for both patients and providers around sensitive health data. Birthing parents require transparency about SDoH data use and assurance of non-discrimination, while healthcare teams need reliable resources, administrative support, and clear workflows. The iterative, multi-method approach—moving from observation to interviews to participatory workshops—enabled deep understanding of stakeholder priorities. These findings can inform the design of patient-centered SDoH screening and referral processes in maternity care and other healthcare contexts, with attention to language equity, bias training, and shared accountability.