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Lombardi BM, de Saxe Zerden L, Fraher E. Varying Estimates of Social Workers in the United States: Which Data Source to Use? Med Care Res Rev 2024; 81:408-416. [PMID: 38864259 PMCID: PMC11389054 DOI: 10.1177/10775587241257983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2024]
Abstract
Behavioral health needs continue rise in the United States and constitute a key driver of health care utilization, costs, and outcomes. Social workers provide a wide range of services across health, behavioral health, and community settings, and while this heterogeneity in practice benefits care delivery, it complicates health workforce analyses. This analysis compares five commonly used national data sources and details similarities and differences in their estimates of the number, type, and practice characteristics of social workers. The analysis suggests that estimates vary significantly between data sets ranging from 282,425 to 1,022,859 social workers; as well as yield different findings of types of social workers in the United States, depending on the data set used. These differences have the potential to shape how researchers and policy makers assess the adequacy of the social work workforce and identify solutions to address the nation's behavioral health and social care needs.
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Affiliation(s)
- Brianna M Lombardi
- School of Medicine, The University of North Carolina at Chapel Hill, USA
- Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC, USA
- School of Social Work, The University of North Carolina at Chapel Hill, USA
| | - Lisa de Saxe Zerden
- Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC, USA
- School of Social Work, The University of North Carolina at Chapel Hill, USA
| | - Erin Fraher
- School of Medicine, The University of North Carolina at Chapel Hill, USA
- Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC, USA
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Abiri A, Starks S, Leppke A, Woodbury V, McFarland M, Vohra-Khullar P, Becklenberg A. Incorporating Social Needs Screening in Simulation for Family Nurse Practitioner Students. J Nurs Educ 2024:1-4. [PMID: 39292717 DOI: 10.3928/01484834-20240521-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2024]
Abstract
BACKGROUND A pilot simulation was implemented at a private university school of nursing to provide an opportunity for family nurse practitioner (FNP) students to apply their knowledge of assessing and addressing social determinants of health (SDOH). METHOD The Social Needs Screening Tool (SNST), developed by the American Academy of Family Physicians, and SDOH content were incorporated into a tele-health simulation-based learning experience. Using Zoom [Zoom Video Communications, Inc.], students encountered a standardized patient who sought care for shoulder pain and shared concerns about transportation and finances. RESULTS Thirty-nine FNP students individually completed the simulation. Evaluation was conducted via an adapted Simulation Effectiveness Tool-Modified and written feedback to assess confidence and skills. Eighty-nine percent of students reported they felt more comfortable using the SNST following the simulation. CONCLUSION Incorporating SDOH content and the SNST within simulation-based learning is an effective learning activity to enhance FNP student confidence and skills in assessing and addressing SDOH. [J Nurs Educ. 2024;63(X):XXX-XXX.].
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Zuñiga J, Thurman W, West Ohueri C, Cho E, Chineyemba P, Martin CA, Mathews WC, Christopoulos K, Davy-Mendez T, García AA. Construction of a Theoretical Model of Chronic Disease Self-Management: Self-Management Within a Syndemic. ANS Adv Nurs Sci 2024:00012272-990000000-00095. [PMID: 39235280 DOI: 10.1097/ans.0000000000000526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
The purpose of this article is to describe a model of chronic disease self-management that incorporates the complexity of social and environmental interactions experienced by people who self-manage chronic conditions. This study combines quantitative data from a large national research cohort and qualitative interviews to test and refine a self-management model. The self-management within a syndemic model depicts the contextual, psychological, and social factors that predict self-management behaviors and clinical and long-term outcomes.
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Affiliation(s)
- Julie Zuñiga
- Author Affiliations: The University of Texas at Austin, Austin (Drs Zuñiga, Thurman, West Ohueri, Cho, and García and Ms Chineyemba); Regis College, Weston, Massachusetts (Dr Martin); University of California San Diego, San Diego (Dr Mathews); University of San Francisco, San Francisco, California (Dr Christopoulos); and University of North Carolina, Chapel Hill (Dr Davy-Mendez)
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Walker RJ, Williams JS, Linde S, Egede LE. Social Risk and Clinical Outcomes Among Adults With Type 2 Diabetes. JAMA Netw Open 2024; 7:e2425996. [PMID: 39207760 PMCID: PMC11362860 DOI: 10.1001/jamanetworkopen.2024.25996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 05/28/2024] [Indexed: 09/04/2024] Open
Abstract
Importance No clear process exists for categorizing social risks in a way that informs effective social risk screening and intervention development. Objective To investigate social risk profiles and associations of those profiles with clinical outcomes in adults with diabetes using latent profile analysis. Design, Setting, and Participants For this cross-sectional study, a latent profile analysis was conducted using data for adults with type 2 diabetes collected at 2 primary care clinics in the Southeastern US from 2013 to 2014. Data were analyzed from November to December 2023. Main Outcomes and Measures Participants completed validated questionnaires for 26 social risk factors within 5 domains of social determinants of health: socioeconomic, neighborhood, education, food, and social and community context. In addition, participants completed questions that assessed psychological risk and behavioral risk. A 3-step latent profile analysis was used to identify different subgroups within the sample. Profiles were then regressed on outcomes of hemoglobin A1c (HbA1c), blood pressure, and quality of life. Results A total of 615 participants (mean [SD] age, 61.3 [10.9] years; 379 men [61.6%]) were included. Five latent class profiles were identified. The lowest risk group had significantly higher mental health-related quality of life compared with a group with higher neighborhood risk (β, 1.11; 95% CI, 0.67 to 1.55). The second group had low economic risk but high neighborhood risk and served as the reference group. The third group had high economic and neighborhood risk and had significantly higher blood pressure (β, 8.08; 95% CI, 2.16 to 14.01) compared with the reference. The fourth group had high psychological and behavioral risks but low socioeconomic and neighborhood risks. This group had significantly higher HbA1c (β, 0.47; 95% CI, 0.01 to 0.92) and lower mental health-related quality of life (β, -1.83; 95% CI, -2.41 to -1.24) compared with the reference. The highest risk group indicated high risk in all domains, had significantly higher HbA1c (β, 1.07; 95% CI, 0.50 to 1.63), and had lower mental health-related quality of life (β, -2.15; 95% CI, -2.87 to -1.42) compared with the reference. Conclusions and Relevance These findings suggest that social risk profiles can be identified according to social, psychological, and behavioral risk domains and the health outcome of concern among adults with diabetes. Future work should consider the use of social risk profiles in intervention development and testing.
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Affiliation(s)
- Rebekah J. Walker
- Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
| | - Joni S. Williams
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee
- Center for Advancing Population Science, Medical College of Wisconsin, Milwaukee
| | - Sebastian Linde
- Department of Health Policy & Management, Texas A&M School of Public Health, College Station
| | - Leonard E. Egede
- Division of Population Health, Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York
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Roh S, Lee YS, Moon H, Steele JS, Warne DK, Lee JA. Cognitive Impairment and Social Determinants of Health Among Indigenous Women. THE GERONTOLOGIST 2024; 64:gnae072. [PMID: 38860660 PMCID: PMC11234291 DOI: 10.1093/geront/gnae072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Indexed: 06/12/2024] Open
Abstract
BACKGROUND AND OBJECTIVES Cognitive impairment and Alzheimer's disease and related dementias (ADRD) pose significant challenges for Indigenous populations, necessitating urgent research. Limited evidence suggests that high rates of ADRD among Indigenous peoples are associated with social determinants of health (SDOH), such as education, income, health literacy, religion, and social engagement. RESEARCH DESIGN AND METHODS Collaborating with a Northern Plains tribe, participants were recruited 123 self-identified Indigenous women aged 40-70 through a comprehensive recruitment strategy. Employing the SDOH framework, the research assessed cognitive impairment and Alzheimer's disease knowledge (ADK), utilizing the Ascertain Dementia 8 and Alzheimer's disease knowledge scales (ADK-30). The investigation examined the relationships between selected SDOH variables and cognitive impairment status. RESULTS More than half of the participants showed signs of cognitive impairment, which correlated with lower income and education levels. Increased knowledge about Alzheimer's disease, particularly in terms of treatment management and its life impact subscales, was associated with lower odds of cognitive impairment. Conversely, higher levels of depressive symptoms and participation in religious activities were linked to increased odds of cognitive impairment. DISCUSSION AND IMPLICATIONS The findings underscore the importance of culturally grounded tools and SDOH frameworks tailored to Indigenous contexts in addressing ADRD disparities. Future research should integrate historical and cultural factors to advance health equity within Indigenous communities, ultimately mitigating the impact of ADRD and promoting overall well-being.
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Affiliation(s)
- Soonhee Roh
- Department of Social Work, University of South Dakota-Sioux Falls, Sioux Falls, South Dakota, USA
| | - Yeon-Shim Lee
- School of Social Work, San Francisco State University, San Francisco, California, USA
| | - Heehyul Moon
- Raymond A. Kent School of Social Work, University of Louisville, Louisville, Kentucky, USA
| | - Joel S Steele
- School of Medicine & Health Sciences, University of North Dakota, Grand Forks, North Dakota, USA
| | - Donald K Warne
- Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Jung-Ah Lee
- Sue and Bill Gross School of Nursing, University of California, Irvine, California, USA
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Calloway EE, Coakley KE, Carpenter LR, Gargano T, Yaroch AL. Benefits of using both the Hunger Vital Sign and brief nutrition security screener in health-related social needs screening. Transl Behav Med 2024; 14:445-451. [PMID: 38954835 DOI: 10.1093/tbm/ibae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
Food security is a commonly screened for health-related social need at hospitals and community settings, and until recently, there were no tools to additionally screen for nutrition security. The purpose of this study was to assess the potential advantage of including a one-item brief nutrition security screener (BNSS) alongside the commonly used two-item Hunger Vital Sign (HVS) food security screener for identifying individuals with diet-related health risks. Cross-sectional survey data were collected from April to June 2021. Generalized linear mixed models were used to assess associations between screening status and dietary and health variables. Recruitment was done across five states (California, Florida, Maryland, North Carolina, and Washington) from community-based organizations. Participants (n = 435) were, on average, 44.7 years old (SD = 14.5), predominantly women (77%), and racially/ethnically diverse. In adjusted analyses, being in the food insecure and nutrition insecure group (but not the food insecure and nutrition secure or food secure and nutrition insecure groups) was associated with significantly increased odds for self-reported "fair" or "poor" general health [OR = 2.914 (95% CI = 1.521-5.581)], reporting at least one chronic condition [2.028 (1.024-4.018)], and "low" fruit and vegetable intake [2.421 (1.258-4.660)], compared with the food secure and nutrition secure group. These findings support using both the HVS and BNSS simultaneously in health-related social needs screening to identify participants at the highest risk for poor dietary and health outcomes and warrant further investigation into applying these screeners to clinical and community settings.
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Affiliation(s)
- Eric E Calloway
- The Center for Nutrition and Health Impact, Omaha, NE 68154, USA
| | - Kathryn E Coakley
- College of Population Health, University of New Mexico, Albuquerque, NM 87131, USA
| | - Leah R Carpenter
- The Center for Nutrition and Health Impact, Omaha, NE 68154, USA
| | - Tony Gargano
- The Center for Nutrition and Health Impact, Omaha, NE 68154, USA
| | - Amy L Yaroch
- The Center for Nutrition and Health Impact, Omaha, NE 68154, USA
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Haines E, Shelton RC, Foley K, Beidas RS, Dressler EV, Kittel CA, Chaiyachati KH, Fayanju OM, Birken SA, Blumenthal D, Rendle KA. Addressing social needs in oncology care: another research-to-practice gap. JNCI Cancer Spectr 2024; 8:pkae032. [PMID: 38676669 PMCID: PMC11104529 DOI: 10.1093/jncics/pkae032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
Social determinants of health and unmet social needs are directly related to cancer outcomes, from diagnosis to survivorship. If identified, unmet social needs can be addressed in oncology care by changing care plans in collaboration with patients' preferences and accounting for clinical practice guidelines (eg, reducing the frequency of appointments, switching treatment modalities) and connecting patients to resources within healthcare organizations (eg, social work support, patient navigation) and with community organizations (eg, food banks, housing assistance programs). Screening for social needs is the first step to identifying those who need additional support and is increasingly recognized as a necessary component of high-quality cancer care delivery. Despite evidence about the relationship between social needs and cancer outcomes and the abundance of screening tools, the implementation of social needs screening remains a challenge, and little is known regarding the adoption, reach, and sustainability of social needs screening in routine clinical practice. We present data on the adoption and implementation of social needs screening at two large academic cancer centers and discuss three challenges associated with implementing evidence-based social needs screening in clinical practice: (1) identifying an optimal approach for administering social needs screening in oncology care, (2) adequately addressing identified unmet needs with resources and support, and (3) coordinating social needs screening between oncology and primary care.
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Affiliation(s)
- Emily Haines
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rachel C Shelton
- Mailman School of Public Health, Department of Sociomedical Sciences, Columbia University, New York, NY, USA
| | - Kristie Foley
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Rinad S Beidas
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily V Dressler
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Carol A Kittel
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Krisda H Chaiyachati
- Perelman School of Medicine, Department of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Oluwadamilola M Fayanju
- Perelman School of Medicine, Department of Surgery, University of Pennsylvania, Philadelphia, PA, USA
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Philadelphia, PA, USA
| | - Sarah A Birken
- Department of Implementation Science, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Daniel Blumenthal
- Perelman School of Medicine, Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Katharine A Rendle
- Penn Center for Cancer Care Innovation, Abramson Cancer Center, Philadelphia, PA, USA
- Perelman School of Medicine, Department of Family Medicine and Community Health, University of Pennsylvania, Philadelphia, PA, USA
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Lombardi BM, de Saxe Zerden L, Prentice A, Downs SG. Social workers roles in achieving health quality metrics in primary care: a quality improvement case study. SOCIAL WORK IN HEALTH CARE 2024; 63:102-116. [PMID: 38111375 DOI: 10.1080/00981389.2023.2292542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 11/13/2023] [Indexed: 12/20/2023]
Abstract
Value-based payment models may improve patient health by targeting quality of care over quantity of health services. Social workers in primary care settings are well-positioned to improve the quality of health services for vulnerable patients by identifying and addressing patients' social determinants of health. This case study describes a Plan Do Study Act (PDSA) quality improvement approach implemented and refined by social workers to proactively address clinical quality gaps in one family medicine practice. The studied program - entitled Gap Closure Day - was led by a team of social workers to improve quality outcomes of patients. Findings highlight the important roles of social workers as members of health care teams to improve the quality of health services and address health equity.
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Affiliation(s)
- Brianna M Lombardi
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA
- Cecil G. Sheps Center for Health Services Research, Chapel Hill, NC, USA
| | - Lisa de Saxe Zerden
- University of North Carolina at Chapel Hill School of Social Work, Chapel Hill, North Carolina, USA
| | - Amy Prentice
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Sarah Grace Downs
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA
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Msw RET, Warner L, Shy BD, Manikowski C, Roosevelt GE. A descriptive study of screening and navigation on health-related social needs in a safety-net hospital emergency department. Am J Emerg Med 2023; 74:65-72. [PMID: 37778164 DOI: 10.1016/j.ajem.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Health-related social needs (HRSN) have been associated with worse clinical outcomes, increased Emergency Department (ED) utilization and higher healthcare costs. The ED is uniquely positioned to bring HRSN screening to the bedside and develop effective interventions. We evaluated whether navigation services for high-risk patients led to the resolution of HRSN. METHODS Navigators screened a convenience sample of patients for HRSN with the Accountable Health Communities Screening Tool from October 2019 to January 2022. Patients with HRSN were considered high-risk if they had at least two ED visits in the previous 12 months. Patients who were high-risk were eligible for navigation including community referrals and one-on-one close follow-up. The HRSN status (resolved, in-progress, unable to resolve) was queried from the Centers for Medicare and Medicaid database. The state hospital association provided data on ED visits and inpatient hospitalizations within 6 months of the screening visit. RESULTS Of 185,470 ED visits, HRSN screening occurred in 4050 (2%). HRSN were self-reported in 48% (1944) of patient visits, with 71% of these (1379) considered high-risk. 15% of high-risk patients with HRSN opted out of navigation. Food insecurity was the most identified HRSN (35%) followed by housing instability (26%), transportation needs (24%) and utility assistance (15%). Food insecurity was the most resolved HRSN (39%, in-progress 32%) followed by utility assistance (37%, in-progress 26%), transportation needs (35%, in-progress 35%) and housing instability (28%, in-progress 36%). High-risk visits in which the patient or guardian accepted navigation were less likely to be associated with an ED visit within 6 months of the screening visit (51%) compared to high-risk patients in which the patient or guardian opted out of navigation (61%, p < 0.001), but there was no difference in inpatient hospitalizations (p = 0.427). CONCLUSIONS During the study period, one-third of HRSN were successfully resolved with another one-third in-progress. Navigation in high-risk patients was associated with fewer subsequent ED visits.
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Affiliation(s)
- Ruth Ellen Tubbs Msw
- Previous/Main: Denver Regional Council of Governments, 1001 17(th) Street, Suite 700, Denver, CO 80202, USA
| | - Leah Warner
- Department of Emergency Medicine, Denver Health, University of Colorado School of Medicine, 601 Broadway, Denver, CO 80204, USA.
| | - Bradley D Shy
- Department of Emergency Medicine, Denver Health, University of Colorado School of Medicine, 601 Broadway, Denver, CO 80204, USA.
| | - Christine Manikowski
- Previous/Main: Denver Regional Council of Governments, 1001 17(th) Street, Suite 700, Denver, CO 80202, USA
| | - Genie E Roosevelt
- Department of Emergency Medicine, Denver Health, University of Colorado School of Medicine, 601 Broadway, Denver, CO 80204, USA.
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Adekoya I, Delahunty-Pike A, Howse D, Kosowan L, Seshie Z, Abaga E, Cooney J, Robinson M, Senior D, Zsager A, Aubrey-Bassler K, Irwin M, Jackson L, Katz A, Marshall E, Muhajarine N, Neudorf C, Pinto AD. Screening for poverty and related social determinants to improve knowledge of and links to resources (SPARK): development and cognitive testing of a tool for primary care. BMC PRIMARY CARE 2023; 24:247. [PMID: 38007462 PMCID: PMC10675961 DOI: 10.1186/s12875-023-02173-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Accepted: 10/06/2023] [Indexed: 11/27/2023]
Abstract
BACKGROUND Healthcare organizations are increasingly exploring ways to address the social determinants of health. Accurate data on social determinants is essential to identify opportunities for action to improve health outcomes, to identify patterns of inequity, and to help evaluate the impact of interventions. The objective of this study was to refine a standardized tool for the collection of social determinants data through cognitive testing. METHODS An initial set of questions on social determinants for use in healthcare settings was developed by a collaboration of hospitals and a local public health organization in Toronto, Canada during 2011-2012. Subsequent research on how patients interpreted the questions, and how they performed in primary care and other settings led to revisions. We administered these questions and conducted in-depth cognitive interviews with all the participants, who were from Saskatchewan, Manitoba, Ontario, and Newfoundland and Labrador. Cognitive interviewing was used, with participants invited to verbalize thoughts and feelings as they read the questions. Interview notes were grouped thematically, and high frequency themes were addressed. RESULTS Three hundred and seventy-five individuals responded to the study advertisements and 195 ultimately participated in the study. Although all interviews were conducted in English, participants were diverse. For many, the value of this information being collected in typical healthcare settings was unclear, and hence, we included descriptors for each question. In general, the questions were understood, but participants highlighted a number of ways the questions could be changed to be even clearer and more inclusive. For example, more response options were added to the question of sexual orientation and the "making ends meet" question was completely reworded in light of challenges to understand the informal phrasing cited by English as a Second Language (ESL) users of the tool. CONCLUSION In this work we have refined an initial set of 16 sociodemographic and social needs questions into a simple yet comprehensive 18-question tool. The changes were largely related to wording, rather than content. These questions require validation against accepted, standardized tools. Further work is required to enable community data governance, and to ensure implementation of the tool as well as the use of its data is successful in a range of organizations.
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Affiliation(s)
- Itunuoluwa Adekoya
- Upstream Lab, Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | | | - Dana Howse
- Primary Healthcare Research Unit, Memorial University of Newfoundland and Labrador, St. John's, Canada
| | - Leanne Kosowan
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Zita Seshie
- Department of Community Health & Epidemiology, University of Saskatchewan, Saskatoon, Canada
| | - Eunice Abaga
- Upstream Lab, Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Jane Cooney
- Upstream Lab, Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Marjeiry Robinson
- Upstream Lab, Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Dorothy Senior
- Upstream Lab, Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Alexander Zsager
- Upstream Lab, Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Kris Aubrey-Bassler
- Primary Healthcare Research Unit, Memorial University of Newfoundland and Labrador, St. John's, Canada
- Faculty of Medicine, Memorial University, St. John's, Canada
| | - Mandi Irwin
- Department of Family Medicine, Dalhousie University, Halifax, Canada
| | - Lois Jackson
- School of Health and Human Performance, Dalhousie University, Halifax, Canada
| | - Alan Katz
- Department of Family Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
- Manitoba Centre for Health Policy, University of Manitoba, Winnipeg, Canada
| | - Emily Marshall
- Department of Family Medicine, Dalhousie University, Halifax, Canada
| | - Nazeem Muhajarine
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Canada
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Cory Neudorf
- Saskatchewan Population Health and Evaluation Research Unit, Saskatoon, Canada
- College of Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Andrew D Pinto
- Upstream Lab, Li Ka Shing Knowledge Institute, MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
- Department of Family and Community Medicine, St. Michael's Hospital, Toronto, Canada.
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
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Wang D, Tankumpuan T, Utriyaprasit K, Davidson PM. Reliability and Validity of the Chinese Version of the Perceived Access to Health Care Questionnaire. JOURNAL OF NURSING AND MIDWIFERY SCIENCES 2023; 10. [DOI: 10.5812/jnms-139931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2024] Open
Abstract
Background: The Perceived Access to Health Care Questionnaire (PAHCQ) is the latest specific tool used to evaluate patients' accessibility to the health system. Objectives: This study aimed to translate and verify the item analysis, test-retest reliability, content validity, construct validity, and known-group analysis of the PAHCQ in a Chinese population. Methods: This study developed and validated the Chinese version of the PAHCQ. The translation of the PAHCQ was based on the back translation of Brislin. This study used simple random sampling to include a sample of 591 subjects in Jiangsu, China. Item analysis was used to verify the questionnaire's expert consistency and cultural adaptation. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate the effectiveness of the structure. Internal consistency was determined using Cronbach's α, and item validity and test-retest reliability were analyzed. Results: The CFA results indicated that the modified PAHCQ is reasonable. The Cronbach alpha value of the PAHCQ was 0.96. The correlation coefficients for the six domains in test-retest reliability were between 0.67 and 0.91. Comparison of the total PAHCQ scores among participants in different groups of age, gender, maternal status, education level, per capita monthly income, and CCI levels showed statistically significant differences (P < 0.05). Conclusions: The Chinese version of the PAHCQ is a feasible, effective, and reliable tool that can be used to evaluate Chinese patients' perception of health system accessibility.
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. Circulation 2023; 148:e9-e119. [PMID: 37471501 DOI: 10.1161/cir.0000000000001168] [Citation(s) in RCA: 240] [Impact Index Per Article: 240.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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Affiliation(s)
| | | | | | | | | | | | - Dave L Dixon
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | - William F Fearon
- Society for Cardiovascular Angiography and Interventions representative
| | | | | | | | - Dhaval Kolte
- AHA/ACC Joint Committee on Clinical Data Standards
| | | | | | | | - Daniel B Mark
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
| | | | | | | | - Mariann R Piano
- Former Joint Committee on Clinical Practice Guideline member; current member during the writing effort
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13
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Virani SS, Newby LK, Arnold SV, Bittner V, Brewer LC, Demeter SH, Dixon DL, Fearon WF, Hess B, Johnson HM, Kazi DS, Kolte D, Kumbhani DJ, LoFaso J, Mahtta D, Mark DB, Minissian M, Navar AM, Patel AR, Piano MR, Rodriguez F, Talbot AW, Taqueti VR, Thomas RJ, van Diepen S, Wiggins B, Williams MS. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease: A Report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2023; 82:833-955. [PMID: 37480922 DOI: 10.1016/j.jacc.2023.04.003] [Citation(s) in RCA: 89] [Impact Index Per Article: 89.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/24/2023]
Abstract
AIM The "2023 AHA/ACC/ACCP/ASPC/NLA/PCNA Guideline for the Management of Patients With Chronic Coronary Disease" provides an update to and consolidates new evidence since the "2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease" and the corresponding "2014 ACC/AHA/AATS/PCNA/SCAI/STS Focused Update of the Guideline for the Diagnosis and Management of Patients With Stable Ischemic Heart Disease." METHODS A comprehensive literature search was conducted from September 2021 to May 2022. Clinical studies, systematic reviews and meta-analyses, and other evidence conducted on human participants were identified that were published in English from MEDLINE (through PubMed), EMBASE, the Cochrane Library, Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. STRUCTURE This guideline provides an evidenced-based and patient-centered approach to management of patients with chronic coronary disease, considering social determinants of health and incorporating the principles of shared decision-making and team-based care. Relevant topics include general approaches to treatment decisions, guideline-directed management and therapy to reduce symptoms and future cardiovascular events, decision-making pertaining to revascularization in patients with chronic coronary disease, recommendations for management in special populations, patient follow-up and monitoring, evidence gaps, and areas in need of future research. Where applicable, and based on availability of cost-effectiveness data, cost-value recommendations are also provided for clinicians. Many recommendations from previously published guidelines have been updated with new evidence, and new recommendations have been created when supported by published data.
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14
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Sturm ET, Thomas ML, Sares AG, Dave S, Baron D, Compton MT, Palmer BW, Jester DJ, Jeste DV. Review of Major Social Determinants of Health in Schizophrenia-Spectrum Disorders: II. Assessments. Schizophr Bull 2023; 49:851-866. [PMID: 37022911 PMCID: PMC10318889 DOI: 10.1093/schbul/sbad024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
BACKGROUND AND AIMS Social determinants of health (SDoHs) impact the development and course of schizophrenia-spectrum psychotic disorders (SSPDs). Yet, we found no published scholarly reviews of psychometric properties and pragmatic utility of SDoH assessments among people with SSPDs. We aim to review those aspects of SDoH assessments. STUDY DESIGN PsychInfo, PubMed, and Google Scholar databases were examined to obtain data on reliability, validity, administration process, strengths, and limitations of the measures for SDoHs identified in a paired scoping review. STUDY RESULTS SDoHs were assessed using different approaches including self-reports, interviews, rating scales, and review of public databases. Of the major SDoHs, early-life adversities, social disconnection, racism, social fragmentation, and food insecurity had measures with satisfactory psychometric properties. Internal consistency reliabilities-evaluated in the general population for 13 measures of early-life adversities, social disconnection, racism, social fragmentation, and food insecurity-ranged from poor to excellent (0.68-0.96). The number of items varied from 1 to more than 100 and administration time ranged from less than 5 minutes to over an hour. Measures of urbanicity, low socioeconomic status, immigration status, homelessness/housing instability, and incarceration were based on public records or targeted sampling. CONCLUSIONS Although the reported assessments of SDoHs show promise, there is a need to develop and test brief but validated screening measures suitable for clinical application. Novel assessment tools, including objective assessments at individual and community levels utilizing new technology, and sophisticated psychometric evaluations for reliability, validity, and sensitivity to change with effective interventions are recommended, and suggestions for training curricula are offered.
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Affiliation(s)
- Emily T Sturm
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Michael L Thomas
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | - Anastasia G Sares
- Department of Psychology, Colorado State University, Fort Collins, CO, USA
| | | | - David Baron
- Western University of Health Sciences, CA, USA
| | - Michael T Compton
- Department of Psychiatry, Columbia University Vagelos College of Physicians & Surgeons, and New York State Psychiatric Institute, New York, NY, USA
| | - Barton W Palmer
- Department of Psychiatry, University of California, San Diego, CA, USA
- Veterans Affairs San Diego Healthcare System, Mental Illness Research, Education, and Clinical Center, San Diego, CA, USA
| | - Dylan J Jester
- Department of Psychiatry, University of California, San Diego, CA, USA
| | - Dilip V Jeste
- Department of Psychiatry, University of California, San Diego, CA, USA (Retired)
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15
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Saragosa M, Singh H, Steele Gray C, Tang T, Orchanian-Cheff A, Nelson MLA. Use of eco-mapping in health services research: a scoping review protocol. BMJ Open 2023; 13:e072588. [PMID: 37236661 DOI: 10.1136/bmjopen-2023-072588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION People with complex health and social needs often require care from different providers and services. Identifying their existing sources of support could assist with addressing potential gaps and opportunities for enhanced service delivery. Eco-mapping is an approach used to visually capture people's social relationships and their linkages to the larger social systems. As it is an emerging and promising approach in the health services field, a scoping review on eco-mapping is warranted. This scoping review aims to synthesise the empirical literature that has focused on the application of eco-mapping by describing characteristics, populations, methodological approaches and other features of eco-mapping in health services research. METHODS AND ANALYSIS This scoping review will follow the Joanna Briggs Institute methodology. From the date of database construction to 16 January 2023, the following databases in English will be searched: Ovid Medline, Ovid Embase, CINAHL Ultimate (EBSCOhost), Emcare (Ovid), Cochrane Central Register of Controlled Trials (Ovid) and Cochrane Database of Systematic Reviews (Ovid) Study/Source of Evidence selection. The inclusion criteria consist of empirical literature that uses eco-mapping or a related tool in the context of health services research. Two researchers will independently screen references against inclusion and exclusion criteria using Covidence software. Once screened, the data will be extracted and organised according to the following research questions: (1) What research questions and phenomena of interest do researchers address when using eco-mapping? (2) What are the characteristics of studies that use eco-mapping in health services research? (3) What are the methodological considerations for eco-mapping in health services research? ETHICS AND DISSEMINATION This scoping review does not require ethical approval. The findings will be disseminated through publications, conference presentations and stakeholder meetings. TRIAL REGISTRATION NUMBER https://doi.org/10.17605/OSF.IO/GAWYN.
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Affiliation(s)
- Marianne Saragosa
- Science of Care Institute, Lunenfeld-Tanenbaum Research Institute, Science Health System, Toronto, Ontario, Canada
| | - Hardeep Singh
- Occupational Science and Occupational Therapy Department, University of Toronto, Toronto, Ontario, Canada
| | - Carolyn Steele Gray
- Science of Care Institute, Lunenfeld-Tanenbaum Research Institute, Science Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Terence Tang
- Institute for Better Health and General Internal Medicine, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Ani Orchanian-Cheff
- Library and Information Services, University Health Network, Toronto, Ontario, Canada
| | - Michelle L A Nelson
- Science of Care Institute, Lunenfeld-Tanenbaum Research Institute, Science Health System, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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16
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Canas M, Fonseca R, Diaz L, Filippis AD, Afzal H, Aldana JA, Machica C, Leonard J, Liang SY, Bochicchio K, Bochicchio GV. Open Mandible and Maxillary Fractures Associated with Higher Risk of Infection in Victims of Assault. Surg Infect (Larchmt) 2023; 24:376-381. [PMID: 36799978 PMCID: PMC10398716 DOI: 10.1089/sur.2022.295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Background: Victims of assault (VOA) often present with fractures of the mandible and maxilla. They represent a complex challenge because of possible compromise of the airway, and infection-related complications because of potential involvement of the oral cavity. We hypothesized that open mandible and maxillary fractures in VOA are associated with a higher rate of infection compared with non-VOA patients with open facial fractures. Patients and Methods: Patients admitted to our level 1 trauma center from 2005 to 2020 with a diagnosis of open mandible and maxillary fractures were included. Demographics, mechanisms of injury, fracture location, cultures, infectious complications, antibiotic treatments, and clinical outcomes were abstracted. Patients were stratified by their mechanism of injury into VOA or non-VOA and were compared using χ2 and Student t-test using SPSS (IBM Corp, Armonk, NY). Results: We identified 316 patients with open mandible and maxillary fractures. There were 198 patients categorized as being VOA, and 118 as non-VOA. Nineteen of 316 patients were diagnosed with infection related to the fracture (3.8% abscesses, 1.9% cellulitis, and 1.9% osteomyelitis). Although the Injury Severity Score (ISS) was higher in non-VOA patients (5.8 ± 2.6 vs. 4.9 ± 1.8; p < 0.013), most of the infections were in the VOA cohort (17/19; 89.5%; p < 0.013). Conclusions: Open fractures of the mandible and maxilla in VOA are associated with a greater risk of infection compared with non-victims of assault. The relation between VOA and poor SDH has been studied recently; clinicians should be aware of this association and implement special considerations and appropriate follow-up visits to decrease the rate of infection in this currently expanding population.
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Affiliation(s)
- Melissa Canas
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Ricardo Fonseca
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Leonardo Diaz
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Alejandro De Filippis
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Hussain Afzal
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jose A. Aldana
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Chris Machica
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jennifer Leonard
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Stephen Y. Liang
- Divisions of Emergency Medicine and Infectious Diseases, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Kelly Bochicchio
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Grant V. Bochicchio
- Acute and Critical Care Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
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McGowan DA, Mather C, Stirling C. Use of Social Determinants of Health Screening among Primary Health Care Nurses of Developed Countries: An Integrative Review. NURSING REPORTS 2023; 13:194-213. [PMID: 36810271 PMCID: PMC9944459 DOI: 10.3390/nursrep13010020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/10/2023] Open
Abstract
The aims of the study are to evaluate and synthesise research that has investigated social determinants of health screening by primary healthcare nurses; how and when primary health care nurses perform social determinants of health screening; and implications for advancing nursing practice. Systematic searches in electronic databases identified fifteen published studies which met the inclusion criteria. Studies were synthesised using reflexive thematic analysis. This review found little evidence of primary health care nurses using standardised social determinants of health screening tools. Eleven subthemes were identified and collapsed into three main themes: organisation and health system supports are required to enable primary health care nurses; primary health care nurses are often reluctant to perform social determinants of health screening; and the importance of interpersonal relationships for social determinants of health screening. The social determinants of health screening practices of primary health care nurses are poorly defined and understood. Evidence suggests that primary health care nurses are not routinely using standardised screening tools or other objective methods. Recommendations are made for valuing therapeutic relationships, social determinants of health education and the promotion of screening by health systems and professional bodies. Overall, further research examining the best social determinant of health screening method is required.
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Affiliation(s)
- Deirdre A. McGowan
- School of Nursing, College of Health and Medicine, University of Tasmania, Glebe, TAS 7000, Australia
| | - Carey Mather
- Australian Institute of Health Services Management, College of Business and Economics, University of Tasmania, Launceston, TAS 7250, Australia
| | - Christine Stirling
- School of Nursing, College of Health and Medicine, University of Tasmania, Glebe, TAS 7000, Australia
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18
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Zvolensky MJ, Shepherd JM, Clausen BK, Garey L, Redmond BY, Heggeness LF, Bizier A. Perceived Racial/Ethnic Discrimination and Smoking Outcome Expectancies among Adult Latinx Smokers Living in the United States. Subst Use Misuse 2023; 58:528-535. [PMID: 36748119 PMCID: PMC10091509 DOI: 10.1080/10826084.2023.2177114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Background: Smoking-related health disparities are prevalent in the Latinx community in the United States (US). Although Social Determinants of Health (SDoH) are known to contribute to a myriad of health problems among the Latinx population, there is relatively limited work expressly aimed at elucidating SDoH among Latinx smokers. Perceived racial/ethnic discrimination is one SDoH construct that may be especially relevant to understanding smoking-related cognition for Latinx smokers in the US. Smoking outcome expectancies, reflecting beliefs about the consequences of smoking, are established cognitive processes that have been linked to the maintenance and relapse of smoking. The purpose of the present work is to investigate perceived racial/ethnic discrimination in relation to smoking outcome expectancies amongst Latinx smokers in the US. Method: Participants included 338 English-speaking Latinx adult daily cigarette smokers from the US (Mage = 35.5 years; SD = 8.65; age range 18-61; 37.3% female). Results: Results indicated that perceived racial/ethnic discrimination was related to greater levels of negative reinforcement, positive reinforcement, and appetite-weight control expectancies, but not negative consequences expectancies. Discussion: Overall, the current findings provide novel insight into the relationship between perceived racial/ethnic discrimination and smoking outcome expectancies amongst English-speaking Latinx cigarette users in the US.
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Affiliation(s)
- Michael J. Zvolensky
- Department of Psychology, University of Houston
- Department of Behavioral Science, The University of Texas MD Anderson Cancer Center
- HEALTH Institute, University of Houston
| | | | | | - Lorra Garey
- Department of Psychology, University of Houston
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19
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Oster C, Dawson S, Kernot J, Lawn S. Mental health outcome measures in the Australian context: what is the problem represented to be? BMC Psychiatry 2023; 23:24. [PMID: 36627588 PMCID: PMC9832818 DOI: 10.1186/s12888-022-04459-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 12/08/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND There is growing interest in the use of routine outcome measures (ROM) in mental health services worldwide. Australia has been at the forefront of introducing ROM in public mental health services, with the aim of improving services and consumer outcomes. METHODS An in-depth policy and document analysis was conducted using Carol Bacchi's 'What is the problem represented to be?' approach to critically analyse the use of ROM. This approach was used to identify and analyse the problem representations relating to the need for, and the choice of, outcome measures in Australian public mental health services, and the potential consequences of policy and practice. Data included in the analysis were seven policy documents, four reports on the introduction of outcome measures in Australia, the Australian Mental Health Outcomes and Classifications Network website, and the content of the outcome measures themselves. RESULTS Two dominant representations of the 'problem' were identified: 1) the 'problem' of mental health service quality and accountability, relating to the need for mental health outcome measures; and 2) the 'problem' of addressing deficits in biopsychosocial functioning of mental health consumers, which relates to the choice of outcome measures. Framing the 'problem' of mental health outcomes in these ways locates the problem within individual health providers, services, and consumers, ignoring the broader socioeconomic conditions underpinning mental health and effective service provision. CONCLUSIONS This critical analysis of the introduction and use of ROM in public mental health services in Australia highlights the need to consider the role of the social determinants of mental health, mental health service funding, and recovery-oriented care in ensuring services are meeting consumer needs and expectations. Broader governmental engagement is central to genuine change and opportunities.
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Affiliation(s)
- Candice Oster
- Present Address: Caring Futures Institute, College of Nursing & Health Sciences, Flinders University, GPO Box 2100, Bedford Park, Adelaide, 5001, South Australia.
| | - Suzanne Dawson
- Present Address: Caring Futures Institute, College of Nursing & Health Sciences, Flinders University, GPO Box 2100, Bedford Park, Adelaide, 5001, South Australia
- School of Allied health and Practice, University of Adelaide, Adelaide, 5005, South Australia
- Central Adelaide Local Health Network, Adelaide, South Australia
| | - Jocelyn Kernot
- Allied Health & Human Performance, University of South Australia, GPO Box 2471, Adelaide, 5001, South Australia
| | - Sharon Lawn
- Lived Experience Australia Ltd, PO Box 12, Oaklands Park, 5046, South Australia
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Bedford Park, Adelaide, 5001, South Australia
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20
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Brown J, Ahmed N, Biel M, Patchen L, Rethy J, Thomas A, Arem H. Considerations in implementation of social risk factor screening and referral in maternal and infant care in Washington, DC: A qualitative study. PLoS One 2023; 18:e0283815. [PMID: 37053233 PMCID: PMC10101493 DOI: 10.1371/journal.pone.0283815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 03/17/2023] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND The District of Columbia (DC) has striking disparities in maternal and infant outcomes comparing Black to White women and babies. Social determinants of health (SDoH) are widely recognized as a significant contributor to these disparities in health outcomes. Screening for social risk factors and referral for appropriate services is a critical step in addressing social needs and reducing outcome disparities. METHODS We conducted interviews among employees (n = 18) and patients (n = 9) across three diverse, urban clinics within a healthcare system and one community-based organization involved in a five-year initiative to reduce maternal and infant disparities in DC. Interviews were guided by the Consolidated Framework for Implementation Research to understand current processes and organizational factors that contributed to or impeded delivery of social risk factor screening and referral for indicated needs. RESULTS We found that current processes for social risk factor screening and referral differed between and within clinics depending on the patient population. Key facilitators of successful screening included a supportive organizational culture and adaptability of more patient-centered screening processes. Key barriers to delivery included high patient volume and limited electronic health record capabilities to record results and track the status of internal and community referrals. Areas identified for improvement included additional social risk factor assessment training for new providers, patient-centered approaches to screening, improved tracking processes, and facilitation of connections to social services within clinical settings. CONCLUSION Despite proliferation of social risk factor screeners and recognition of their importance within health care settings, few studies detail implementation processes for social risk factor screening and referrals. Future studies should test implementation strategies for screening and referral services to address identified barriers to implementation.
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Affiliation(s)
- Jason Brown
- Medstar Health Research Institute, Healthcare Delivery Research, Washington, DC, United States of America
| | - Naheed Ahmed
- Medstar Health Research Institute, Healthcare Delivery Research, Washington, DC, United States of America
| | - Matthew Biel
- Department of Psychiatry, Georgetown University School of Medicine, Washington, DC, United States of America
- Department of Psychiatry, MedStar Georgetown University Hospital, Washington, DC, United States of America
| | - Loral Patchen
- MedStar Washington Hospital Center, Women and Infant Services, Washington, DC, United States of America
- MedStar Washington Hospital Center, Obstetrics/Gynecology, Washington, DC, United States of America
| | - Janine Rethy
- Department of Pediatrics, MedStar Georgetown University Hospital, Washington, DC, United States of America
| | - Angela Thomas
- Medstar Health Research Institute, Healthcare Delivery Research, Washington, DC, United States of America
| | - Hannah Arem
- Medstar Health Research Institute, Healthcare Delivery Research, Washington, DC, United States of America
- Department of Oncology, Georgetown University School of Medicine, Washington, DC, United States of America
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21
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Giorgi EM, Drescher MJ, Winkelmann ZK, Eberman LE. Validation of a Script to Facilitate Social Determinant of Health Conversations with Adolescent Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192214810. [PMID: 36429530 PMCID: PMC9690555 DOI: 10.3390/ijerph192214810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 05/13/2023]
Abstract
Current social determinants of health (SDOH) tools exist to assess patient exposure; however, healthcare providers for the adolescent population are unsure of how to integrate SDOH knowledge into clinical practice. The purpose of this study was to validate a focused history script designed to facilitate SDOH conversations between clinicians and adolescents through the use of the Delphi method. Six individuals (1 clinician, 5 educators/researchers) participated as expert panelists. Panelists provided critical feedback on the script for rounds 1 and 2. For rounds 3-7, panelists received an electronic questionnaire asking them to indicate agreement on a 6-point Likert scale (1 = strongly disagree, 6 = strongly agree). We defined consensus as mean item agreement ≥ 5.0 and percent agreement ≥ 80%. In round 7, panelists rated overall script level of agreement. After seven rounds of feedback, the focused history script achieved content validity with 100% of panelists agreeing on the final 40-item script. A focused history script for the SDOH was content validated to aid conversations between healthcare providers and adolescent patients on factors that affect their life, school, and play. Addressing social determinants of health with adolescent patients will improve cultural proficiency and family-centered care delivered by school healthcare professionals.
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Affiliation(s)
- Emily M. Giorgi
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN 47803, USA
- Correspondence: ; Tel.: +1-916-822-1338
| | - Matthew J. Drescher
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN 47803, USA
| | - Zachary K. Winkelmann
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | - Lindsey E. Eberman
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN 47803, USA
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22
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Muirhead L, Echt KV, Alexis AM, Mirk A. Social Determinants of Health: Considerations for Care of Older Veterans. Nurs Clin North Am 2022; 57:329-345. [PMID: 35985723 DOI: 10.1016/j.cnur.2022.04.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
Social determinants of health (SDOH), the environments and circumstances in which people are born, grow, live, work and age, are potent drivers of health, health disparities, and health outcomes over the lifespan. Military service affords unique experiences, exposures, and social and health vulnerabilities which impact the life course and may alter health equity and health outcomes for older veterans. Identifying and addressing SDOH, inclusive of the military experience, allows person-centered, more equitable care to this vulnerable population. Nurses and other health professionals should be familiar with how to identify and address health-related social needs and implement interdiciplinary, team-based approaches to connect patients with resources and benefits specifically available to veterans.
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Affiliation(s)
- Lisa Muirhead
- Emory University, Nell Hodgson Woodruff School of Nursing, 1520 Clifton Road, Atlanta, GA 30322, USA.
| | - Katharina V Echt
- Veterans Affairs Birmingham/ Atlanta Geriatric Research, Education and Clinical Center (GRECC), Atlanta VA Health Care System, 3101 Clairmont Road Northeast, Brookhaven, GA 30329-1044, USA; Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Andrea M Alexis
- Atlanta VA Health Care System, Nursing Education, 1M-116A, 1670 Clairmont Road, Decatur, GA 30033, USA
| | - Anna Mirk
- Veterans Affairs Birmingham/ Atlanta Geriatric Research, Education and Clinical Center (GRECC), Atlanta VA Health Care System, 3101 Clairmont Road Northeast, Brookhaven, GA 30329-1044, USA; Division of Geriatrics and Gerontology, Department of Medicine, Emory University School of Medicine, Atlanta, GA, USA
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Informal Employment and Poor Mental Health in a Sample of 180,260 Workers from 13 Iberoamerican Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137883. [PMID: 35805540 PMCID: PMC9265366 DOI: 10.3390/ijerph19137883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 06/21/2022] [Accepted: 06/23/2022] [Indexed: 02/05/2023]
Abstract
The aim of this study is to estimate the association between employment conditions and mental health status in the working population of Iberoamerica. In this cross-sectional study, we pooled individual-level data from nationally representative surveys across 13 countries. A sample of 180,260 workers was analyzed. Informality was assessed by social security, health affiliation, or contract holding. Mental health was assessed using several instruments. We used Poisson regression models to estimate the contribution of informality to poor mental health by sex and country, adjusted by sociodemographic and work-related characteristics. Then, we performed a meta-analysis pooling of aggregate data using a random-effects inverse-variance model. Workers in informal employments showed a higher adjusted prevalence ratio (aPR) of poor mental health than those in formal employment in Peru (aPR men 1.5 [95% confidence intervals 1.16; 1.93]), Spain (aPR men 2.2 [1.01; 4.78]) and Mexico (aPR men 1.24 [1.04; 1.47]; women 1.39 [1.18; 1.64]). Overall estimates showed that workers in informal employment have a higher prevalence of poor mental health than formal workers, with it being 1.19 times higher (aPR 1.19 [1.02; 1.39]) among men, and 1.11 times higher prevalence among women (aPR 1.11 [1.00; 1.23]). Addressing informal employment could contribute to improving workers’ mental health.
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Gagnon K, Ortiz-Siberón Á, Patel ND, James R, Hawk M, Damian AJ, Beidas R. Identifying facilitators, barriers, and strategies to implement social determinants of health screening, referral, and follow-up in the US: a scoping review protocol. JBI Evid Synth 2022; 20:1568-1577. [PMID: 35184099 PMCID: PMC9385883 DOI: 10.11124/jbies-21-00161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVE This review will assess the literature exploring facilitators, barriers, and strategies for the implementation of social determinants of health and social needs screening, referral to community resources, and follow-up in clinical settings and clinical training curricula in the United States. INTRODUCTION Social determinants of health and social needs are a central cause of health inequity and poor health outcomes in the United States. Existing research primarily focuses on theoretical implications of social determinants of health on health outcomes, with a growing secondary focus on the development of screening tools that identify patients' specific unmet social needs. However, summative research has not yet focused on the barriers, facilitators, and strategies relating to the implementation of social determinants of health and social need screenings into routine clinical care. This scoping review aims to examine literature on the implementation of social determinants of health and social needs screening in clinical settings and clinical training curricula while also identifying gaps that require further exploration. INCLUSION CRITERIA This review will include relevant studies examining the facilitators, barriers, and strategies for the implementation of social determinants of health and social needs screening, referral, and follow-up as they relate to human subjects. The literature must be in English from 2010 and focus on United States clinical health settings and curricula. METHODS We will search PubMed, CINAHL, and Embase databases for relevant articles. Two independent reviewers will screen abstracts for eligibility. Data will be extracted from eligible articles and results will be presented in narrative and tabular format in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews.
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Affiliation(s)
- Kelly Gagnon
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
- Weitzman Institute at Community Health Center, Inc., Middletown, CT, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | | | - Nirali Deepak Patel
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
| | - Richard James
- University of Pennsylvania Biomedical Library, Philadelphia, PA, USA
| | - Mary Hawk
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA
- Center for LGBT Health Research, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA
| | - April Joy Damian
- Weitzman Institute at Community Health Center, Inc., Middletown, CT, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rinad Beidas
- Department of Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Medical Ethics and Health Policy, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Department of Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
- Penn Implementation Science Center at the Leonard Davis Institute of Health Economics (PISCE@LDI), University of Pennsylvania, Philadelphia, PA, USA
- Center for Health Incentives and Behavioral Economics (CHIBE), University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Heidari E, Brown C, Johnsrud M, Mastrangelo V, Spears A, Parikh M, Campbell PJ. Procurement and use of social determinants of health data among key health care stakeholders. J Manag Care Spec Pharm 2022; 28:538-543. [PMID: 35471072 PMCID: PMC10373048 DOI: 10.18553/jmcp.2022.28.5.538] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: A growing body of evidence supports the need for health systems to shift towards addressing social determinants of health (SDoH) as part of routine care. However, little is known about the state of the industry in terms of procurement and use of SDoH data. OBJECTIVES: To assess stakeholders' perceptions and experiences in collecting and utilizing SDoH data. METHODS: A prospective, cross-sectional study was conducted using a 24-item electronic survey. The pilot-tested survey was distributed to a diverse convenience sample of 94 health care stakeholder organizations that are members of the Pharmacy Quality Alliance organization. Survey responses were collected from November to December 2020. Descriptive statistics were used to analyze responses. RESULTS: A total of 25 respondents completed the survey (response rate = 26.6%). More than half (n = 14, 56.0%) collected and tracked SDoH data, and of those, most (n = 6, 42.85%) reported using organization-specific tools instead of standardized SDoH tools. Economic stability and health and health care indicators were the most frequently identified types of SDoH data collected. Participants reported that both identifying (mean = 3.88 ± SD = 0.88; 1 = not important to 5 = extremely important) and addressing (3.88 ± 0.93) patients' SDoH were moderately important to their organization. Lack of standard data format (72.0%), lack of time (52.0%), and lack of technological capabilities (44.0%) were the most commonly reported barriers to collecting SDoH data. However, value-based payment programs that reward addressing SDoH needs (76.0%) and a coding structure or reimbursement mechanism for identification and management of SDoH (60.0%) were most commonly reported as mechanisms to overcome SDoH data collection barriers. CONCLUSIONS: Health care stakeholders consider patient SDoH indicators important but report significant challenges in collecting these data. Solutions that address data standardization, time burden, technological barriers, and the offering of incentives could facilitate its collection and effective use. DISCLOSURES: Pharmacy Quality Alliance received an unrestricted grant from Pfizer, Inc, to support this work.
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Affiliation(s)
- Elham Heidari
- College of Pharmacy, The University of Texas at Austin
| | - Carolyn Brown
- College of Pharmacy, The University of Texas at Austin
| | | | | | - Asya Spears
- Pharmacy Quality Alliance, Alexandria, Virginia
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Handerer F, Kinderman P, Shafti M, Tai S. A Scoping Review and Narrative Synthesis Comparing the Constructs of Social Determinants of Health and Social Determinants of Mental Health: Matryoshka or Two Independent Constructs? Front Psychiatry 2022; 13:848556. [PMID: 35492698 PMCID: PMC9046700 DOI: 10.3389/fpsyt.2022.848556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/10/2022] [Indexed: 11/21/2022] Open
Abstract
Background Many health research policies invoke the construct of Social Determinants of Health, and more recently the construct of Social Determinants of Mental Health. While frequently referred to in the literature, it is unclear how these constructs relate to each other. Some commentators conceptualise the Determinants of Mental Health as a subgroup of the Determinants of general Health and others describe the Determinants of Mental Health as an autonomous construct. The current review investigates the relationship between both constructs. Methods Comprehensive literature searches were conducted for both constructs separately within seven electronic databases. A template analysis was conducted to compare the conceptualisations of the Social Determinants of Health and the Social Determinants of Mental Health. Results Of 4250 search results, 50 papers (25 for each construct) fulfilled our inclusion criteria and were incorporated into a narrative synthesis. Discussions of the Social Determinants of both general and Mental Health listed the same determinants. Both constructs were conceptualised on multiple levels and factors. Stress and health behaviour were also described as mediators for both constructs. The constructs differed, however, with respect to two components of their aetiologies and epistemologies. First, the causal mechanisms invoked for the Determinants of general Health followed predominantly direct pathways, in contrast to indirect pathways for the Social Determinants of Mental Health. Second, the Social Determinants of Mental Health were reported to influence mental health mediated through individuals' perceptions and appraisal processes. Appraisal processes were considered of far less relevance in the construct of Social Determinants of Health. Conclusion The constructs of Social Determinants of Health and Social Determinants of Mental Health align in many respects but differ on important aetiological and epistemological grounds. Similar social factors are considered important, but whereas physical health conditions are primarily conceptualised to be driven by objective realities, mental health is explained mainly in terms of perception of these realities. This differentiation between physical and mental health is in line with a modern understanding of mind-body-dualism, the naturalistic dualism after Chalmers. Differentiating the Social Determinants of Mental Health from the Social Determinants of Health might bear relevance for policy making and research.
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Affiliation(s)
- Fritz Handerer
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Peter Kinderman
- Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Matina Shafti
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
| | - Sara Tai
- School of Health Sciences, University of Manchester, Manchester, United Kingdom
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Modha B. Utilising dentist-dental health educator skill-mix to implement oral health promotion that better supports diverse communities. JOURNAL OF INTEGRATED CARE 2022. [DOI: 10.1108/jica-08-2021-0043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
PurposeDentists may be seen as the most prominent figures within dentistry. Yet, a number of dental care professionals make significant contributions to the profession. The dental health educator (DHE) is one prime example. This teammate is typically a dental nurse who has achieved a post-registration qualification in oral health education (OHE). Through interactions with patients, members of the community and other pertinent stakeholders, the DHE empowers people through promoting the importance of good oral health. The purpose of this paper is to cast light on the unique and invaluable roles that DHEs can play within their organisations.Design/methodology/approachThis paper aims to share some examples of dentist-DHE collaborations, where OHE initiatives were implemented within an ethnically diverse London Borough in England.FindingsIt was found that such interprofessional, skill-mix efforts were more productive, when the dentist and DHE worked together, rather than the latter working independently.Originality/valueThere exists great potential for DHEs to act as ambassadors for their dental establishments, network and collaborate with other organisations and build worthwhile relations with other healthcare professionals and stakeholders.
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Birault F, Le Bonheur L, Langbour N, Clodion S, Jaafari N, Perault-Pochat MC, Thirioux B. Exposure to High Precariousness Prevalence Negatively Impacts Drug Prescriptions of General Practitioners to Precarious and Non-Precarious Populations: A Retrospective Pharmaco-Epidemiological Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19052962. [PMID: 35270655 PMCID: PMC8910740 DOI: 10.3390/ijerph19052962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 12/10/2022]
Abstract
(1) Background: Precarious patients are more difficult to care for due to low literacy rates and poor adherence to treatment and hospitalization. These difficulties have detrimental effects on general practitioners (GPs), deteriorating medical communication, advice, diagnoses, and drug prescriptions. To better understand how precariousness affects primary care, we tested whether, among GPs, exposure to high precariousness prevalence more severely impacts drug prescriptions to precarious and non-precarious populations compared to low precariousness prevalence. Materials and methods: This pharmaco-epidemiological study, using linear regression analyses, compared the defined daily dose of 20 drugs prescribed by GPs to precarious and non-precarious patients in four French regions with low and high precariousness prevalence in 2015. (2) Findings: Exposure to high precariousness prevalence significantly impacted the prescriptions of nine medications to precarious patients and two medications to non-precarious patients, and distributed into three interaction patterns. (3) Interpretation: The selective over-prescription of drugs with easy intake modalities to precarious patients probably reflects GPs’ attempts to compensate for poor patient compliance. In contrast, the under-prescription of drugs targeting fungal infections in precarious populations and diabetes and cardiovascular diseases in non-precarious populations was seemingly due to a breakdown of empathy and professional exhaustion, causing medical neglect.
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Affiliation(s)
- François Birault
- Département de Médecine Générale, Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France;
- Département de Médecine Générale, Maison de Santé Pluriprofessionnelle Universitaire des Couronneries, F-86000 Poitiers, France;
- Correspondence: ; Tel.: +33-549-451-111; Fax: +33-549-455-041
| | - Lakshmipriva Le Bonheur
- Département de Médecine Générale, Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France;
- Département de Médecine Générale, Maison de Santé Pluriprofessionnelle Universitaire des Couronneries, F-86000 Poitiers, France;
| | - Nicolas Langbour
- Centre Hospitalier Henri Laborit, Unité de Recherche Clinique Pierre Deniker, F-86021 Poitiers, France; (N.L.); (N.J.); (B.T.)
- Centre de Recherches sur la Cognition et l’Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, F-86021 Poitiers, France
| | - Sandivanie Clodion
- Département de Médecine Générale, Maison de Santé Pluriprofessionnelle Universitaire des Couronneries, F-86000 Poitiers, France;
| | - Nematollah Jaafari
- Centre Hospitalier Henri Laborit, Unité de Recherche Clinique Pierre Deniker, F-86021 Poitiers, France; (N.L.); (N.J.); (B.T.)
- Centre de Recherches sur la Cognition et l’Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, F-86021 Poitiers, France
- Département de Psychiatrie, Faculté de Médecine et de Pharmacie, Université de Poitiers, F-86000 Poitiers, France
| | - Marie-Christine Perault-Pochat
- Laboratoire de Neurosciences Expérimentales et Cliniques, Institut National de la Santé et de la Recherche Médicale (INSERM U 1084), Université de Poitiers, F-86000 Poitiers, France;
- Service de Pharmacologie Clinique et Vigilances, Centre Hospitalo-Universitaire de Poitiers, F-86021 Poitiers, France
- Centre Hospitalo-Universitaire de Poitiers, Institut National de la Santé et de la Recherche Médicale (INSERM CIC1402), Université de Poitiers, F-86021 Poitiers, France
| | - Bérangère Thirioux
- Centre Hospitalier Henri Laborit, Unité de Recherche Clinique Pierre Deniker, F-86021 Poitiers, France; (N.L.); (N.J.); (B.T.)
- Centre de Recherches sur la Cognition et l’Apprentissage, Centre National de la Recherche Scientifique (CNRS 7295), Université de Poitiers, F-86021 Poitiers, France
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van der Velde LA, Steyerberg EW, Numans ME, Kiefte-de Jong JC. Food insecurity status is of added value in explaining poor health: a cross-sectional study among parents living in disadvantaged neighbourhoods in the Netherlands. BMJ Open 2022; 12:e052827. [PMID: 35140151 PMCID: PMC8830251 DOI: 10.1136/bmjopen-2021-052827] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The aim of this study was to examine the added value of food insecurity in explaining poor physical and mental health beyond other socioeconomic risk factors. DESIGN, SETTING, PARTICIPANTS AND OUTCOME MEASURES Data for this cross-sectional study were collected using questionnaires with validated measures for food insecurity status and health status, including 199 adult participants with at least 1 child living at home, living in or near disadvantaged neighbourhoods in The Hague, the Netherlands. To assess the added value of food insecurity, optimism-corrected goodness-of-fit statistics of multivariate regression models with and without food insecurity status as a covariate were compared. RESULTS In the multivariable models explaining poor physical health (Physical Component Summary: PCS) and mental health (Mental Component Summary: MCS), from all included socioeconomic risk factors, food insecurity score was the most important covariate. Including food insecurity score in those models led to an improvement of explained variance from 6.3% to 9.2% for PCS, and from 5.8% to 11.0% for MCS, and a slightly lower root mean square error. Further analyses showed that including food insecurity score improved the discriminative ability between those individuals most at risk of poor health, reflected by an improvement in C-statistic from 0.64 (95% CI 0.59 to 0.71) to 0.69 (95% CI 0.62 to 0.73) for PCS and from 0.65 (95% CI 0.55 to 0.68) to 0.70 (95% CI 0.61 to 0.73) for MCS. Further, explained variance in these models improved with approximately one-half for PCS and doubled for MCS. CONCLUSIONS From these results it follows that food insecurity score is of added value in explaining poor physical and mental health beyond traditionally used socioeconomic risk factors (ie, age, educational level, income, living situation, employment status and migration background) in disadvantaged communities. Therefore, routine food insecurity screening may be important for effective risk stratification to identify populations at increased risk of poor health and provide targeted interventions.
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Affiliation(s)
- Laura A van der Velde
- Department of Public Health and Primary Care/ LUMC-Campus The Hague, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ewout W Steyerberg
- Department of Biomedical Data Sciences, Leiden University Medical Centre, Leiden, The Netherlands
| | - Mattijs E Numans
- Department of Public Health and Primary Care/ LUMC-Campus The Hague, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jessica C Kiefte-de Jong
- Department of Public Health and Primary Care/ LUMC-Campus The Hague, Leiden University Medical Centre, Leiden, The Netherlands
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Brown MJ, Joseph C, James T, Haider MR, Zahnd WE, Cohen SA. Gender and Racial/Ethnic Disparities in Social Determinants of Health and Subjective Cognitive Decline: The Mediating Role of Depression. J Gerontol Nurs 2022; 48:13-22. [PMID: 35103521 PMCID: PMC9003396 DOI: 10.3928/00989134-20220110-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Social determinants of health (SDOH) may be associated with subjective cognitive decline (SCD), which is a precursor for Alzheimer's disease. The main aims of the current study were to examine the association between SDOH and SCD; to determine if there is an indirect pathway among SDOH, depression, and SCD; and to examine the related gender and racial/ethnic disparities. Cross-sectional data were obtained from the 2017 Behavioral Risk Factor Surveillance System Survey (N = 6,509; 2,530 men and 3,978 women aged ≥45 years). Path analyses (stratified by gender and race) were used to determine the relationship between a SDOH index, depression, and SCD. After controlling for gender, age, income, education, employment, and other health-related behaviors, SDOH were positively associated with SCD among the overall population, men, and White populations. SDOH were associated with depression, and depression was associated with SCD among men, women, and White and Black populations. After adjustment for confounders, the indirect pathway among SDOH, depression, and SCD was statistically significant for men (β = 0.035, p < 0.001), women (β = 0.040, p < 0.001), White populations (β = 0.034, p < 0.001), and Black populations (β = 0.036, p = 0.026). Gender and racial/ethnic disparities existed in the relationship among SDOH, depression, and SCD. Future research should assess alternative mediational pathways between SDOH and SCD. [Journal of Gerontological Nursing, 48(2), 13-22.].
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Affiliation(s)
- Monique J. Brown
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina,South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina,Rural and Minority Health Research Center, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina,Office for the Study of Aging, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Chantaezia Joseph
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Titilayo James
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina
| | - Mohammad Rifat Haider
- Department of Health Policy and Management, College of Public Health, University of Georgia, Athens, Georgia
| | - Whitney E. Zahnd
- Department of Health Management and Policy, College of Public Health, University of Iowa, Iowa City, Iowa
| | - Steven A. Cohen
- Department of Health Studies, University of Rhode Island, Kingston, Rhode Island
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Sensitivity and Specificity of Real-World Social Factor Screening Approaches. J Med Syst 2021; 45:111. [PMID: 34767091 PMCID: PMC8588755 DOI: 10.1007/s10916-021-01788-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 11/01/2021] [Indexed: 11/03/2022]
Abstract
Health care organizations are increasingly documenting patients for social risk factors in structured data. Two main approaches to documentation, ICD-10 Z codes and screening questions, face limited adoption and conceptual challenges. This study compared estimates of social risk factors obtained via screening questions and ICD-10 Z diagnoses coding, as used in clinical practice, to estiamtes from validated survey instruments in a sample of adult primary care and emergency department patients at an urban safety-net health system. Financial strain, transportation barriers, food insecurity, and housing instability were independently assessed using instruments with published reliability and validity. These four social factors were also being collected by the health system in screening questions or could be mapped to ICD-10 Z code diagnosis code concepts. Neither the screening questions nor ICD-10 Z codes performed particularly well in terms of accuracy. For the screening questions, the Area Under the Curve (AUC) scores were 0.609 for financial strain, 0.703 for transportation, 0.698 for food insecurity, and 0.714 for housing instability. For the ICD-10 Z codes, AUC scores tended to be lower in the range of 0.523 to 0.535. For both screening questions and ICD-10 Z codes, the measures were much more specific than sensitive. Under real world conditions, ICD-10 Z codes and screening questions are at the minimal, or below, threshold for being diagnostically useful approaches to identifying patients’ social risk factors. Data collection support through information technology or novel approaches combining data sources may be necessary to improve the usefulness of these data.
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Parry J, Vanstone M, Grignon M, Dunn JR. Primary care-based interventions to address the financial needs of patients experiencing poverty: a scoping review of the literature. Int J Equity Health 2021; 20:219. [PMID: 34620188 PMCID: PMC8496150 DOI: 10.1186/s12939-021-01546-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 09/05/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is broadly accepted that poverty is associated with poor health, and the health impact of poverty has been explored in numerous high-income country settings. There is a large and growing body of evidence of the role that primary care practitioners can play in identifying poverty as a health determinant, and in interventions to address it. PURPOSE OF STUDY This study maps the published peer-reviewed and grey literature on primary care setting interventions to address poverty in high-income countries in order to identify key concepts and gaps in the research. This scoping review seeks to map the tools in use to identify and address patients' economic needs; describe the key types of primary care-based interventions; and examine barriers and facilitators to successful implementation. METHODS Using a scoping review methodology, we searched five databases, the grey literature and the reference lists of relevant studies to identify studies on interventions to address the economic needs-related social determinants of health that occur in primary health care delivery settings, in high-income countries. Findings were synthesized narratively, and examined using thematic analysis, according to iteratively identified themes. RESULTS Two hundred and fourteen papers were included in the review and fell into two broad categories of description and evaluation: screening tools, and economic needs-specific interventions. Primary care-based interventions that aim to address patients' financial needs operate at all levels, from passive sociodemographic data collection upon patient registration, through referral to external services, to direct intervention in addressing patients' income needs. CONCLUSION Tools and processes to identify and address patients' economic social needs range from those tailored to individual health practices, or addressing one specific dimension of need, to wide-ranging protocols. Primary care-based interventions to address income needs operate at all levels, from passive sociodemographic data collection, through referral to external services, to direct intervention. Measuring success has proven challenging. The decision to undertake this work requires courage on the part of health care providers because it can be difficult, time-consuming and complex. However, it is often appreciated by patients, even when the scope of action available to health care providers is quite narrow.
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Affiliation(s)
- Jane Parry
- Department of Health, Aging and Society, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - Meredith Vanstone
- Department of Family Medicine, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - Michel Grignon
- Department of Health, Aging and Society, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
| | - James R. Dunn
- Department of Health, Aging and Society, McMaster University, 1280 Main St West, Hamilton, ON L8S 4L8 Canada
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Murray E, Roosevelt GE, Vogel JA. Screening for health-related social needs in the emergency department: Adaptability and fidelity during the COVID-19 pandemic. Am J Emerg Med 2021; 54:323.e1-323.e4. [PMID: 34654599 PMCID: PMC8492605 DOI: 10.1016/j.ajem.2021.09.071] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 09/20/2021] [Accepted: 09/27/2021] [Indexed: 01/11/2023] Open
Abstract
Background and objectives We sought to evaluate a screening and referral program for health-related social needs (HRSN) in our ED. Our goals were to (1) quantify successful screenings prior to and during the initial peak of the pandemic, and (2) describe the HRSNs identified. Methods We performed an observational analysis of ED-based screening for HRSN in Medicare and Medicaid patients at our large urban safety-net hospital. Screening was performed by patient navigators utilizing the ten question, validated Accountable Health Communities (AHC) Screening Tool, which screens for food insecurity, housing instability, transportation needs and utility assistance and interpersonal safety. Patients who screened positive for HRSN were provided with handouts listing community resources. For patients with two or more self-reported ED visits in the last 12 months and any identified HRSN, ongoing navigation after discharge was provided utilizing community resource referrals. During the pre-pandemic period from November 1, 2019 – January 31, 2020, screening occurred in-person. Screening during the pandemic from March 1, 2020 – May 31, 2020 occurred remotely via telephone. Descriptive statistics including frequency rates and percentages were calculated. Successful screening was defined as completing the screening survey with a navigator and being triaged to either no assistance, resource handouts, or navigation services. Results Among the adult and pediatric patients screened for HRSN, 158 (16%) qualified for community resource handouts and 440 (44.4%) qualified for patient navigator services. The proportion of patients receiving both resources and care navigation remained similar in the pre- and post-periods of the study, at 227 (45%) and 213 (43.9%) respectively. However, the proportion of ED patients with a HRSN need doubled from 56 (11.1%) in the pre-period to 102 (21%) in the post-period. Food insecurity was the most identified HRSN in both the pre-pandemic period (27.3%) and during the pandemic (35.8%). Conclusion We found that remote HRSN screening for ED patients during the COVID-19 pandemic resulted in similar proportions of successfully completed screenings compared to pre-pandemic efforts. This demonstrates the feasibility of utilizing alternative methods of screening and referral to community resources from the ED, which could facilitate this type of intervention in other EDs. During the pandemic HRSN increased, likely reflecting the economic impact of the pandemic.
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Affiliation(s)
- Evangelia Murray
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA.
| | - Genie E Roosevelt
- Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA; Department of Emergency Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Jody A Vogel
- Department of Emergency Medicine, Stanford University, Palo Alto, CA, USA
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Felter CE, Cicone J, Mathis L, Smith DL. Identifying and Addressing Social Determinants of Learning During the COVID-19 Pandemic. Phys Ther 2021; 101:6365142. [PMID: 34499180 PMCID: PMC8499936 DOI: 10.1093/ptj/pzab210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/02/2021] [Accepted: 07/25/2021] [Indexed: 11/22/2022]
Abstract
UNLABELLED The COVID-19 pandemic has negatively impacted the health of people from communities of color and people of limited socioeconomic means in a disproportionate way due to social determinants of health (SDoH). The Centers for Disease Control defines SDoH as the "conditions in the places where people live, learn, work, and play that affect a wide range of health and quality-of life-risks and outcomes." A related construct, social determinants of learning (SDoL), includes contextual conditions and variables that impact students' ability to optimally participate in their education, including academic and clinical development. SDoL directly impact students' ability to participate in the educational process. During the COVID-19 pandemic, students struggling with SDoH and, by extension SDoL, may be more likely to have sick family members, caregiving responsibilities, food and housing insecurity, and obligations to supplement lost family wages. SDoL are also influenced by individual experiences within and outside of the classroom. Beyond bringing this matter to the attention of our profession, especially clinical and academic educators, we must take action to reach and support students who are at higher academic risk due to the SDoL. The purpose of this paper is to (1) define SDoL, (2) explain how SDoL are impacting doctor of physical therapy and physical therapist assistant students, and (3) discuss actions that physical therapists and physical therapist assistants can take to mitigate the effects of SDoL on current doctor of physical therapy and physical therapist assistant students. IMPACT This Perspective is one of the first explorations of how SDoL affect physical therapy students during the pandemic and provides concrete suggestions on how educators in both academic and clinical settings can help students succeed when they are negatively affected by SDoL.
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Affiliation(s)
- Cara E Felter
- Address all correspondence to Cara Felter, , 100 Penn St., Suite 240 C, Baltimore, MD 21201
| | - Jonathan Cicone
- Cecil College, Department of Health and Human Sciences, Physical Therapist Assistant Program
| | - Lindsey Mathis
- University of Maryland School of Medicine, Department of Physical Therapy and Rehabilitation Science
| | - Deanna L Smith
- Cecil College, Department of Health and Human Sciences, Physical Therapist Assistant Program
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Kiles TM, Borja-Hart N, Wofford BR, Renfro CP. Screening for social determinants of health in community pharmacy: Identifying best practices, barriers, and strategies for success. J Am Pharm Assoc (2003) 2021; 61:e59-e63. [PMID: 34078562 DOI: 10.1016/j.japh.2021.05.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/12/2021] [Accepted: 05/07/2021] [Indexed: 11/15/2022]
Abstract
The social determinants of health (SDOH) play a key role in patients' access to health care and medications. There exists an area of opportunity to leverage community pharmacists to make a large impact in identifying and incorporating an understanding of a patient's SDOH into their treatment plan. Community pharmacies are accessible and trusted avenues for health care interventions. With the advancement of appointment-based models as well as the increased training of support personnel, community pharmacies may be well suited for this public health task. However, there are major challenges such as paradigm shifts in workflow, reimbursement, and training that must be addressed to make this endeavor successful. This commentary explores the sparse literature related to community pharmacists conducting screening for social risk factors to identify best practices and barriers to implementation and outlines how screening for social needs aligns with the Pharmacists' Patient Care Process.
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Ross H, Dritz R, Morano B, Lubetsky S, Saenger P, Seligman A, Ornstein KA. The unique role of the social worker within the Hospital at Home care delivery team. SOCIAL WORK IN HEALTH CARE 2021; 60:354-368. [PMID: 33645451 DOI: 10.1080/00981389.2021.1894308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 06/12/2023]
Abstract
Hospital at Home (HaH) provides acute, hospital-level care at home and post-discharge follow-up. Through a review of 293 HaH admissions conducted by an urban, multidisciplinary HaH program from 2014 to 2017, we find that the social worker is involved in 71% of admissions and plays a crucial role in pre-emergency department discharge home care and safety screening, home intake, follow-up support, and transition of care to primary care providers and community-based services. We describe the social work activities involved in this model of care and present composite case studies for further illustration.
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Affiliation(s)
- Helena Ross
- Department of Social Work, Mount Sinai Hospital, New York, New York, USA
| | - Ryan Dritz
- Department of Social Work, Mount Sinai Hospital, New York, New York, USA
| | - Barbara Morano
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Sara Lubetsky
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Pamela Saenger
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Audrey Seligman
- Master of Public Health Student, University of Minnesota School of Public Health, Minneapolis, Minnesota, USA
| | - Katherine A Ornstein
- Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Schneiderman JU, Olshansky EF. Nurses' perceptions: Addressing social determinants of health to improve patient outcomes. Nurs Forum 2021; 56:313-321. [PMID: 33484172 DOI: 10.1111/nuf.12549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 12/27/2020] [Accepted: 01/03/2021] [Indexed: 01/13/2023]
Abstract
Nursing organizations and leaders adopted the social determinants of health (SDOH) as essential to the delivery of health care, but little is known about working registered nurses' (hereafter nurses) views on the SDOH. The purpose of this study was to (1) explore nurses' perceptions of how SDOH affect patient care and (2) describe nurses' ideas about how SDOH can be addressed to improve outcomes and services. Thirteen registered nurses with a baccalaureate in nursing beginning their online graduate advanced practice educational program were interviewed. This qualitative descriptive study used constant comparative analysis for data analysis. The analysis found two major themes: (1) SDOH are integrated into the nurses' care. The SDOH experienced by patients challenges the nurses to provide care at the patient's level and to provide usable patient education, and (2) health-care delivery change is needed to achieve equity and to provide health care to those in need. The nurses recommended more organized, seamless health-care delivery and interdisciplinary advocacy to achieve these needed changes. Nurse educators and nurse leaders can harness the frustration and ingenuity of nurses to help the nurses advocate for health-care change that integrates the SDOH.
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Affiliation(s)
- Janet U Schneiderman
- Nursing Department, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
| | - Ellen F Olshansky
- Sue & Bill Gross School of Nursing, University of California, Irvine, California, USA
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Lo Moro G, Soneson E, Jones PB, Galante J. Establishing a Theory-Based Multi-Level Approach for Primary Prevention of Mental Disorders in Young People. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E9445. [PMID: 33339317 PMCID: PMC7766147 DOI: 10.3390/ijerph17249445] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 12/06/2020] [Accepted: 12/12/2020] [Indexed: 12/14/2022]
Abstract
The increasing prevalence of mental health disorders and psychosocial distress among young people exceeds the capacity of mental health services. Social and systemic factors determine mental health as much as individual factors. To determine how best to address multi-level risk factors, we must first understand the distribution of risk. Previously, we have used psychometric methods applied to two epidemiologically-principled samples of people aged 14-24 to establish a robust, latent common mental distress (CMD) factor of depression and anxiety normally distributed across the population. This was linearly associated with suicidal thoughts and non-suicidal self-harm such that effective interventions to reduce CMD across the whole population could have a greater total benefit than those that focus on the minority with the most severe scores. In a randomised trial of mindfulness interventions in university students (the Mindful Student Study), we demonstrated a population-shift effect whereby the intervention group appeared resilient to a universal stressor. Given these findings, and in light of the COVID-19 pandemic, we argue that population-based interventions to reduce CMD are urgently required. To target all types of mental health determinants, these interventions must be multi-level. Careful design and evaluation, interdisciplinary work, and extensive local stakeholder involvement are crucial for these interventions to be effective.
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Affiliation(s)
- Giuseppina Lo Moro
- Department of Public Health Sciences, University of Turin, 10126 Torino, Italy;
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK;
| | - Emma Soneson
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK;
| | - Peter B. Jones
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK;
- National Institute for Health Research Applied Research Collaboration East of England, Cambridge CB2 8AH, UK
| | - Julieta Galante
- Department of Psychiatry, University of Cambridge, Cambridge CB2 0SZ, UK;
- National Institute for Health Research Applied Research Collaboration East of England, Cambridge CB2 8AH, UK
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