Support Systems and Patient Care Delivery for Nonnative English-Speaking Patients: A Study of Secondary School Athletic Trainers

Secondary School Athletic Trainers' Perceptions of the Influence of Social Determinants of Health and Socioeconomic Status on Clinical Management Decisions

CONTEXT

Evidence suggests that lower socioeconomic status (SES) and negative social determinants of health (SDOH) contribute to health care disparities. Due to their accessibility in the high school setting, secondary school athletic trainers (SSATs) may encounter patients who are historically underserved in health care, such as patients with low SES. However, a significant gap in knowledge exists regarding how SDOH and SES may influence SSATs' clinical management decisions.

OBJECTIVES

To describe SSATs' perceptions of how patient SDOH and SES influence clinical management decisions and to identify barriers to athletic health care.

DESIGN

Cross-sectional study.

SETTING

Online survey.

PARTICIPANTS OR OTHER PARTICIPANTS

National Athletic Trainers' Association SSATs (6.7% response rate).

MAIN OUTCOME MEASURE(S)

Secondary school athletic trainers were asked about their perceptions of patient SDOH and SES (content validity index = 0.83 for relevancy). The levels of relevance and agreement were answered on a 4-point Likert scale. Data were summarized using means and SDs, frequencies and proportions (%), and median scores.

RESULTS

A total of 380 SSATs participated (mean years of experience = 14.9 ± 11.7 years). When providing care, most (71.3%) SSATs believed their patients' health or health care access to be the most relevant of the 5 SDOH, whereas the other 4 SDOH were less than 60% relevant. Most SSATs agreed or strongly agreed that patient SES affected both referral (67.4%) and the reliance on conservative treatment before referral (71.2%). Secondary school athletic trainers identified patient or guardian compliance (70.2%) and type of health insurance (61.5%) as barriers to providing care to patients with low SES.

CONCLUSIONS

Secondary school athletic trainers perceived health or health care access as the most relevant social determinant when providing care to patients with low SES. When SSATs further considered the SES of patients, they identified all SDOH as barriers that they were ill equipped to navigate as they delivered care and engaged in patient referral.

Embedding Diversity, Equity, and Inclusion into a Kinesiology Curriculum: A Detailed Report of a Curriculum Redesign

Students need to be properly prepared by their education to work respectfully and effectively with diverse populations and in diverse environments. Our purpose is twofold: (i) to provide a thorough description of the curriculum redesign process for an undergraduate kinesiology and health promotion (KHP) program, and (ii) to use our experience to provide more general recommendations to other departments and universities undergoing curricular redesign. The catalyst for this redesign was the conversion from a quarter-system to a semester-system and the opportunities for improvement identified through that process. The redesign was guided by a newly created departmental strategic plan, faculty professional development trainings, student feedback, faculty hirings and their areas of expertise, and industry demands. Diversity, equity, and inclusion (DEI) was mindfully embedded into the curriculum to reflect the department-, college-, and university-level core value of inclusivity. The redesign allows prospective KHP students to complete several courses that address DEI themes, in addition to the courses that build their technical competencies. Providing foundational exposure to DEI concepts through the undergraduate curriculum can better prepare students to work in diverse settings. As such, this report provides other programs with a framework to follow to make curriculum more DEI centric for their students.