Exploring social determinants of health in a Saudi\xa0Arabian primary health care setting: the need for a multidisciplinary approach

Basmah Almujadidi,Tibor Schuster,Alayne Adams,Gerald Van Gurp,Aljohara Alquaiz,Anne Andermann

doi:10.1186/s12939-022-01627-2

Abstract

BackgroundAction on social determinants of health (SDH) in primary health care settings is constrained by practitioners, organizational, and contextual factors. The aim of this study is to identify barriers and enablers for addressing SDH in clinical settings in Saudi Arabia, taking into consideration the influence of local cultural and social norms, to improve care and support for marginalized and underserved patients.MethodsWe conducted a qualitative study involving individual in-depth interviews with a sample of 17 primary health care physicians purposefully selected based on the inclusion criteria, as well as a focus group with four social workers, all recruited from King Khalid University Hospital (KKUH) in Riyadh, Saudi Arabia. All interviews were audio-recorded, translated from Arabic to English, transcribed verbatim, and analyzed using thematic analysis following a deductive-inductive approach.ResultsAccording to study participants, financial burdens, challenges in familial dynamics, mental health issues and aging population difficulties were common social problems in Saudi primary health care. Action on SDH in primary care was hindered by 1) lack of physician knowledge or training; 2) organizational barriers including time constraints, patient referral/follow up; 3) patient cultural norms and 4) lack of awareness of physician’s role in managing SDH. Enablers to more socially accountable care suggested by participants includes: 1) more education and training on addressing SDH in clinical care; 2) organizational innovations to streamline identification of SDH during patient encounters (e.g. case finding questionnaire completed in waiting room); 3) better interprofessional coordination and clarification of roles (e.g. when to refer to social work, what support is provided by physicians); 4) identifying opportunities for broader advocacy to improve living conditions for marginalized groups.ConclusionEnabling more socially accountable care requires a multipronged approach including leadership from the Ministry of Health, hospital administrations and medical schools. In particular, there is a need for: 1) training physicians to help patients in navigating social challenges; 2) improving clinical/administrative interprofessional teams, 3) mobilizing local communities in addressing social challenges; and 4) advocating for intersectoral action to prevent health inequities before they become more complex issues presenting to clinical care.

Highlights

Action on social determinants of health (SDH) in primary health care settings is constrained by practitioners, organizational, and contextual factors
Frontline health workers continue to witness the detrimental impacts of social challenges on their patients’ health, a growing movement is advocating for increased social accountability in primary health care, and investments in clinical competencies to act on SDH [1, 3]
Our study aims to explore the views of primary health care physicians in Saudi Arabia about addressing SDH in clinical practice, describe their current culture of practice regarding SDH and identify perceived barriers and enablers in asking and managing patient social challenges in clinical care

Summary

Introduction

Action on social determinants of health (SDH) in primary health care settings is constrained by practitioners, organizational, and contextual factors. The relationship between primary health care (PHC) and the social determinants of health (SDH) has garnered increasing attention [1, 2]. Incorporating SDH into the PHC discourse reflects acceptance of the idea that social factors influence a patient’s presentation to his or her primary care physician and the ability to support patients in navigating these challenges can promote improved patient outcomes [1, 5, 6]. The report urges adoption of a more socially accountable model of health care by taking increased action across a range of SDH and highlights the importance of action at the primary level of entry to care [8]. Doing so will lead to a better response to people’s needs and improve community health outcomes [1, 2]

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