Social Determinants and Health Disparities Associated With Outcomes of Women of Childbearing Age Who Receive Public Health Nurse Home Visiting Services

Abstract

ObjectiveTo examine the associations between social and behavioral determinants of health (SBDH), health disparities, and the outcomes of women who received public health nurse home visits for pregnancy and parenting support. DesignObservational exploratory data analysis and comparative outcome evaluation. SettingAn extant dataset from women served in a Midwestern U.S. state, including demographics and Omaha System problems, signs/symptoms, interventions, and outcome assessments. ParticipantsWomen (N = 4,263) with an average age of 23.6 years (SD = 6.1); 21.4% were married, and 39.1% were White. MethodsAn evaluation dataset was constructed that included all women of childbearing age, their demographics, and outcome assessments. A summative SBDH Index based on Institute of Medicine-recommended instruments was computed based on sign/symptom data. Visualizations were developed using Microsoft Excel, and outcome significance statistics were computed using SPSS version 22 and SAS version 9.4. ResultsOutcome evaluation showed positive, significant changes from baseline after public health nurse intervention. Visualization showed variable concentrations of problem-specific signs/symptoms by SBDH Index subgroups. There were between-group differences in overall outcome attainment across SBDH Index subgroups. Compared with White women, minority women had greater improvement; however, despite these gains overall minority final ratings were lower. ConclusionAn informatics approach showed that SBDH are important factors for understanding a comprehensive and holistic view of health and health care outcomes. There is potential to use large datasets to further explore intervention effectiveness and progress toward health equity related to SBDH.