Social Need Research Articles

Disparities in time to diagnosis of Radiographic Axial Spondyloarthritis.

Radiographic axial spondyloarthritis (r-axSpA) has a 7-year average diagnostic delay. While the impact of sex or gender on time to diagnosis has been evaluated, the role of social determinants of health remains understudied. We assessed whether time from initial clinical documentation of r-axSpA symptoms to r-axSpA diagnosis (diagnostic delay) varies based on sex, race, ethnicity, or the presence of social needs. We studied patients with r-axSpA from a tertiary center from 2000 to 2022. The cohort was built with the Observational Health Data Sciences and Informatics (OHDSI) network. For the primary analysis, we assessed the time from back pain/spinal pain to r-axSpA diagnosis and secondarily, the time to r-axSpA from any other r-axSpA -related condition. To estimate differences in diagnostic delay, we employed a parametric survival model, accelerated failure time. We included 404 patients (mean age 49, 37% female), with 25.5% identifying as Black, 31.1% as other or unknown race and 14.1% as Hispanic. Patients with a documented social need had a 21% increase in time from back pain to r-axSpA diagnosis (95% CI 0.93, 1.56). In patients with any r-axSpA related condition, time to diagnosis increased similarly by 21% (95% CI 0.92, 1.57). Considering an average time to diagnosis of 34 months, a social need increased time to diagnosis by 7 months. This study reveals a trend toward diagnostic delay in r-axSpA related to social need, sex, race, and ethnicity. Future studies should focus on referral strategies to enable prompt diagnosis and optimize care.

In at the Deep End: Innovative approaches to engaging underserved communities in Northern England

Abstract Background People living in socio-economically deprived communities have greater health needs, but worse access and outcomes from care. A growing international movement of Deep End (DE) general practice networks established to promote health equity, address challenges posed by the inverse care law and advocate for increased research involvement. Researchers, community members and practitioners in the North of England are exploring ways of engaging with underserved communities and addressing low levels of inclusion in research. Methods DE research i) co-designing the North East and North Cumbria (NENC) DE network with practitioners to prioritise service investment, research activities and initiatives for local communities; ii) Deep End Research Alliance Yorkshire and Humber (DERA-YH) and Participatory Action Research to increase research capacity and reflect upon the evolution of a novel primary care Community Research Link Worker role (CRLWs). Results Prioritisation activities in the NENC DE network, uncovered the volume and complexity of clinical and social need, leading to the co-design and evaluation of initiatives to improve mental health care, increase childhood immunisations, tailor deprescribing, support training, and increase patient inclusion in research. In the DERA-YH, the CRLW model increased participation in research from ethnic minority communities regarding prostate cancer, lung health, dementia, and contraceptive services. Community leaders stated that sharing resources and power in the research process builds trust and interest in research in their communities. Conclusions DE networks in Northern England have driven innovative approaches to engage underserved communities in research, fostering empowering and enduring relationships to address health and care inequalities. Co-design methodologies and CRLWs integration into research teams had a transformative impact on the accessibility of research for communities and for the researchers’ positionality. Key messages • Deep End networks are advancing approaches to meaningful engagement and partnership working with underserved communities, to address health, care and research participation inequalities. • We recommend co-design by default and CRLW models to build capacity and embed reflective practice, mutual respect, and power sharing across the research team.

47 Association between unmet social needs and parental stress in a paediatric asthma clinic

Abstract Background There are well documented associations between unmet social needs and undesirable health outcomes, but little data exist on the association between unmet social needs and stress in families of children with asthma. Objectives To document the relationship between unmet social needs and parental stress in a Canadian paediatric asthma clinic. Design/Methods Ongoing prospective observational study to determine the association between unmet social needs and parental stress was conducted in a tertiary care paediatric asthma clinic, between September 2022 and September 2023. Participants were parents of children with a diagnosis of asthma, treated with at least one controller medication. Unmet social needs were collected by parental self-report using a questionnaire assessing 8 domains: employment, housing, ability to pay for utilities, financial resources, food security, transportation, childcare, and education. The four-item Perceived Stress Scale was used to assess how parents perceived stress and how they felt they were able to manage situations in their lives. Chi-square tests compared our independent variable, the presence vs. absence of unmet social needs, to our dependent variables; each measure of stress (control over important aspects of ones’ life, confidence in ability to overcome problems, feeling that everything was going well, ability to overcome too many accumulated difficulties). Results Of 162 participants, seventy-seven (48%) reported at least one unmet social need. Compared to participants without unmet social needs, those with unmet needs were more likely to report having no control over important aspect of their work or main activity (p< 0.001); less likely to report having confidence in their ability to overcome problems (p< 0.001); less likely to report having the feeling that everything was going well (p< 0.001); and less likely to report having the ability to overcome too many accumulated difficulties (p< 0.001). Conclusion Findings suggest significant association between unmet social needs and parental stress of asthmatic children. Parental stress and unmet needs may concomitantly increase the burden of adhering to asthma controller medication, making adherence more challenging through pathways related to the interactions between cognitive burden and precarious living situations. This ongoing Canadian study seeks to elucidate the mechanisms by which these factors make adherence to asthma medication more challenging for families, so these challenges can be addressed.

Social need fulfillment model for human–AI relationships.

Social need fulfillment model for human–AI relationships.

A Content Analysis of Vision and Mission of Private Universities in Mogadishu in the Light of Competitive Advantages

This study aims at analyzing the vision and mission of eleven private universities run in Mogadishu based on their competitive advantages. Quantitative analysis was applied where the author used coding in QDA MINER.LITE 1.4.1 for data analysis under three categories reflected by the content of the vision and mission posted on their official website, namely; Academic & Research, Values & Culture, and Social Need & Development. Each category has a sub-category. The results of the study generally showed that the non-competitive advantages of the universities 71% while competitive advantages scored up 29%. The study also explored that the most competitive advantages of the universities concentrated on the dimensions: values & culture and social needs & development. Besides, there is a variance among the universities regarding their non-competitive advantages and competitive advantages. Finally, the study recommends enhancing the quality of the statement strategies of the vision and mission for the private universities in Mogadishu in line with national and international standards.

Development of an evaluation list for older adult community-based rehabilitation needs through a Delphi method

Older adults’ functional and intrinsic abilities may decline with increasing age. The positive effects of comprehensive community-based rehabilitation services to maintain physical, mental, and social function are essential. Nevertheless, few tools are available to assess the community-based rehabilitation needs of older adults. Therefore, we aimed to construct a list for the comprehensive evaluation of community-based rehabilitation needs of older adults. The International Classification of Functioning, Disability, and Health (ICF) was used to construct a first draft of the assessment list. From September to November 2023, 18 experts from five provinces and nine tertiary hospitals and institutions of higher education in China participated in this Delphi study. The older adult community-based rehabilitation needs evaluation list included six dimensions and 29 items. The weights of the six dimensions, from high to low, included mental function rehabilitation need (0.30), body function rehabilitation need (0.24), social participation need (0.18), individual activity rehabilitation need (0.14), environmental rehabilitation need (0.09) and rehabilitation information need (0.05). Using the Delphi method, an assessment list of older adult community-based rehabilitation needs based on ICF was developed. Future work should evaluate the list’s reliability and validity and its application in managing community-based rehabilitation for older adults.

Signals in Health Inequity

Previous research has demonstrated that social determinants of health are drivers of medical utilization, cost, and health outcomes. In this study, we compared the mean annual total cost to deliver health services per patient by health-related social need (HRSN) status and total HRSNs using linear regression and ANOVA, respectively. Patients with ≥1 HRSN (n = 8409) yielded $1772 higher annual costs compared to patients without HRSNs (n = 34 775) (P < .0001). Compared to patients without HRSNs, delivering care to patients with 1 HRSN (n = 4222) cost $1689 (P < .0001) more and to patients with ≥2 HRSN (n = 4187) cost $1856 (P < .0001) more per year.

Identifying Veterans with a Higher Risk of Social Needs Using Cluster Analysis.

Many social need screening to advance population health and reduce health disparities, but barriers to screening remain. Improved knowledge of patient populations at risk for social needs based on administrative data could facilitate more targeted practices, and by extension, feasible social need screening and referral efforts. To illustrate the use of cluster analysis to identify patient population segments at risk for social needs. We used clustering analysis to identify population segments among Veterans (N=2010) who participated in a survey assessing nine social needs (food, housing, utility, financial, employment, social disconnection, legal, transportation, and neighborhood safety). Clusters were based on eight variables (age, race, gender, comorbidity, region, no-show rate, rurality, and VA priority group). We used weighted logistic regression to assess association of clusters with the risk of experiencing social needs. National random sample of Veterans with and at risk for cardiovascular disease who responded to a mail survey (N=2010). Self-reported social needs defined as the risk of endorsing (1) each individual social need, (2) one or more needs, and (3) a higher total count of needs. From the clustering analysis process with sensitivity analysis, we identified a consistent population segment of Veterans. From regression modeling, we found that this cluster, with lower average age and higher proportions of women and racial minorities, was at higher risk of experiencing ≥ 1 unmet need (OR 1.74, CI 1.17-2.56). This cluster was also at a higher risk for several individual needs, especially utility needs (OR 3.78, CI 2.11-6.78). The identification of characteristics associated with increased unmet social needs may provide opportunities for targeted screenings. As this cluster was also younger and had fewer comorbidities, they may be less likely to be identified as experiencing need through interactions with healthcare providers.

Creative employment as a modern resource of socio-economic recovery of Ukraine

The article's main idea is to substantiate the importance of creative employment for Ukraine's socio-economic recovery. Human capital, its creative element, can accelerate the transformation of a raw economy with its export orientation into a new economy dominated by technology and technologies inherent in Industry 4.0. The use of methods of dialectical analysis, synthesis, generalization, systemic, strategic, and process approaches, and techniques of abstraction made it possible to reveal the high potential of creative employment for preserving existing jobs and generating new jobs, making it attractive to investors. The systematization of the thoughts and work of domestic and foreign scientists regarding the content of creative employment is of theoretical and practical importance. In accordance with the defined goals and objectives, the conceptual principles of "narrow" and "broad" approaches to the content of creative employment are summarized and deepened. It was found that, according to the "narrow" approach, creative workers are mainly people of art and creative professions, people employed in the media industry, and specialists in the field of information systems and technologies, for which individual work is characteristic. According to the author's position, in accordance with the "broad" approach, creative employment takes place in all branches and spheres that produce material, cultural, and spiritual goods, as well as in management activities. This concept not only brings new knowledge to socioeconomics but also has practical significance for determining the scope of creative employment and evaluating state social and economic policy. The study concluded that creative employment is not an artificial phenomenon detached from technical and social progress. Its development is connected primarily with the increase in the economy's and the social and humanitarian sphere's need for innovative developments, which are subsequently commercialized. According to the author, new industrial relations are formed on this basis, which are gradually transformed into partnership ones.

Intersectional Analysis of Social Risk and Need Among a Large Representative Sample of Adults From an Integrated Health System in the U.S.

IntroductionSocial health is increasingly a focus of healthcare systems. Representative and intersectional analyses of individuals’ social risks such as food, housing, transportation, and financial insecurity, and their interest in receiving assistance from the healthcare system (social needs), can provide healthcare organizations with more nuanced estimates that can lead to more effective interventions. MethodsWe conducted cross-sectional survey of a representative sample of 43,936 Kaiser Permanente members in December 2019-September 2020. Study inclusion was based on membership, age, address, and absence of dementia. Modified Poisson regression models estimated respondents' social risks and needs overall and within domain (food, housing, finances, or transportation). and by intersectional strata based on a combination of age, income, gender, and race and ethnicity. ResultsOf 10,274 who completed the survey, 52% reported any social risk and 32% had any social need. Financial strain was the most prevalent risk (44%), followed by food insecurity (31%), housing instability (17%), and transportation (7%). Our intersectional analyses generated 74 intersectional groups. Across the intersectional groups, higher income (>$50,000/year) or older age (>60) adults consistently had lower risk and need. However, this pattern varied by race and ethnicity. In particular, older and lower-income, Pacific Islander, African-American/Black and Multiracial adults had the highest estimates of social risk and need. ConclusionsHigher risk and need among particular intersectional groups suggest the importance of tailored interventions for social needs. The high aggregate prevalence of social risks and needs suggests that system and policy changes must compliment universal and population-based social health screening and assistance interventions in healthcare organizations.

Financial toxicity and unmet social needs in adolescents and young adults (AYA) with cancer.

13 Background: Cancer incidence is rising in adolescents and young adults (AYA) (age 18-39), a population that faces durable financial challenges during and after treatment. Although AYA cancer survivors face unique risks for poor outcomes due to financial toxicity (FT), best practices for FT and social needs screening (i.e. food, housing, transportation insecurity) are unknown. Further, the relationship between FT and social needs is largely unexplored in AYA. Methods: A FT and social needs screening quality improvement project was conducted at a comprehensive cancer center. The Comprehensive Score for Financial Toxicity (COST) assessed FT, and patients reported unmet social needs and treatment payment methods. Quality of life (QOL) was assessed via a visual analog scale. Multivariate linear and logistic regression tested for associations with FT and unmet social needs, adjusting for demographic and clinical characteristics. Results: Of 70,983 requests, 38,249 patients completed the screening (54% response rate): 2,519 were AYA. Mean age of AYA was 33.7 years (SD 4.7), and most (65%) were non-Hispanic white. Disease sites included 41% breast, 20% gastrointestinal, and 19% gynecologic. Over one-half (54%) had active cancer treatment (chemotherapy, radiation, or surgery) within 120 days of assessment. Mean COST was 23.2 (SD 10.8; 0-44, with lower scores indicating worse FT), and 54% had COST <26, suggesting FT. Racial/ethnic minority patients (β -4.37, p<0.001) and those who had recent treatment (β -3.21, p<0.001) had worse FT. Of those who screened positive for FT, only 44% accepted a referral for financial assistance. About one-quarter of the sample (28%) were unable to afford at least one social need, with 16% facing housing, 14% transportation, and 13% food insecurity. Patients who are a racial/ethnic minority (OR 2.98, 95% CI 2.35-3.79, p<0.001) and those with metastatic disease (OR 2.45, 95% CI 1.10-5.45, p=0.028) were more likely to have at least one unmet social need. One-quarter of the sample (24%) used at least some of their savings to pay for treatment, with 7% reporting they did not have any savings. 25% borrowed money or took on new loans to pay for treatment: of those, 58% borrowed from friends/family. 10% did not have enough money for medications, and 7% took less medications than prescribed due to cost. Mean QOL was 7.3 [(SD 1.8) 0 “as bad as it can be”-10 “as good as it can be”]. Increased FT was associated with reduced QOL (β -0.10, p<0.001), using more savings to pay for treatment (β 0.52, p<0.001), and taking less medications due to cost (β 0.01, p<0.001). Conclusions: Routine FT and social needs screening is feasible for AYA patients and uncovers high rates of FT and unmet social needs. Given lower QOL and decreased adherence to treatment associated with FT, future research should focus on interventions to support the specific needs of AYA and increase acceptance of financial assistance and navigation.

Effects of Social Vulnerability and Environmental Burden on Care Fragmentation and Social Needs Among Individuals With Rheumatic Conditions.

Environmental hazards and heightened neighborhood social vulnerability coexist and disproportionately affect minoritized populations. We investigated associations between exposure to adverse environmental burden concentrated in areas with high social vulnerability and care fragmentation (missed appointments, emergency department visits, and hospitalizations) and social needs (eg, food and housing insecurity) among individuals with rheumatic conditions. We identified adults receiving care in a Massachusetts multihospital system with at least two rheumatic disease codes and complete street addresses. Geocoded addresses were linked to the Centers for Disease Control and Prevention/Agency for Toxic Substances and Disease Registry Social-Environmental Ranking (SER), which combines census-tract social vulnerability variables (eg, socioeconomic status) with environmental hazards (eg, air and water pollution). Social needs were obtained from self-reported surveys. Multilevel, multinomial regression models estimated associations between SER quartiles and care fragmentation and social need burden, accounting for demographics and comorbidities. Among 16,856 individuals with rheumatic conditions, 70% were female, 6% were Black, 82% were White, and 7% resided in the highest combined social vulnerability and environmental burden (SER quartile 4) areas. Among 7,083 with social needs data, 19% experienced more than one challenge. Individuals in SER quartile 4 areas (vs quartile 1) had 2.02 (95% confidence interval [CI] 1.67-2.46) times greater odds of at least four care fragmentation occurrences (vs 0) and 2.37 (95% CI 1.73-3.25) times greater odds of at least two social needs (vs 0). Residence in areas of high combined adverse environmental burden and social vulnerability was associated with significantly greater odds of care fragmentation and social needs. Addressing structural factors and emerging environmental threats contributing to these adverse exposures is essential to reduce rheumatic disease care inequities.

Care gaps among people presenting to the hospital following self-harm: observational study of three emergency departments in England

ObjectivesThis study aims to examine the proportions of patients referred to mental health, social and voluntary, community and social enterprise (VCSE) services and general practice and to assess care gaps...

Association between Unmet Social Need and Ambulatory Quality of Care for U.S. Children

ObjectivesChildren who experience socioeconomic adversity often have worse health; however, less is known about their quality of care. We sought to evaluate the association between parent/caregiver-reported socioeconomic adversity and quality of pediatric primary, acute, and chronic ambulatory care on a national level. MethodsThis was a retrospective cohort study of 5,368 representative U.S. children (1-17 years) in the 2021 Medical Expenditure Panel Survey. Socioeconomic adversity was defined as parent/caregiver-reported food, housing, transportation, or utility insecurity in the past 12 months. Outcomes included 10 quality measures of primary, acute, and chronic care, and experience of care measured through parent/caregiver survey. We described variation in socioeconomic adversity and used multivariable regression to examine associations with quality outcomes. ResultsOne-third of parent/caregivers reported socioeconomic adversity. Food insecurity (23.6%) was most common followed by utility (19.5%), housing (15.0%), and transportation (4.7%) insecurity. Black (53.2%) and Hispanic (46.9%) parent/caregivers experienced the highest rates of socioeconomic adversity. Children with socioeconomic adversity received lower quality of care for 4 quality measures, including more frequent ED visits (Odds Ratio (OR)=1.69 [95% Confidence Interval (CI):1.28-2.23]), less favorable asthma medication ratio (OR=0.04 [95%CI:0.01-0.31]), and less frequent well child (OR=0.73 [95%CI:0.59-0.90]) and dental care (OR=0.76 [95%CI:0.63-0.94], p <.05 for all). There were no statistically significant differences in experience of care. ConclusionsSocioeconomic adversity is common among U.S children with disproportionate impact on Black and Hispanic families. There are significant disparities in pediatric primary, acute, and chronic care quality, based on parent/caregiver-reported socioeconomic adversity, highlighting the need for systems-level interventions.

Development and validation of a questionnaire (QSPC-Q) for assessment of quality and strengthening of primary care in Brazil.

The performance evaluation of services through instruments is relevant, as it can support thoughts, actions and political approaches to meet a social need. The objective of the article was to develop and validate the Quality and Strengthening of Primary Care Questionnaire (QSPC-Q) for professionals and users based on Starfield attributes and Donabedian pillars. A mixed sequential study was performed to develop the QSPC-Q. The test was applied to 149 doctors and 795 users of basic health units. Psychometric properties was assessed by testing internal consistency using Cronbach's alpha and exploratory factor analysis. Reproducibility od scale was assessed using intraclass cognitive and test-retest correlation. The final version of the follow-up consisted of 45 items aimed at physicians (Cronbach's alpha = 0.921) and 33 at users (Cronbach's alpha = 0.86); the intraclass respiratory capacity was 0.88. An exploratory factor analysis identified 13 factors associated with the pattern components. A short version with 29 items for professionals was also elaborated. Professional QSPC-Q (short and braided versions) and user QSPC-Q were valid.

A Choice-Functional Characterization of Welfarism

Welfarism is the view that individual welfare is the only thing that matters. One important contribution of social choice theory has been to provide a precise formulation and axiomatic characterization of welfarism using Amartya Sen's framework of social welfare functionals. This paper is motivated by the observation that the standard formalization of welfarism is too restrictive, since a welfarist social planner need not be committed to maximizing a preference ordering or any other binary relation over alternatives. We therefore provide a characterization of welfarism in a more general choice-functional setting and show that welfarism, so understood, carries no commitment to rationalizability. This characterization is compatible with welfare values having any structure whatsoever. It also sheds light on different formulations of anonymity, revealing only some of these to be fundamental requirements of impartiality.

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Digitalization has significantly influenced the challenges facing the media industry. The very process of media transformations "is no longer a technical need, but is already a social reflection and need, a need for communication, a need for solving political and technological problems in the society of this time" (Bebić &amp; Volarević, 2016). Therefore, the attention of users is increasingly difficult to capture, thanks to the diversity of media publications, and in this sense traditional media often fail to respond to specific audience demands (Trattner, et al., 2022).Today, users are exposed to a large amount of information on a daily basis, their content is increasing, so media content cannot be imposed on users, but they choose only what they are interested in for consumption. However, traditional electronic media have understood the importance of the new multidimensional environment, therefore they are using a multiplatform through the Internet that use digital technology both to place the content and to personalize the offers against the user (Ćitić, 2020).

Social needs and healthcare utilization in NICU graduates.

Unplanned healthcare utilization after neonatal intensive care unit (NICU) discharge challenges families and healthcare systems. The impact of social needs on post-NICU healthcare utilization is underexplored. Our objective was to identify social needs among NICU graduates and examine associations between social needs and post-NICU healthcare utilization. A prospective cohort design was used to screen for social needs and track healthcare utilization among 112 NICU graduates attending a NICU follow-up clinic (2021-2022). Associations between social needs and healthcare utilization were analyzed using non-parametric statistical tests. Of 112 patients screened, 20 (18%) had some social need. Infants with social needs experienced statistically significant higher rates of hospitalizations, overall encounters, and missed appointments. Social needs are associated with increased unplanned healthcare utilization and missed appointments. Addressing these needs during NICU follow-up may improve preventative care attendance and reduce unplanned healthcare use, leading to better outcomes for vulnerable infants and cost-savings for healthcare systems.

THE APPLICATION OF VISUAL SOCIAL STORY AND ROLE PLAY INTERVENTIONS TO IMPROVE SOCIAL COMMUNICATION IN ADOLESCENTS WITH AUTISM SPECTRUM DISORDER AT SLB HARAPAN BUNDA SURABAYA.

Individuals with autism have barriers to social communication and need methods to improve their social communication. The application of the intervention aims to determine the improvement of children's social communication consisting of communication skills as a basis for developing social skills with the subject being an 18-year- old woman who has a diagnosis of Autism Spectrum Disorder (ASD) who attends SLB Harapan Bunda Surabaya. Improved communication skills are obtained by visual social story method and improved social skills using role play method. The results of the application of the intervention showed that there was an improvement in the communication skills of subjects who became the basis for the development of social skills in adolescents with Autism Spectrum Disorder. Keywords: social communication, visual social stories, role play, teenagers, autism spectrum disorder.

Associations Between a Social Determinant of Health Summary Measure and Self‐Reported Physical and Mental Health Among Cancer Survivors

ABSTRACTObjectiveWe sought to examine the associations between a social needs measure and physical, and mental health among cancer survivors in the United States.MethodsWe conducted a cross‐sectional analysis using the 2022 Behavioral Risk Factor Surveillance System survey involving 16,930 eligible cancer survivors. The primary outcomes of interest were self‐reported physical and mental health in the past 30 days. A social needs measure was our primary exposure of interest. Multivariate logistic regression was used to examine the associations of interest.ResultsOverall, 56% and 73% survivors with several days of poor physical and mental health, respectively, reported having two or more social needs. In multivariate analysis, those having at least one social need were more likely to report several days of poor physical (one need: OR, 1.62; 95% CI, 1.31–2.00, two or more needs: OR, 3.52; 95% CI, 2.84–4.35) and mental health (one need: OR, 3.07; 95% CI, 2.07–4.57, two or more needs: OR, 9.69; 95% CI, 6.83–13.74). Among survivors with two or more social needs, having exercised in the past 30 days were 41% and 59% less likely to experience poor physical and mental health, respectively (p‐value &lt; 0.05). However, having at least one chronic disease was associated with several days of poor physical/mental health among those with two or more needs (p‐value &lt; 0.05).ConclusionHaving social needs was associated with self‐reporting of several days of poor physical and mental health among cancer survivors. Integrated care should include mental/physical health management addressing cancer survivors' various social needs.