Understanding Of Social Determinants Research Articles

176 Translational Challenges and Facilitators of Health Equity Research Integrating Social Determinants of Health with Patient- and Community-Centered Technology

OBJECTIVES/GOALS: - Illustrate findings of a translational science case study of multi-pronged research aimed at understanding of social determinants in health disparities and integrating patient-centered technology; - Illuminate translational mechanisms by analyzing and sharing research challenges, facilitators, and benefits. METHODS/STUDY POPULATION: Utilized novel TS evaluation methods and tools: - Translational Science Case Study protocol to examine translational path from innovation to practice, barriers and facilitators for that translational movement. - Translational Science Benefits Model (TSBM) Checklist for translational/research impact analysis. Triangulated diverse data sources: - Primary data: semi-structured interviews with research partners. - Secondary data: researchers’ grant applications, reports, and publications; public stories/news related to their research; scientific publications; organizational/policy documents; and interviews with research stakeholders featured in published sources. RESULTS/ANTICIPATED RESULTS: Translational challenges include: culturally tailored education and outreach; data analysis and intervention planning; engaging community stakeholders in the development and implementation; addressing economic and resource-related challenges. Translational facilitators are: UMN CTSA funding and other support; access to data and resources; use of open-source materials; evidence-based/best practice approaches; diversity and collaboration between researchers, community organizations, healthcare providers; researchers’ drive to translate. The research contributes to community and public health, clinical/medical, and economic benefits, health equity advocacy, catalyzing further research, and public awareness. DISCUSSION/SIGNIFICANCE: The evaluation case study contributes to translational science by providing evidence and lessons learned related to translational benefits, challenges, and facilitators of community-based, patient-centered research bringing people, knowledge, and technology together and contributing to health equity.

Developing and teaching an interprofessional service-learning undergraduate course for pre-health and human services students

This interprofessional service-learning course focused on exploring how social determinants of health such as economic stability, education, social and community environment, and health and health care affect populations. Through reading narratives and eliciting stories from participants and students during their volunteer hours at a local hospital, students increased their understanding of social determinants and learned effective interprofessional communication and collaboration strategies. The paper outlines the process and steps to building a partnership with a health care institution and supporting students as they engaged in service learning. Reflections from the instructors, facilitators, and students are discussed.

Integrating Narrative Medicine Through Story-Telling: A Feasibility Study in a Community Medicine Curriculum for Undergraduate and Postgraduate Students.

Introduction The routine curriculum of community medicine includes clinico-social case-taking with a focus on the physical, biological, and psychosocial determinants of health. There is an opportunity to integrate narrative medicine with this for undergraduate and postgraduate medical students using story-telling. The objective of the current study was to assess its feasibility, challenges, and opportunities. Methods We conducted a need assessment cross-sectional survey of the teaching faculty of community medicine across India using Google Forms. Considering an 80% positive response in a pilot within the department, a relative error of 10%, and a 20% non-response rate, the sample size was 120. The questionnaire included closed-ended questions with a Likert scale that dealt with affective, cognitive, and communication domains and open-ended questions for insights into opportunities and challenges. The results of the former were expressed as descriptive statistics, in frequencies and proportions. Open-ended questions were summarized to guide the refinement of further implementation. Results Of the 120 participants, 92 (77%) quoted low/medium empathy quotient in students, and 107 (89.2%) felt that the listening skills of students can improve with the introduction of story-telling. A hundred and twelve (93.4%) participants felt that their history-taking skills can improve with story-telling, and all agreed that the language of medicine can be improved. One hundred nine (90.8%) felt that it will lead to better student-patient interaction. Opportunities included a better understanding of social determinants, patient-/family-centered care, improved communication skills, and better mental health. The key challenges included time, motivation, the need for training/capacity building, and streamlining of assessment metrics. Conclusion We conclude that story-telling may help medical students investigate various social determinants of health, disease, and lived environments that createvulnerabilities.

Racism, Not Race: A Physician Perspective on Anti‐Black Racism in America

In this commentary, which responds to the article "Anti-Black Racism as a Chronic Condition," by Nneka Sederstrom and Tamika Lasege, I draw on my experience as a physician who cares for a largely Black patient population. Physicians are trained to "first do no harm" and strive to treat patients to the best of their abilities. However well intentioned, many of us fall short of this goal and witness the consequences of health inequities that disproportionally impact the lives of Black patients. Recent years have brought increased acknowledgment and understanding of social determinants of health, but these modest changes fail to identify the true culprit of health disparities. Racism, not race, is responsible for the negative outcomes that we see in our communities of color. Both subtle and overt forms of systemic racism plague the educational systems and scientific metrics of medicine in the United States. Physicians' training, culture, and biases are founded in White norms. To decenter Whiteness as a normality, medicine must enact a multipronged approach that begins with increasing the diversity of physicians and providers to better reflect the patients that they care for. Bioethicists must publicly state that racism is real and that we are dedicated to changing it, but to get beyond statements, we must also have a measure of improvement and success in battling racism.

Global Is Local: Interprofessional Experiential Learning for Migrant Farmworker Health Equity.

PurposeMedical educators recognize the importance of addressing social determinants of health and providing opportunities for learners to work with diverse populations. Still, social, geographic, resource, and language barriers prevent institutions from connecting with globally diverse populations within their own communities. In this article, we describe the migrant farmworker health course at the University of Minnesota, the importance of longitudinal partnership with community-based organizations, and ways to increase access to care and educate health professional learners in health equity.MethodsThe migrant farmworker health course is a clinical rotation that combines didactic learning on social determinants of health with hands-on clinical experience. Learners work with community organizations to provide mobile health care while learning about a diverse and underserved rural population. Twenty-eight learners who participated in the course between 2015 and 2019 were surveyed about their experience, knowledge, and skills gained, and recommendations for improvement.ResultsOver 90% of participants rated their overall experience in the course as “good” or “outstanding.” Most learners increased confidence in the subjects that were covered during didactic sessions. Qualitative feedback provided insight on how the migrant farmworker health course shaped learners' understanding of social determinants of health and influenced their career trajectories.ConclusionThe migrant farmworker health course has educated interprofessional learners and is expanding to include more opportunities for mobile health care. The feedback from this survey helped improve didactic teaching and will help deepen relationships with community partners. Learning through service with global populations locally in a “global is local” rotation is a rewarding way to engage in and learn about health equity.

Telomere Length and Preterm Birth in Pregnant Mexican-Origin Women.

Despite the obstacles of limited education and employment opportunities-and the stress associated with immigration and pregnancy-Mexican immigrant women have low rates of preterm birth (PTB) compared to the US national average for all races and ethnicities. Stressors during pregnancy, and stressors associated with acculturation, may accelerate cellular aging manifested by shortened telomere length (TL) in pregnant women. Our objectives were to: (1) determine whether women with PTBs had shorter telomere lengths compared to women who had full term births; (2) assess the association of acculturation with TL and PTB. This prospective pilot study collected data from 100 self-identified Mexican-origin pregnant women. Survey data included self-administered sociodemographic and acculturation measures and was collected from participants via paper and pen, while biologic data was collected via a single blood draw during a regularly scheduled prenatal visit between 26 and 36weeks gestation. PTB data was collected from the participant's medical record after delivery. TL was significantly associated with PTB; the median TL of the women with PTB was less than the median TL for the full sample (p = 0.02). Based on regression analysis for PTB vs acculturation, we found no significant associations between acculturation and PTB or TL. This study provides important evidence of the association between shortened maternal TL and adverse birth outcomes. By linking social, clinical and biologic data, we can enhance our understanding of social determinants that may affect racial and ethnic disparities in preterm birth.

The politicians\u2019 perspectives on participation in mammographic screening: an interview-based study from a region in Sweden

BackgroundBreast cancer is the most common cancer type among women globally. To facilitate early detection, all 40–74-year-old female residents of Sweden are invited to participate in a population-based mammographic screening programme. Approximately 20% of all invited women decline the offer, and if this is due to systematic differences that can be adjusted, it can indicate inequity in healthcare. Assessment of and being updated about the health and healthcare of the residents are largely the responsibilities of the self-governed regions in Sweden. The understanding of the residents’ health serves as a basis for decision making and priority setting. This study aims to describe how politicians representing a region in Sweden perceive women’s participation in mammographic screening and the politicians’ own possibility to promote such participation.MethodsQualitative thematic analysis was conducted on the data obtained from individual semi-structured interviews held in 2019. The interviewees comprised ten politicians (six women and four men, 38–71 years old) representing a sub-committee focusing on public health and healthcare issues.ResultsTwo main themes have been identified: 1) expected actions and 2) expected conditions for acting, including a total of four sub-themes. According to the politicians, the expected actions, such as obtaining information and being updated about matters regarding mammographic screening, concern both the women invited to the screening and the politicians themselves. Additionally, for both the individual and the healthcare organisation, here represented by the politicians, expected actions entail a shared commitment to maintain health. The expected conditions for acting refer to the politician’s awareness of the factors influencing the women’s decision to undergo or refuse the screening and having the resources to enable taking actions to facilitate participation.ConclusionsExpected actions and expected conditions for acting are tightly connected and entail some form of prioritisation by the politicians. Setting the priorities can be based on information about the purpose of the screening and an understanding of social determinants’ impacts on women’s decision to refrain from mammographic screening, as well as available resources.

An evaluation of cascading mentorship as advocacy training in undergraduate medical education

BackgroundPhysicians are in a position of great influence to advocate for health equity. As such, it is important for physicians-in-training to develop the knowledge and skills necessary to fulfil this role. Although various undergraduate medical programs have implemented health advocacy training, they often lack experiential learning and physician involvement. These aspects are foundational to the Advocacy Mentorship Initiative (AMI) which utilizes cascading mentorship as a novel approach to advocacy training. Medical students develop advocacy competency as peer mentors to youth raised in at-risk environments, while also being mentored themselves by physician residents. We aim to determine whether there are specific advantages to utilizing cascading mentorship to facilitate the attainment of advocacy competencies in undergraduate medical education.MethodsMedical students participating in AMI between 2017 to 2020 completed pre- and post-exposure questionnaires. Questionnaires assessed confidence in advocacy-related skills and knowledge of youth advocacy concepts, as well as learning goals, skills gained, benefits of AMI and resident mentors, and impact on future career. Sign tests were utilized to analyze quantitative results, and content analysis was used for open-ended responses. A triangulation protocol was also utilized.ResultsFifty mentors participated, 24 (48%) of which completed both pre- and post-exposure questionnaires. Participants gained confidence in advocacy-related skills (p < 0.05) such as working with vulnerable populations and advocating for medical and non-medical needs. They also reported significant improvements (p < 0.01) in their understanding of social determinants of health and concepts related to children’s health and development. Content analysis showed that participants built meaningful relationships with mentees in which they learned about social determinants of health, youth advocacy, and developed various advocacy-related skills. Participants greatly valued mentorship by residents, identifying benefits such as support and advice regarding relations with at-risk youth, and career mentorship. AMI impacted participants’ career trajectories in terms of interest in working with youth, psychiatry, and advocacy.ConclusionsAMI offers a unique method of advocacy training through cascading mentorship that engages medical students both as mentors to at-risk youth and mentees to resident physicians. Through cascading mentorship, medical students advance in their advocacy-related skills and understanding of social determinants of health.

Students\u2019 understanding of social determinants of health in a community-based curriculum: a general inductive approach for qualitative data analysis

BackgroundA community-based medical education (CBME) curriculum may provide opportunities to learn about the social determinants of health (SDH) by encouraging reflection on context, but the categories that students can learn about and their level of reflection are unclear. We aimed to analyze medical students’ understanding and level of reflection about SDH in a CBME curriculum.MethodsStudy design: General inductive approach for qualitative data analysis.Education Program: All 5th-year and 6th-year medical students at the University of Tsukuba School of Medicine in Japan who completed a mandatory 4-week clinical clerkship in general medicine and primary care during October 2018 and May 2019 were included. The curriculum included 3 weeks of rotations in community clinics and hospitals in suburban and rural areas of Ibaraki Prefecture. On the first day, students learned about SDH through a lecture and a group activity. As an SDH assignment, they were instructed to prepare a structural case description using the Solid Facts framework based on encounters during the curriculum. On the final day, they submitted the structural reflection report.Analysis: Content analysis was based on the Solid Facts framework. Levels of reflection were categorized as reflective, analytical, or descriptive.ResultsWe analyzed 113 SDH case descriptions and 118 reports. On the SDH assignments, the students frequently reported on social support (85%), stress (75%), and food (58%), but less frequently on early life (15%), unemployment (14%), and social gradient (6%). Of the 118 reports, 2 were reflective, 9 were analytical, and 36 were descriptive. The others were not evaluable.ConclusionsThe CBME curriculum enabled medical students to understand the factors of SDH to some extent. Further work is needed to deepen their levels of reflection.

Gaining Support for Child and Family Policies by Raising Awareness of the Link between Physical and Mental Health and the Impact of Social Determinants on Both

ABSTRACTResults of a pilot study examining young adults’ beliefs about what factors contribute to physical and mental health are reported. Existing research and the results of the pilot study are used to argue for the need for improved education on the connection between physical and mental health, the impact of social determinants on physical and mental health, and the potential for social policies that better the lives of children and families to improve health outcomes. Benefits of and suggestions for increasing understanding of social determinants and social policies on physical and mental health are explored.

The Slippery Slope of Child Feeding Practices in India

National Family Health Survey 4 (NFHS-4) data shows a ten percentage point decline in timely complementary feeding rates in the backdrop of increases in breastfeeding indicators. There is large-scale decline in this indicator across all regions and states. An understanding of social determinants is critical for generating transformative ideas to address these challenges.

Aprendizagens acadêmicas sobre saúde pública em uma universidade canadense: contribuições para a formação brasileira

This paper aims to discuss Brazilian undergraduate students'learning in the public health. This is a descriptive, reflexive study, characterized as an experience report. Theoretical references of the Canadian and Brazilian health systems were used in order to analyze the public health and the impact of international educational exchange in professional qualification. There are theoretical and conceptual similarities in health systems, in the understanding of social determinants. However, the application of the social determinants of health yielded more results in the Canadian system. Public health learning in a Canadian university highlighted a great focus on determinants, allowing the students to think about Brazilian health care models. With this experience, discussions can be held in educational spaces, reflecting the social implication of Science without Borders Program in professional education.

An interdisciplinary approach to cultural competence education in an academic health center

Described in this paper is an example of integrating humanities into health interventions or clinical care via a Masters course for graduate students in medical education. The paper outlines the background of the authors (a linguist and a family physician) and explores how their diverse experiences have impacted course development. It describes an increasing number of clinical cases in a large academic health center that spotlight cultural discordancy and subsequent barriers to quality clinician-patient communication and decision-making. It focuses on cultural and linguistic competency and demonstrates how these skills enhance our understanding of social determinants of health. Lastly, it identifies new areas for improving the quality of care in our increasingly diverse community.

Using Digital Stories to Educate Public Health Students About Local Social Determinants of Health

Digital stories are short videos that use narrative structures to address issues from a personal perspective. They have been used to educate populations about health topics, including teen pregnancy, cancer screening, and substance abuse. Social determinants of health and structural inequalities are known contributors to health inequity and are a set of fundamental concepts for public health students to understand, particularly within local communities. To address this issue, a digital story was created by an instructor of undergraduate and graduate public health courses with both the instructor’s personal narrative and commentary when driving between adjacent racially segregated neighborhoods in a suburb near where she lives. The health disparities and the connection between place and health were highlighted in the narration. Public health students at a university that borders the communities featured were shown the video, pre- and posttests were administered ( n = 119) and a paired t test was performed to measure differences in the students’ knowledge about social determinants of health. An open-ended question about the video was also analyzed. Students demonstrated increased understanding of social determinants of health ( p &lt; .001), local health inequity ( p &lt; .001), and residential segregation ( p &lt; .000). Qualitative responses indicated that students had seen these differences in local neighborhoods but were unaware of the connection between residential segregation and health. Digital stories, particularly rooted in local neighborhoods, can be an effective way to educate undergraduate and graduate students about social determinants of health.

Integrating Social Determinants of Health into Primary Care Clinical and Informational Workflow during Care Transitions.

Context:Care continuity during transitions between the hospital and home requires reliable communication between providers and settings and an understanding of social determinants that influence recovery.Case Description:The coordinating transitions intervention uses real time alerts, delivered directly to the primary care practice for complex chronically ill patients discharged from an acute care setting, to facilitate nurse care coordinator led telephone outreach. The intervention incorporates claims-based risk stratification to prioritize patients for follow-up and an assessment of social determinants of health using the Patient-centered Assessment Method (PCAM). Results from transitional care are stored and transmitted to qualified healthcare providers across the continuum.Findings:Reliance on tools that incorporated interoperability standards facilitated exchange of health information between the hospital and primary care. The PCAM was incorporated into both the clinical and informational workflow through the collaboration of clinical, industry, and academic partners. Health outcomes improved at the study practice over their baseline and in comparison with control practices and the regional Medicaid population.Major Themes:Current research supports the potential impact of systems approaches to care coordination in improving utilization value after discharge. The project demonstrated that flexibility in developing the informational and clinical workflow was critical in developing a solution that improved continuity during transitions. There is additional work needed in developing managerial continuity across settings such as shared comprehensive care plans.Conclusions:New clinical and informational workflows which incorporate social determinant of health data into standard practice transformed clinical practice and improved outcomes for patients.

Rural health in a global context: case study of human trafficking

education centered on the social determinants of health for both Ugandan and international health professional students engages the contentious topic through structured intercultural dialogue. The methodology utilized provides Ugandan and international students alike the opportunity to not only examine the neglected and controversial global health issue but to develop the critical ability to constructively dialogue. Structure/Method/Design: SocMed’s intercultural dialogue on sexual orientation aims to challenge students to engage in effective communication and develop an attitude and skill-set associated with inquiry rather than one that reinforces ideologies. SocMed utilizes Freirian pedagogy to create an innovative learning environment inwhich students participate as both learners and teachers to advance understanding of social determinants of health, social experience of illness, effective models for intervention, and applicable models for health advocacy. To discuss sexual orientation, SocMed utilizes a structured intercultural dialogue process, in which students develop skills of activelistening, inquiry, social analysis, and respectful articulation of personal beliefs. After defining terms and soliciting anonymous questions, students are broken into small groups with diverse representation. A series of questions are provided that prompt students to reflect on their own experiences of marginalization, their own socialization to sexual orientation, and health-related concerns of LGBTQpersons. Furthermore, in small groups, students are given the text of recent Ugandan legislation on the topic and are asked to read it, discuss it, and explore explanations for why the bill was introduced in Uganda. Outcomes & Evaluation: To gauge the impact of the sexual orientation dialogue along with other sessions taught in the 4-week immersion course, a formal self-assessment evaluation tool is utilized at the end of the course. Seventy-nine percent of the students stated that they “agreed” or “strongly agreed” that they found the [sexual orientation] section of the course interesting and [they] learned a considerable amount. Given the polarizing indications of students prior to the session, this represents significant impact. Furthermore, ethnographic observation indicates that students continue to effectively dialogue on sexual orientation outside of class. Going Forward: Creating safe spaces of trust and mutuality are central in SocMed’s evolution; it is an essential dimension for sensitive dialogue to be fruitful. An ongoing challenge is SocMed’s capacity to measure the impact of the dialogue on students and on their communities to which they return after the course. Funding: None. Abstract #: 01ETC030

The Interface of Mental Health and Human Rights in Indigenous Peoples: Triple Jeopardy and Triple Opportunity

Insufficient understanding of the reciprocal interactions between health and human rights, mental health and human rights and the realization of all human rights by Indigenous peoples constitute a triple jeopardy in how these topics are currently being addressed and/or openly antagonized. This paper will attempt to show how a combined health and human rights approach to mental health in Indigenous peoples can transform a triple jeopardy into a triple opportunity. The vast and growing body of literature on mental health, health as a whole, and human rights as these relate to health and to Indigenous peoples will be used to frame the discussion. Attention to the complex interactions of health and human rights can guide policy formulation and action by offering a method of analysis, a process of participatory decision and a framework for accountability. In addition, mental health can find its rightful place in the health and human rights discourse through efforts to help policymakers and practitioners broaden their vision of mental illness to holistically encompass aspects of physical, social, emotional and cultural wellbeing. Finally, connecting the role that rights realization plays in determining health and wellbeing will add power to the rightful claims by Indigenous peoples to the promotion and protection of all their human rights--civil, political, economic, social and cultural. Broadening the research agenda by applying systematically a health and human rights analytical framework to the understanding of social determinants of health would minimize the risk of assigning health outcome merely to behaviours, practices and lifestyles, uncovering structural determinants of holistic health entrenched in policies and governmental conduct. Building the evidence of the negative impact of human rights violation on health and the negative impact of ill-health on the fulfilment of other human rights can help in designing comprehensive interventions, building on the synergy between the promotion of health and the promotion of rights. A way forward is proposed for which it is essential that work be carried out across ethnic lines and professional boundaries to further advance the claim of Indigenous peoples for better health and greater enjoyment of human rights.