scholarly journals Evaluation of a social determinants of health screening questionnaire and workflow pilot within an adult ambulatory clinic

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Rachel L. Berkowitz ◽  
Linh Bui ◽  
Zijun Shen ◽  
Alice Pressman ◽  
Maria Moreno ◽  
...  
Keyword(s):  
Physical Activity ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Average Length ◽  
Determinants Of Health ◽  
Ambulatory Setting ◽  
Social Connections ◽  
Screening Questionnaire ◽  
Ambulatory Clinic ◽  
Length Of Visit

Abstract Background There is increased recognition in clinical settings of the importance of documenting, understanding, and addressing patients’ social determinants of health (SDOH) to improve health and address health inequities. This study evaluated a pilot of a standardized SDOH screening questionnaire and workflow in an ambulatory clinic within a large integrated health network in Northern California. Methods The pilot screened for SDOH needs using an 11-question Epic-compatible paper questionnaire assessing eight SDOH and health behavior domains: financial resource, transportation, stress, depression, intimate partner violence, social connections, physical activity, and alcohol consumption. Eligible patients for the pilot receiving a Medicare wellness, adult annual, or new patient visits during a five-week period (February-March, 2020), and a comparison group from the same time period in 2019 were identified. Sociodemographic data (age, sex, race/ethnicity, and payment type), visit type, length of visit, and responses to SDOH questions were extracted from electronic health records, and a staff experience survey was administered. The evaluation was guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework. Results Two-hundred eighty-nine patients were eligible for SDOH screening. Responsiveness by domain ranged from 55 to 67%, except for depression. Half of patients had at least one identified social need, the most common being stress (33%), physical activity (22%), alcohol (12%), and social connections (6%). Physical activity needs were identified more in females (81% vs. 19% in males, p < .01) and at new patient/transfer visits (48% vs. 13% at Medicare wellness and 38% at adult wellness visits, p < .05). Average length of visit was 39.8 min, which was 1.7 min longer than that in 2019. Visit lengths were longer among patients 65+ (43.4 min) and patients having public insurance (43.6 min). Most staff agreed that collecting SDOH data was relevant and accepted the SDOH questionnaire and workflow but highlighted opportunities for improvement in training and connecting patients to resources. Conclusion Use of evidence-based SDOH screening questions and associated workflow was effective in gathering patient SDOH information and identifying social needs in an ambulatory setting. Future studies should use qualitative data to understand patient and staff experiences with collecting SDOH information in healthcare settings.

scholarly journals Aktywność fizyczna determinantą zdrowia populacji

Ekonomia ◽  
2018 ◽  
Vol 23 (4) ◽  
pp. 305-318
Author(s):  
Paulina Ucieklak-Jeż ◽  
Agnieszka Bem
Keyword(s):  
Physical Activity ◽  
Social Determinants Of Health ◽  
Public Space ◽  
Social Determinants ◽  
Health Assessment ◽  
Determinants Of Health ◽  
Average Intensity ◽  
Chi Square ◽  
Physically Active ◽  
Large Cities

Physical activity as a determinant of population’s hea lth statusIn this paper we verified and analysed the relationship between: 1 cycling in minutes and doing another sports, in a typical week, and social determinants of health; 2 moving on foot in public space and social determinants of health; 3 physical activity associated with the performance of work and the social determinants of health; 4 physical activity and health assessment, long-term health problems, diseases and chronic ailments, and athleticism. We constructed three research hypotheses: H1 residents of densely populated areas large cities are physically active; H2 the longer the time average intensity of physical activity, the healthier the population; H3 the healthiest group are people physically active. The first hypothesis was positively verified — inhabitants of large cities often spend a lot of time at work, are stressed and need some physical activity. The second hypothesis was confirmed only partially: Chi square = 1692,469; Yul φ = 0,322; Q-Kendalla = 0,297 indicate that there is a statistically significant relationship between the amount of time spent on sports and health. The longer time spent on sport, the better health. The third hypothesis was also confirmed — active physical enjoy better health.

scholarly journals Assessing Physical Activity Behavior of Cancer Survivors by Race and Social Determinants of Health

2019 ◽  
Vol 40 (1) ◽  
pp. 7-16
Author(s):  
Matthew Asare ◽  
Scott McIntosh ◽  
Eva Culakova ◽  
Amina Alio ◽  
M. Renee Umstattd Meyer ◽  
...  
Keyword(s):  
Physical Activity ◽  
Health Care ◽  
Cancer Survivors ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Access To Health Care ◽  
Determinants Of Health ◽  
Outcome Variable ◽  
Economic Stability ◽  
Access To Health

Introduction Black cancer survivors remain at a higher risk for secondary cancers, cancer recurrence, and comorbid conditions than non-Hispanic White survivors. Physical activity may help improve health outcomes and overall quality of life. We assessed cancer survivors’ physical activity by race/ethnicity and the effect of social determinants of health (SDH) constructs (i.e., economic stability, education, and access to health care) on physical activity. Methods This was a cross-sectional analysis of data from the 2016 Behavioral Risk Factor Surveillance System. The outcome variable was physical activity after cancer diagnosis and the predictor variables were SDH and race. Multivariable logistic regressions were used to examine associations between race and physical activity and the effect of SDH on physical activity. Results Among 3,787 cancer survivors, 91.6% self-identified as White and 8.4% as Black. Blacks were more likely than Whites to report low economic stability, low access to health care, and low health literacy (all ps < .01). Blacks were less likely than Whites to engage in physical activity after controlling for demographic and clinical factors (adjusted odds ratio [ORAdj] = 0.71; 95% confidence interval [CI] = 0.56–0.91; p = .01) and after additional adjustment of SDH (ORAdj = 0.77; 95% CI = 0.60–0.99; p = .04). Conclusions The findings suggest that though Black cancer survivors are less than White to engage in physical activity, and SDH partially explained the racial difference in physical activity behaviors. These findings highlight the need to address barriers to health-care access, economic stability, and educational attainment.

scholarly journals COVID‐19, Social Determinants of Health, and Opportunities for Preventing Cardiovascular Disease: A Conceptual Framework

2021 ◽  
Author(s):  
Rienna G. Russo ◽  
Yan Li ◽  
Lan N. Ðoàn ◽  
Shahmir H. Ali ◽  
David Siscovick ◽  
...  
Keyword(s):  
Physical Activity ◽  
Cardiovascular Disease ◽  
Health Care ◽  
Conceptual Framework ◽  
Social Determinants Of Health ◽  
Social Determinants ◽  
Low Income ◽  
Disease Incidence ◽  
The United States ◽  
Determinants Of Health

Abstract The COVID‐19 pandemic has disrupted the social, economic, and health care systems in the United States and shined a spotlight on the burden of disease associated with social determinants of health (SDOH). Addressing SDOH, while a challenge, provides important opportunities to mitigate cardiovascular disease incidence, morbidity, and mortality. We present a conceptual framework to examine the differential effects of the COVID‐19 pandemic on SDOH across demographically diverse populations, focusing on the short‐ and long‐term development of cardiovascular disease, as well as future research opportunities for cardiovascular disease prevention. The COVID‐19 pandemic exerted negative shifts in SDOH and cardiovascular risk factors (ie, smoking, body mass index, physical activity, dietary behavior, cholesterol, blood pressure, and blood sugar). For example, evidence suggests that unemployment and food insecurity have increased, whereas health care access and income have decreased; changes to SDOH have resulted in increases in loneliness and processed food consumption, as well as decreases in physical activity and hypertension management. We found that policy measures enacted to mitigate economic, social, and health issues inadequately protected populations. Low‐income and racial and ethnic minority communities, historically underserved populations, were not only disproportionately adversely affected by the pandemic but also less likely to receive assistance, likely attributable in part to the deep structural inequities pervasive in our society. Effective and culturally appropriate interventions are needed to mitigate the negative health impacts of historical systems, policies, and programs that created and maintain structural racism, especially for immigrants, racial and ethnic minorities, and populations experiencing social disadvantage.

scholarly journals A critique of the English national policy from a social determinants of health perspective using a realist and problem representation approach: the ‘Childhood Obesity: a plan for action’ (2016, 2018, 2019)

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Naomi Griffin ◽  
Sophie M. Phillips ◽  
Frances Hillier-Brown ◽  
Jonathan Wistow ◽  
Hannah Fairbrother ◽  
...  
Keyword(s):  
Physical Activity ◽  
Childhood Obesity ◽  
Social Determinants Of Health ◽  
Health Inequalities ◽  
Social Determinants ◽  
Policy Development ◽  
Determinants Of Health ◽  
Problem Representation ◽  
Calorie Intake ◽  
Physical And Mental Health

Abstract Background The UK government released Chapter 1 of the ‘Childhood Obesity: a plan for action’ (2016), followed by Chapter 2 (2018) and preliminary Chapter 3 was published for consultation in 2019 (hereon collectively ‘The Policy’). The stated policy aims were to reduce the prevalence of childhood obesity in England, addressing disparities in health by reducing the gap (approximately two-fold) in childhood obesity between those from the most and least deprived areas. Methods Combining a realist approach with an analysis of policy discourses, we analysed the policies using a social determinants of health (SDH) perspective (focusing on socio-economic inequalities). This novel approach reveals how the framing of policy ‘problems’ leads to particular approaches and interventions. Results While recognising a social gradient in relation to obesity measures, we critique obesity problem narratives. The Policy included some upstream, structural approaches (e.g. restrictions in food advertising and the soft-drinks industry levy). However, the focus on downstream individual-level behavioural approaches to reduce calorie intake and increase physical activity does not account for the SDH and the complexity and contestedness of ‘obesity’ and pays insufficient attention to how proposals will help to reduce inequalities. Our findings illustrate that individualising of responsibility to respond to what wider evidence shows is structural inequalities, can perpetuate damaging narratives and lead to ineffective interventions, providing caution to academics, practitioners and policy makers (local and national), of the power of problem representation. Our findings also show that the problem framing in The Policy risks reducing important public health aims to encourage healthy diets and increase opportunities for physical activity (and the physical and mental health benefits of both) for children to weight management with a focus on particular children. Conclusions We propose an alternative conceptualisation of the policy ‘problem’, that obesity rates are illustrative of inequality, arguing there needs to be policy focus on the structural and factors that maintain health inequalities, including poverty and food insecurity. We hope that our findings can be used to challenge and strengthen future policy development, leading to more effective action against health inequalities and intervention-generated inequalities in health.

Sign in / Sign up

Export Citation Format

Share Document