An Educational Initiative to Affect Poverty and Social Determinants of Health-Related Knowledge and Attitudes in Primary Care Settings

AbstractObjectiveFor nursing students, competency in population health management involves acquiring knowledge and forming attitudes about the impact of the social determinants of health (SDoH) on health equity. The purpose of this pilot study was to assess nursing students’ knowledge and attitudes about the SDoH and health equity following a focused simulation activity.MethodBaccalaureate nursing students (N=182) participated in a ninety-minute health equity simulation and a post-simulation debrief. Forty-four students (23%) completed a 19-item post-simulation survey.ResultsSixty-four percent of participants reported positive attitude change in working with marginalized populations caused by the SDoH, and 89% reported being knowledgeable about the role of the registered nurse in addressing health equity. Seventy-five percent reported enhanced knowledge of the SDoH through the health equity simulation.ConclusionUsing health equity simulation may be effective in enhancing students’ knowledge, as well as their attitudes in caring for the health of marginalized populations by addressing the SDoH.

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Pushing poverty off limits: quality improvement and the architecture of healthcare values

BMC Medical Ethics ◽

10.1186/s12910-021-00655-x ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Polly Mitchell ◽

Alan Cribb ◽

Vikki Entwistle ◽

Guddi Singh

Keyword(s):

Quality Improvement ◽

Social Determinants Of Health ◽

Social Determinants ◽

Social Deprivation ◽

Ethical Dilemmas ◽

Determinants Of Health ◽

Ethical Challenges ◽

The Social ◽

Significant Burden ◽

Health Related

Abstract Background Poverty and social deprivation have adverse effects on health outcomes and place a significant burden on healthcare systems. There are some actions that can be taken to tackle them from within healthcare institutions, but clinicians who seek to make frontline services more responsive to the social determinants of health and the social context of people’s lives can face a range of ethical challenges. We summarise and consider a case in which clinicians introduced a poverty screening initiative (PSI) into paediatric practice using the discourse and methodology of healthcare quality improvement (QI). Discussion Whilst suggesting that interventions like the PSI are a potentially valuable extension of clinical roles, which take advantage of the unique affordances of clinical settings, we argue that there is a tendency for such settings to continuously reproduce a narrower set of norms. We illustrate how the framing of an initiative as QI can help legitimate and secure funding for practical efforts to help address social ends from within clinical service, but also how it can constrain and disguise the value of this work. A combination of methodological emphases within QI and managerialism within healthcare institutions leads to the prioritisation, often implicitly, of a limited set of aims and governing values for healthcare. This can act as an obstacle to a genuine broadening of the clinical agenda, reinforcing norms of clinical practice that effectively push poverty ‘off limits.’ We set out the ethical dilemmas facing clinicians who seek to navigate this landscape in order to address poverty and the social determinants of health. Conclusions We suggest that reclaiming QI as a more deliberative tool that is sensitive to these ethical dilemmas can enable managers, clinicians and patients to pursue health-related values and ends, broadly conceived, as part of an expansive range of social and personal goods.

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Evaluation of an educational online intervention aiming to improve primary care physicians’ awareness of addressing social determinants of health in clinical care in Saudi Arabia

http://isrctn.com/ ◽

10.1186/isrctn14600984 ◽

2021 ◽

Author(s):

Basmah Almujadidi

Keyword(s):

Primary Care ◽

Saudi Arabia ◽

Social Determinants Of Health ◽

Social Determinants ◽

Primary Care Physicians ◽

Clinical Care ◽

Online Intervention ◽

Determinants Of Health

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How 6 Organizations Developed Tools and Processes for Social Determinants of Health Screening in Primary Care

Journal of Ambulatory Care Management ◽

10.1097/jac.0000000000000221 ◽

2018 ◽

Vol 41 (1) ◽

pp. 2-14 ◽

Cited By ~ 30

Author(s):

Kate LaForge ◽

Rachel Gold ◽

Erika Cottrell ◽

Arwen E. Bunce ◽

Michelle Proser ◽

...

Keyword(s):

Primary Care ◽

Social Determinants Of Health ◽

Social Determinants ◽

Health Screening ◽

Determinants Of Health

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Informal Recyclers’ Health Inequities in Vancouver, BC

NEW SOLUTIONS A Journal of Environmental and Occupational Health Policy ◽

10.1177/1048291118777845 ◽

2018 ◽

Vol 28 (2) ◽

pp. 321-343 ◽

Cited By ~ 4

Author(s):

Josie Wittmer ◽

Kate Parizeau

Keyword(s):

Environmental Health ◽

Social Determinants Of Health ◽

Social Determinants ◽

Low Income ◽

Service Providers ◽

Health Inequities ◽

Well Being ◽

Determinants Of Health ◽

Access To Health ◽

Health Related

We explore informal recyclers’ perceptions and experiences of the social determinants of health in Vancouver, Canada, and investigate the factors that contribute to the environmental health inequities they experience. Based on in-depth interviews with 40 informal recyclers and 7 key informants, we used a social determinants of health framework to detail the health threats that informal recyclers associated with their work and the factors that influenced their access to health-related resources and services. Our analysis reveals that the structural factors influencing environmental health inequities included insufficient government resources for low-income urbanites; the potential for stigma, clientization, and discrimination at some health and social service providers; and the legal marginalization of informal recycling and associated activities. We conclude that Vancouver's informal recyclers experience inequitable access to health-related resources and services, and they are knowledgeable observers of the factors that influence their own health and well-being.

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Theory vs Practice: Should Primary Care Practice Take on Social Determinants of Health Now? No.

The Annals of Family Medicine ◽

10.1370/afm.1918 ◽

2016 ◽

Vol 14 (2) ◽

pp. 102-103 ◽

Cited By ~ 14

Author(s):

L. I. Solberg

Keyword(s):

Primary Care ◽

Social Determinants Of Health ◽

Social Determinants ◽

Primary Care Practice ◽

Determinants Of Health ◽

Care Practice

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Measuring social determinants of health and their impact on service use and medical complexity

International Journal for Population Data Science ◽

10.23889/ijpds.v3i4.993 ◽

2018 ◽

Vol 3 (4) ◽

Author(s):

Dan Chateau ◽

Alan Katz ◽

Chelsey McDougall ◽

Carole Taylor ◽

Scott McCulloch

Keyword(s):

Primary Care ◽

Health Services ◽

Social Determinants Of Health ◽

Social Determinants ◽

Social Complexity ◽

Primary Care Providers ◽

Determinants Of Health ◽

Care Providers ◽

Complex Patients ◽

Medical Complexity

IntroductionPopulation based data on the social determinants of health are not widely available, despite a wide body of evidence pointing to their importance. The Mantioba Population Research Data Repository offers a unique opportunity to leverage data from multiple government departments to assess the relationship between measurable social determinants and health. Objectives and ApproachUsing population based data from health, small area level census survey questions, social assisitance, education, social housing, child protective services and justice, linked at the individual level, we measured indicators of social complexity and mapped them in the province of Manitoba. Individuals with high level of social complexity were then compared with indicators of medical complexity and/or high use of medical services to determine the degree of overlap between these attributes of individuals. A matched group of individuals without any of the measured social complexities was developed and the number and reason for visits to primary care providers was compared. ResultsThe rate of individuals having three or more social complexities varied from a low of ~7% to a high of 35%, depending on the geographic location. High residential mobiity, involvement with the justice system and history of social assistance were the most frequent (>15%). Individuals with social complexities tended to be younger and live in poorer neighbourhoods than medically complex individuals or high users of health services. Socially complex persons had on average 5.5 primary care visits annually, compared to only ~3.5 for matched individuals with no social complexities. The overlap with high users of health services was slight (14.4%) and depended on the characteristics of the population. The overlap with medically complex patients ws higher (16.2%), particularly when medical complexity included mental health related diagnoses (20.4%). Conclusion/ImplicationsThe proportion of individuals with social complexities is large, and a substantial number have multiple risk factors. These individuals are for the most part a unique group, distinct from medically complex patients. Different strategies for care may be necessary to promote and sustain mental and physical health and wellbeing.

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