Healthy Eating and Exercising to Reduce Diabetes: Exploring the Potential of Social Determinants of Health Frameworks Within the Context of Community-Based Participatory Diabetes Prevention

Abstract Background A 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. Methods Study 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. Results We 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. Conclusions The CBME curriculum enabled medical students to understand the factors of SDH to some extent. Further work is needed to deepen their levels of reflection.

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Factors That Facilitate Addressing Social Determinants of Health Throughout Community-based Participatory Research Processes

Progress in Community Health Partnerships Research Education and Action ◽

10.1353/cpr.2017.0016 ◽

2017 ◽

Vol 11 (2) ◽

pp. 119-127 ◽

Cited By ~ 3

Author(s):

Rebecca Paradiso de Sayu ◽

Shannon M.A. Sparks

Keyword(s):

Social Determinants Of Health ◽

Participatory Research ◽

Social Determinants ◽

Community Based Participatory Research ◽

Determinants Of Health ◽

Community Based

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Disparities in cancer survival in patients with multiple myeloma: A community-based cancer center experience.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.15_suppl.e20530 ◽

2020 ◽

Vol 38 (15_suppl) ◽

pp. e20530-e20530

Author(s):

Jessica M. Stempel ◽

Vinicius Machado Jorge ◽

Djeneba Audrey Djibo ◽

Claudia M. Dourado

Keyword(s):

Multiple Myeloma ◽

Overall Survival ◽

Social Determinants Of Health ◽

Social Determinants ◽

Household Income ◽

Statistical Significance ◽

Determinants Of Health ◽

Cancer Center ◽

Community Based ◽

Increased Risk

e20530 Background: Multiple myeloma (MM) accounts for nearly 17% of all hematological malignancies and 2% of all cancer-related deaths in 2018. Despite new treatment options, survival disparities among African Americans (AA) and other ethnic minorities still exist. Although cytogenetics and advanced age are high-risk features, equal healthcare access may also impact outcomes. We aim to investigate the social and biological factors which affect overall survival in patients with MM in a community setting with a predominantly AA population. Methods: We retrospectively identified MM cases diagnosed from January 1, 2013 and March 30, 2019, from our tumor registry. We collected demographic, clinical, histopathologic and treatment variables. Our primary endpoint was overall survival (OS). Overall and median survival with 95% confidence intervals were obtained using Kaplan Meier estimates. Results: We identified 73 patients with MM. Median age was 70 years (range, 42-88 years), 31 were female (42%) and 58 were AA (79%). Median household income in the AA group was $37,832 and $50,810 in the non-AA group ( p< 0.05). AA had a median overall survival (OS) of 15.9 months (95% CI, 8.2-23.7) compared to non-AA, 21.9 months (95% CI, 2.1-41.7). After a median follow-up of 20 months, the HR for death in AA was 1.32 (95% CI, 0.71-2.5); p= 0.37. None of the variables investigated were independently associated with an increased risk of mortality. Conclusions: Social determinants of health play a major role in community-based cancer centers, including access to care, income and social support. A difference in household income was found between both groups but was not independently associated with a survival advantage. Although, our results show AA patients with MM have a shorter OS compared to non-AA, this failed to reach statistical significance. The size of our sample limited the discovery of potential discrepancies in social determinants of health between both groups and their effect on outcomes. Larger-scale community-based studies are indispensable to investigate these differences further. [Table: see text]

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An Interprofessional Community‐Based Complex Care Course Grounded in Social Determinants of Health

Journal of the American Geriatrics Society ◽

10.1111/jgs.16884 ◽

2020 ◽

Author(s):

Sara E. Hart ◽

Kyle Turner ◽

Timothy W. Farrell

Keyword(s):

Social Determinants Of Health ◽

Social Determinants ◽

Determinants Of Health ◽

Complex Care ◽

Community Based ◽

Care Course

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Health Equity in Community Assessments: A Participatory Approach in Rural Virginia

SAGE Open ◽

10.1177/2158244019838925 ◽

2019 ◽

Vol 9 (1) ◽

pp. 215824401983892 ◽

Cited By ~ 1

Author(s):

Maria Gilson deValpine ◽

Laura Hunt Trull

Keyword(s):

Community Health ◽

Social Determinants Of Health ◽

Social Determinants ◽

Health Needs ◽

Determinants Of Health ◽

World Health ◽

Health Improvement ◽

Research Approach ◽

Community Based ◽

Community Health Improvement

A coalition of community members and human service professionals in the rural central Shenandoah Valley of Virginia has performed a community assessment every 5 years. Overreliance on quantitative surveys and hospital-based Community Health Needs Assessments resulted in earlier assessments failing to identify the needs of vulnerable populations. As the coalition approached the time for a new assessment, their priority was to develop a deeper understanding of community health needs and solutions. An extended co-learning process between coalition, community, and local academic representatives resulted in a plan to develop assessment methods and community health improvement resources suited to this goal. The coalition identified methods rooted in the social determinants of health and utilized a community-based participatory research approach to provide underserved residents the opportunity to contribute to health research and decision making and produce an assessment more reflective of their community. Resources including local interpretation and implications of the World Health Organization’s 10 Social Determinants of Health, a Healthy People 2020 community health services profile, and user-friendly access to community-based secondary data sets were developed for intervention planning. All information, resources, and implications were shared at meetings, in public announcements, and at a public forum. All data remain publicly available on the coalition’s website. Previously held beliefs regarding access to care and quality of life were substantiated through this process, enabling the coalition to better align itself with local political entities and to move forward immediately with community health improvement planning.

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