Impact of Social Determinants of Health on Self-Perceived Resilience: An Exploratory Study of Two Cohorts of Adults with Congenital Heart Disease

Social determinants of health(SDOH)affect quality of life.We investigated SDOH impacts on self-perceived resilience among people with adult congenital heart disease(ACHD).Secondary analysis of data from two com-plementary studies:a survey study conducted May 2021–June 2022 and a qualitative study conducted June 2020–August 2021.Resilience was assessed through CD-RISC10 score(range 0–40,higher scores reflect greater self-perceived resilience)and interview responses.Sociodemographic and SDOH(education,employment,living situa-tion,monetary stability,financial dependency,area deprivation index)data were collected by healthcare record review and self-report.We used linear regression with robust standard errors to analyze survey data and performed a thematic analysis of interview data.Survey participants(N=127)mean age was 42±14 years;51%were female,87%white.ACHD was moderate(75%)or complex(25%);41%functional class C or D.Resilience(mean 30±7)varied by monetary stability:compared to people with difficulty paying bills,resilience was 15.0 points higher(95%CI:6.9–23.1,p<0.001)for people reporting having enough money and 14.2 points higher(95%CI:5.9–22.4,p=0.001)for those reporting just enough money.Interview participants’(N=25)mean age was 32 years(range 22–44);52%were female,72%white.ACHD was moderate(56%)or complex(44%);76%functional class C or D.Participants discussed factors affecting resilience aligned with each of the major SDOH,prominently,economic stability and healthcare access and quality.Financial stability may be important for supporting self-perceived resi-lience in ACHD.This knowledge can inform the development of resilience interventions for this population.

Social Determinants of Health Behaviors in Primary School Children：A Cross-sectional Study of both Migrant and Resident Children in Beijing,China

Childhood risky behaviors always result in adverse health outcomes. These behaviors are greatly affected by social environment and individual factors. However, few studies explored the social determinants of schoolchildren＇s health behaviors. In this cross-sectional study, the social determinants of health behaviors were examined among both migrant and resident students in Beijing, China. Data of 967 children from six urban and suburban primary schools were analyzed using multiple linear regression analysis. The results showed that less than 60% of children performed some healthy behaviors, although their health knowledge was generally good. Children＇s health behavior scores were greatly determined by school characteristics, health knowledge, demographic characteristics, and family context. Therefore, improving health education and conditions in primary schools is the priority to promote children＇s healthy behaviors, especially for disadvantaged children.

“I Felt Defeated. I Felt Helpless”: Social Determinants of Health Influencing the Cancer Survivorship of a Young Latina Mother

Social determinants of health (SDOH) contribute to cancer disparities among young Latina women (<50 years) residing in the counties along the US-Mexico border. These SDOH are particularly burdensome to young Latina mothers diagnosed with cancer while they are raising school-age children. Conexiones, a culturally adapted program designed to improve mother and child adjustment to maternal cancer, was piloted with diagnosed Latina mothers residing in border counties in New Mexico and Texas. The purpose of this case analysis was to highlight the SDOH affecting a young Latina mother’s cancer survivorship in the U.S.-Mexico border region. The participant’s Conexiones education sessions were recorded, transcribed, translated to English, back translated to Spanish to establish accuracy, and inductively coded. The participant’s baseline survey indicated she was a young (<50 years), married, Spanish-speaking Latina mother diagnosed with breast cancer while raising a teenage daughter. Seventeen SDOH themes affecting the participant’s cancer experience were identified in the cancer-related emotional triggers she reported across five Conexiones sessions. These themes were organized using Yanez’s conceptual model of determinants of cancer outcomes in Hispanics (i.e., socioeconomic, healthcare, cultural context, and psychosocial). Findings provide direction for cultural adaptations of evidence-based programs.

Social determinants of type 2 diabetes and health in the United States

Diabetes is the sixth leading cause of death in the United States. To date, most research and resulting clinical strategies have focused on the individual with shortterm health improvements that have not been maintained over time. Researchers more recently have recognized the need to consider the social determinants of diabetes and health along with individual factors. The purpose of this literature review is to examine current understanding of the social determinants affecting diabetes and health. A search of medical and nursing literature was conducted using PubMed, PsychInfo, CINAHL and MEDLINE databases, selecting articles published between 2000 and 2013. Search terms included: type 2 diabetes, social determinants, and health determinants. Inclusion criteria were: English language, human studies, social determinants of diabetes and health, and research in the United States. Additional search methods included reference chaining of the literature. Twenty research articles met the inclusion criteria for the review and analysis and included quantitative and qualitative methods. All studies selected for this review were descriptive in nature(n = 20). Fifteen studies were quantitative studies and five were qualitative studies. No intervention studies met inclusion criteria. Each study is summarized and critiqued. Study findings indicate that external or upstream factors consistentlyaffect individuals diagnosed with diabetes, influencing self-management. Significant methodological limitations result directly from small sample sizes, convenience or nonprobability sampling, and low statistical power.

Health Hot Spots: Mapping Hospital Costs and Social Determinants of Health

Accountable care organizations (ACOs) and hospitals are facing additional requirements and financial rewards for improving population health. Therefore, ACOs and hospitals will need tools to understand the relationship between their patients and social determinants and health. We demonstrate the use of hot spotting for identifying geographical sources of high hospital costs and examining links between social determinants of health and these high-cost areas, known as hot spots. In 2012, using hospital data, we generated maps of inpatient costs from 2011 throughout New Haven and within an example neighborhood, Dixwell. We defined hot spots as addresses where costs were in the top 25%. We also overlaid data on concerns and assets in the community. Finally, we calculated the number of concerns and assets that fall within the 250 and 500 ft radii of the defined hot spots. We found that 34 addresses in Dixwell accounted for 70% of total costs for Dixwell. Hot spotting is a straightforward, approachable, and easily understood method for ACOs and hospitals to begin to address population health.

Asian-American elders’ health and physician use: An examination of social determinants and lifespan influences

While the Asian American population is growing rapidly, relatively little research has focused on intergroup health comparisons. The application of the life course perspective sheds new light on the inter-section of the ageing process and social determinants of health. This study compares physician use and health equity among Asian ethnic groups and non-Hispanic Whites. Data on Asian American and non-Hispanic White immigrants over 65 were extracted from the California Health Interview Survey. Weighted logistic regression models were tested applying the Commission on Social Determinants of Health model. Intergroup differences in physician use and health equity were observed. Furthermore, physician use and health varied among the groups by age. The diverse background of older Asian Americans and the differential effects of the ageing process point to the need for novel interventions to promote health among this population.

From Social Determinants of Health Actions to Fight against the Lassa Virus Hemorrhagic Fever Epidemic in Tchaourou Commune in Benin, 2018

Background: Lassa Hemorrhagic Fever (LHF) is endemo-epidemic in West Africa with seasonal outbreaks raising a major public health issue. Nigeria borders Benin by the Tchaourou Commune. Since 2016, Tchaourou commune has been affected every year by this epidemic. Objective: To study how an action on the health social determinants can contribute to ending this epidemic in Tchaourou commune, Benin. Methods: This cross-sectional study was conducted in Tchaourou commune. All of the cases of LHF occurring in 2016-2018 were retrospectively tracked throughout the commune. The health workers and 172 participants of the general population of villages of the cases were enrolled. We used absolute frequency to describe the LHF cases because of their small number. The descriptive analyses were performed using EPI-INFO 7.1.14. Results: Overall, 27 cases of LHF occurred in Tchaourou. In these 27 cases, 12 were Laboratory-Confirmed. All 4 probable cases died while 42% and 18% died in the confirmed and suspected cases, respectively. Most (75%) of the cases were female. By direct observations, the commune had a weak health-promoting environment for fighting against LHF outbreak. According to the health care staff in the commune, the interventions were for controlling the outbreak and not the promoting interventions to preventing further outbreaks. Conclusion: To fight effectively against the Lassa fever, it is necessary to act on different social determinants of health with community participation, empowerment and health control. The fight against Lassa fever remains a major challenge facing developing countries like Benin.

The Social Determinants of Health and the Role of the Health Care System: A Case Study of the Significance of Good Governance in Public Hospitals in South Africa

Increasingly international and national policies are being directed at actions for the social determinants of health and for an integrated approach to health care provision, not only in terms of institutional cooperation but also stakeholder involvement. A key component of both these policies is the development of good governance principles in all health care agencies and organizations. A neglected dimension in these debates has been the role of the public hospital which remains a vital and expensive dimension of service provision. In a case study of a public hospital in South Africa, this paper charts the readiness of its management principles and activities to provide quality health care linked to population health and to contribute to the non-medical determinant of health. Using Taylor’s principles of good governance, we conclude that there is a mixture of good and not so good governance activity. The paper concludes by examining the external constraints on the public hospital and by providing suggestions for future activities.

Insights into the Social Determinants of Health in Older Adults

In this paper, we review the social determinants of health in older adults and their complex interrelationship with medical diseases. Also, we provide recommendations to address these determinants in the integrated healthcare plan. The social determinants in older adults and its influence in health outcomes have been studied for decades. There is solid evidence for the interrelationship between social factors and the health of individuals and populations;however, these studies are unable to define their complex interrelatedness. Health is quite variable and depends on multiple biological and social factors such as genetics, country of origin, migrant status, etc. On the other hand, health status can affect social factors such as job or education. Addressing social determinants of health in the integrated healthcare plan is important for improving health outcomes and decreasing existing disparities in older adult health. We recommend a person-centered approach in which individualized interventions should be adopted by organizations to improve the health status of older adults at the national and global level. Some of our practical recommendations to better address the social determinants of health in clinical practice are EHR documentation strategies, screening tools, and the development of linkages to the world outside of the clinic and health system, including social services, community activities, collaborative work, and roles for insurance companies.

Social Determinants of Health in Understanding the Socio-Economic Impacts of Covid-19 Pandemic in Bangladesh

Social determinants of health are some indicating factors such as income, education, class, gender, and race that influence the socio-economic status of people living in a society. Coronavirus affects the social, economic, and also political sectors of people all over the world. In Bangladesh, during the Covid-19 pandemic, people of all ages and classes have faced social and economic crises based on the social determinants of health. Higher-class families had the facility of advanced medical services rather than the lower and lower-middle classes. This article aims to show the relationship between the social determinants of health and the socio-economic impact of the Covid-19 pandemic in Bangladesh. This paper presents some secondary data to describe the socio-economic impact of Covid-19 and the functions of the social determinants of health in this case.

Impact of Social Determinants of Health on the Choice and Use of Long Acting Reversible Contraceptives

Modern women have increased options for birth control with the development of Long Acting Reversible Contraceptives (LARCs). These methods are reliable, easy to use, and require less daily maintenance while providing contraception for an extended period of time. However, despite the surge of LARCs as contraceptive options, the prevalence of unintended pregnancies is still alarmingly high in the United States. As LARCs are the most effective reversible method of birth control at preventing pregnancy, and therefore the potential social, financial, and medical complications associated, we examined whether social determinants of health play a role in LARC usage. While parity and marriage do not seem to affect LARC utilization, increased research is needed to determine the effects of race. Age can affect the type of LARC implemented, as younger women prefer implants to intrauterine devices (IUDs). Insurance coverage was an apparent influencer of LARC usage, as low out-of-pocket costs translate to increased utilization. This is linked to socioeconomic status (SES), as lower SES is associated with decreased access to healthcare in general. Increased research is needed in order to draw conclusions about the effects of education, intimate partner violence, geographic location, and other SDH on LARC usage.

The Analysis on social determinants of health of the floating population

Health literacy refers to the individual obtaining and understanding and dealing with the basic health information and/or services and the ability of use the information and services to make good health decisions.At present, research works related to health literacy in our country are in the initial stage, the information of floating population health literacy is blank, the Chinese Health Education Center （formerly the Chinese Disease Prevention and Control Center Health Education） Ministry of Social welfare studies undertaken special ＂Chinese public health Literacy survey and evaluation System ＂to develop a suitable evaluation index system of health literacy of the public, used for evaluation of our country＇ s public health literacy level. October to December 2007, the Chinese health education center of this set of evaluation index in Jinan Shandong province examines the health literacy status of floating population, analysis the influence factors of health literacy of the floating population, for the national macroeconomic regulation and control of the floating population, the rational allocation of health resources, determine priority health work, and provide evidence for health related policies and regulations of the floating population.

Oral health of adolescents in West Africa:prioritizing its social determinants

Oral health is a major public health issue in West Africa,yet it has gotten little attention.Individual and group disparities in health status are influenced by social determinants of health(SDH),which also affect oral health.Adolescence is a significant transition into adulthood,a time when the SDH can contribute to lifelong health status.This article explored the SDH associated with oral health behaviour,perception,and oral health development amongst adolescents in West Africa.This article engaged articles published in peer-reviewed journals relating to adolescents’oral health and West Africa.The authors undertook this desk review to determine the social determinants of adolescents’oral health in West Africa.The literacy levels and oral health awareness of adolescents,family and social circle influences,socioeconomic status,nutritional levels,and cultural and environmental factors have been identified as important social determinants.Adequate policy implementation with the integration of oral health in schools’curriculum,health systems reorientation with the adoption of oral health delivery in primary health care and expansion in oral health research with the assessment of cultural influences on oral health development have been recommended as interventions to reduce oral health inequalities in West Africa.

Determinants of self-rated private health insurance coverage in Jamaica

The purpose of the current study was to model the health insurance coverage of Jamaicans;and to identify the determinants, strength and predictive power of the model in order to aid clinicians and other health practitioners in understanding those who have health insurance coverage. This study utilized secondary data taken from the dataset of the Jamaica Survey of Living Conditions which was collected between July and October 2002. It was a nationally representative stratified random sample survey of 25,018 respondents, with 50.7% females and 49.3% males. The data was collected by way of a self-administered questionnaire. The non-response rate for the survey was 29.7% with 20.5% not responding to particular questions, 9.0% not participating in the survey and another 0.2% being rejected due to data cleaning. The current research extracted 16,118 people 15 years and older from the survey sample of 25,018 respondents in order to model the determinants of private health insurance coverage in Jamaica. Data were stored, retrieved and analyzed using SPSS for Windows 15.0. A p-value of less than 0.05 was used to establish statistical significance. Descriptive analysis was used to provide baseline information on the sample, and cross-tabulations were used to examine some non-metric variables. Logistic regression was used to identify, determine and establish those factors that influence private health insurance coverage in Jamaica. This study found that approximately 12% of Jamaicans had private health insurance coverage, of which the least health insurance was owned by rural residents (7.5%). Using logistic regression, the findings revealed that twelve variables emerged as statistically significant determinants of health insurance coverage in this sample. These variables are social standing (two weal- thiest quintile: OR = 1.68, 95% CI = 1.23 – 2.30), income (OR = 1.00, 95%CI = 1.00 – 1.00), durable goods (OR = 1.16, 95% CI = 1.12 – 1.19), marital status (married: OR = 1.97, 95% CI = 1.61 – 2.42), area of residence (Peri-urban: OR = 1.45, 95% CI = 1.199 – 1.75;urban: OR = 1.83, 95% CI = 1.40 – 2.40), education (secondary: OR = 1.57, 95% CI = 1.20 – 2.06;tertiary: OR = 9.03, 95% CI = 6.47 – 12.59), social support (OR = 0.64, 95% CI = 0.53 – 0.76), crowding (OR = 1.14, 95% CI = 1.02 – 1.28), psychological conditions (negative affective: OR = 0.97, 95% CI = 0.94 – 1.00;positive affective: OR = 1.11, 95% CI = 1.06 – 1.16), number of males in household (OR = 0.85, 95% CI = 0.77 – 0.93), living arrangements (OR = 0.62, 95% CI = 0.41 – 0.92) and retirement benefits (OR = 1.55, 95% CI = 1.03 – 2.35). This study highlighted the need to address preventative care for the wealthiest, rural residents and the fact that social support is crucial to health care, as well as the fact that medical care costs are borne by the extended family and other social groups in which the individual is (or was) a member, which explains the low demand for health insurance in Jamaica. Private health care in Jamaica is substantially determined by affordability and education rather than illness, and it is a poor measure of the health care- seeking behaviour of Jamaicans.

How does parents’social support impact children’s health practice?Examining a mediating role of health knowledge

Background Family environmental factors play a vital role in shaping children’s health practices(e.g.,obesity pre-vention).It is still unclear how parents’social support affects children’s obesity-related health practices.The present study argues that whether parents’social support positively associates with children’s obesity-related health practice depends on if it could promote parents’obesity-related health knowledge.Thus,we hypothesize that health knowl-edge mediates the relationship between parents’social support and children’s health practice regarding weight management.Methods To test the hypothesis,we conducted a questionnaire survey and collected a nationally representative sample of 1488 household responses in Singapore.The survey included questions about parents’social support,health knowledge,children’s health practices,and socio-demographic variables.All participants have at least one child 14 years old or younger.In the sample,66.1%of the respondents are female,and 93.7%are below 50 years old.Structural equation modeling(SEM)via Stata was used to examine the associations between parents’social support,health knowledge,and children’s health practice.Results The results of our analysis support our hypothesis.Specifically,(1)parents’social support shows a positive relationship with health knowledge(Coef.=0.17,p<0.001 for BMI knowledge and Coef.=0.18,p<0.001 for nutrition knowledge);(2)parents’social support(total effect of social support=0.081,p=0.071)and health knowledge positively associate with children’s obesity-related health practice(coefficient of BMI knowledge=0.10,p<0.01;coefficient of nutrition knowledge=0.31,p<0.001);and(3)the effects of parents’social support on children’s health practice is fully mediated by parents’health knowledge(mediating effect=100%,p=0.007).Conclusion The present study provides fresh evidence from a multicultural context to understand the relationships between parents’social support,health knowledge,and children’s obesity-related health practice.Our findings sup-port the argument that social support from parents’social networks does not necessarily promote health outcomes.The only social support that carries proper health knowledge can facilitate good health practice.

Moving from medical to health systems classifications of deaths:extending verbal autopsy to collect information on the circumstances of mortality

Background:Verbal autopsy(VA)is a health surveillance technique used in low and middle-income countries to establish medical causes of death(CODs)for people who die outside hospitals and/or without registration.By virtue of the deaths it investigates,VA is also an opportunity to examine social exclusion from access to health systems.The aims were to develop a system to collect and interpret information on social and health systems determinants of deaths investigated in VA.Methods:A short set of questions on care pathways,circumstances and events at and around the time of death were developed and integrated into the WHO 2012 short form VA(SF-VA).Data were subsequently analysed from two census rounds in the Agincourt Health and Socio-Demographic Surveillance Site(HDSS),South Africa in 2012 and 2013 where the SF-VA had been applied.InterVA and descriptive analysis were used to calculate cause-specific mortality fractions(CSMFs),and to examine responses to the new indicators and whether and how they varied by medical CODs and age/sex sub-groups.Results:One thousand two hundred forty-nine deaths were recorded in the Agincourt HDSS censuses in 2012-13 of which 1,196(96%)had complete VA data.Infectious and non-communicable conditions accounted for the majority of deaths(47%and 39%respectively)with smaller proportions attributed to external,neonatal and maternal causes(5%,2%and 1%respectively).5%of deaths were of indeterminable cause.The new indicators revealed multiple problems with access to care at the time of death:39%of deaths did not call for help,36%found care unaffordable overall,and 33%did not go to a facility.These problems were reported consistently across age and sex sub-groups.Acute conditions and younger age groups had fewer problems with overall costs but more with not calling for help or going to a facility.An illustrative health systems interpretation suggests extending and promoting existing provisions for transport and financial access in this setting.Conclusions:Supplementing VA with questions on the circumstances of mortality provides complementary information to CSMFs relevant for health planning.Further contextualisation of the method and results are underway with health systems stakeholders to develop the interpretation sequence as part of a health policy and systems research approach.

Health within the Leeds Migrant Roma Community;An Exploration of Health Status and Needs within One UK Area

Existing evidence shows that many Roma communities have received little attention in relation to their health requirements. Evidence illustrates how Roma communities suffer from poorer health and unhealthier living conditions when compared to majority populations, with their poor health closely linked to wider social determinants. This study explored the health status and associated health needs of the Leeds Roma migrant community, a hard to reach and under-explored group across Europe. Questionnaires (n = 70) and focus groups (n = 43) with Roma community members as well as interviews with health professionals (n = 5) working with them were used. The study found language was a key barrier to accessing health care and understanding health messages. Furthermore, participant’s understandings of the health system were hindered by their different experiences within their countries of origin. Self-reports illustrated low mental well-being, high levels of stress and unhealthy lifestyles as common issues. The research also highlighted several wider determinants of health as key concerns within the Roma community including housing, employment opportunities and money. The findings of this study contribute to increasing understandings of this community’s health needs, their support requirements and the barriers faced by them. These need to be considered to inform strategies and ways of working as mechanisms to tackle health inequalities and promote health within this community.

Evaluation Items for Community-Based Health Care Focusing on Social Aspects: A Literature Review

The progressive aging of society has become a global concern, and is expected to lead to the development of effective, sustainable, person-centered, integrated community-based care systems. However, there is insufficient evidence regarding effective integrated community-based care. In particular, few studies have focused on social aspects of the community environment related to elderly health. This study aimed to consider social aspects as evaluation items, focusing particularly on social determinants from the perspective of community-dwelling people, to explore truly effective integrated community-based care to improve elderly health. The definition of social determinants means social cohesion in social and community contexts. A literature review of English articles published in peer-reviewed journals up to October 2019 was conducted using PubMed, MEDLINE, and CINAHL with the following search terms: “social cohesion,” “elderly health,” “mental health” and “community.” Identified articles were screened based on title and abstract, and selected articles were subjected to full-text assessment and critical review. All references cited in the selected articles were also reviewed. The following inclusion criteria were used: 1) studies targeting community-dwelling elderly people or community-dwelling people including elderly people as participants;2) studies with clear descriptions of social factors in the Methods section;and 3) studies with clear descriptions of health-related items in the Methods section. From the 21 articles analyzed, of which 9 articles defined social determinants as social cohesion in social and community context, 37 items were extracted as social aspects at the community level that reflect the perspective of residents. These items can be developed as evaluation items for community-based health care outcomes through consensus among community health care providers and further investigation.

Use of Social Cognitive Theory to Assess Salient Clinical Research in Chronic Disease Self-Management for Older Adults: An Integrative Review

The purpose of this integrative review is to evaluate research pertaining to self-management programs for older adults with chronic diseases using Albert Bandura’s Social Cognitive Theory (SCT) for behavior change. The focus is application of the SCT domains to self-management programs. The exploration of the current chronic disease self-management research provides an understanding of the Social Cognitive Theory concepts studied in interventional self-management research. The integrative review explicated two areas related to the theory in need of further research. First, social support has not been thoroughly explored as a mechanism for enhancing self-management interventions. Second, moral disengagement was not identified as a focus within chronic disease research raising the question about the impact of moral disengagement on long-term adherence and behavior change.

Depressive symptoms and the associations with individual, psychosocial, and structural determinants in Swedish adolescents

Depressive symptoms in adolescents are an increasing public health issue in Sweden and in most Western countries. Aim: To explore how individual, psychosocial, and structural determinants are associated with depressive symptoms in Swedish adolescents. Methods: A web-based questionnaire was answered by 1193 13- to 16-year-old boys (n = 566) and girls (n = 627). Stepwise logistic regressions were employed to analyse the association between depressive symptoms and various determinants at the individual level (self-efficacy), the psychosocial level (parental, peer, and teacher support, school demands, sexual harassment, and bullying) and the structural level (family affluence, having less money than friends, and parental foreign background). Results: Determinants at the individual, psychosocial, and structural levels were independently associated with high levels of depressive symptoms in both boys and girls. The full model explained a high proportion of the variance in depressive symptoms in both genders;34.1% in boys and 36.8% in girls. The psychosocial level contributed the most to explaining the variance in depressive symptoms in boys. In girls, when harassment variables were separated from psychosocial variables, the harassment variables contributed as much to the full model as the rest of the psychosocial variables combined. Conclusions: Addressing psychosocial determinants provides the greatest benefits for preventing depressive symptoms in adolescents. Acknowledging the association between sexual harassment and depressive symptoms for girls and having less money than their friends for boys and girls are particularly important.