Social Determinants of Health

Interview Techniques

When assessing a patient’s history or inquiring about one’s social determinants of health, it is crucial to apply correct interviewing techniques. The use of suitable methods enables a healthcare specialist to obtain the most sincere and reliable information from a person. For the present assessment, it was aimed to choose such interviewing techniques that would enable the visitor to speak freely about the issues that might bother him and not try to conceal anything out of discomfort or distrust.

The first approach utilized was active listening, which enabled the patient to give full answers to all questions. Additionally, this method helped to arrange a friendly and trusting atmosphere during the interview. Active listening is the core approach to conducting interviews since it involves the understanding of both verbal and non-verbal communication of the client (Bickley & Szilagyi, 2016). The second method, reassurance, was employed to make the client feel relaxed and let him know that the interview was aimed at finding out the data pertinent to his future healthcare improvement (Bickley & Szilagyi, 2016). With the help of reassurance, the interviewer can usually make the interviewed individual feel less worried and understand that there can be no wrong answers.

The third technique was guided questioning, which allowed clarifying some aspects of the patient’s responses (Bickley & Szilagyi, 2016). The fourth approach was empowering the patient, which helped to evoke his perspective and demonstrated the interviewer’s sincere interest in hearing the answers (Bickley & Szilagyi, 2016). Each of these techniques enabled the healthcare specialist to arrange an effective dialogue and find out the necessary information about the clients’ attitudes toward social determinants of health.

Justification of Key Questions

Health & Healthcare

Question Asked

What is your current health insurance situation?

Justification for Question

An open-ended question allows for a more extensive answer to the question. By inquiring about the patient’s insurance, I intended to find out whether his healthcare situation is stable or unstable and whether he can rely on medical support whenever he needs it.

Patient Response

I have Aetna medical insurance, monthly payments for which are taken directly from my paycheck. So far, I have not found a healthcare provider nearby whom I could trust.

Economic stability

Question Asked

What is your current career focused on, and where do you see yourself in five years?

Justification for Question

The response to this question will allow finding out how secure the patient’s job position is and whether he has any plausible ambition for the future. This question directly affects the interviewee’s ability to pay for healthcare insurance and explains his social and community background.

Patient Response

I work in the sphere of hotel management. I cannot predict my career prospects in five years since at the moment, my job is highly unstable due to the pandemic.

Neighborhood & Built Environment

Question Asked

How would you describe the level of safety at home and in the neighborhood?

Justification for Question

By asking this question, I aimed at understanding the effect of home and neighborhood security, which strongly influences the client’s ability to access healthy food and engage in health-promoting activities.

Patient Response

I feel safe at home, but I cannot say the same about my neighborhood. The crime level here is rather high, and I would like to move my family to a safer place. Unfortunately, I cannot afford it at the moment.

Social & Community Context

Question Asked

How do you socialize? What is your social life like?

Justification for Question

An answer to this question will elucidate the client’s support systems and explain what social connections help him to overcome work-related stress.

Patient Response

I do not have much of social life: basically, it is just work and home. When I am not working, I enjoy spending time with my wife and four kids by playing board games, watching movies, or singing karaoke. My wife is the best support system I could ever dream of.

Education

Question Asked

What is your education level? Are you satisfied with it?

Justification for Question

This question helps to find out whether the client has any better career prospects in case he should change his job or would like to study further.

Patient Response

I only have a college degree, which is sufficient for my current position. I cannot afford to study further at the moment since I am the only provider in a family of six.

Economic Stability

Economic stability inevitably has an influence on people’s access to healthcare. Without an appropriate level of education, one cannot afford to find a well-paid job. Without a good job, a person cannot meet the basic needs at various levels, including the healthcare one. Specifically, if an individual’s salary does not allow covering medical insurance, the person’s health will be under threat in case of an emergency. As for the patient under assessment, his socioeconomic and employment status, as well as housing stability, have a profound effect on his access to healthcare, which will be detailed in the following subsections.

Socioeconomic Status

The patient’s socioeconomic status may be defined as middle due to the combination of his education, occupation, and income factors. It is viable to say that the client’s status poses certain restrictions on his healthcare access. Specifically, the patient admits that his salary ($45,000 annually) is not enough to meet the needs of his family of six. Hence, if he had higher education and could afford to get a better job, his healthcare needs would be met to a greater extent.

Employment Status

The patient works as a hotel manager, which is generally considered a stable job. However, in the current pandemic situation, the tourism industry was forced to close many of its objects, including hotels. Hence, the patient is worried lest he should lose his position due to being made redundant. Furthermore, the current job does not provide the patient with an income sufficient to support his large family.

Housing Stability

The patient lives in the inner city, which he does not find the best place for a family. He rent a three-bedroom apartment in a low-income area, for which he pays $900 monthly. The housing situation is not stable since the family would like to move to a safer neighborhood. At the same time, however, the patient admits that currently, they cannot afford to look for another place because they are limited in finances.

Educational Status

The role of education in one’s understanding of health care cannot be overestimated, the higher the educational level of an individual is, the more likely he or she is to know about a healthy lifestyle, insurance options, and the ways of preventing diseases. Education is crucial both in the economic and social dimensions of the patient’s development. According to Zimmerman et al. (2015), the advantages of education to health can be noted at the individual, community, and social levels. The more levels of education one have obtained, the easier it is to obtain access to healthcare resources, evaluate the environment’s health-related options, and discern social policies on health (Zimmerman et al., 2015). In the case of the selected patient, it is evident that his level of education has both some pros and cons. A college degree allows him to have a basic knowledge of healthcare options. However, it is not enough to provide the patient with sufficient health insurance opportunities. Furthermore, it is evident that the current educational level prevents the patient from understanding the profound principles of nutrition and wellness concepts.

Healthcare Barriers and Opportunities

Barriers

Higher education provides individuals with a better understanding of core healthcare principles and possibilities. The lack of such education inevitably leads to a lack of health-related knowledge and an inability to cover one’s needs in this sphere (Diviani et al., 2015). Meanwhile, obtaining at least a bachelor’s degree enables individuals to have a higher salary and better healthcare opportunities (Ma et al., 2015). The present patient has a college education, which poses certain barriers to his healthcare options. The first of such limitations is the lack of comprehensive knowledge about peculiar health needs and ways of their attainment, including physical wellbeing, nutrition, diet, and others. The second barrier is a low to moderate salary, which deprives the patient of the opportunity to provide himself and his family with all the needed resources. Due to having a middle-level education, the patient cannot afford all-encompassing healthcare insurance. Also, he cannot buy fresh groceries to keep a healthy diet and minimize several health risks associated with the lack of nutritional elements.

Opportunities

At the same time, a college education is better than a high school education. The major benefit of the patient’s degree is the ability to read relevant healthcare information and understand its significance. Another opportunity involves the ability to learn further and pass his experience to his children in order for them to avoid his current deficiencies related to health care. Overall, a college education increases one’s chances for socioeconomic development (Ma et al., 2015). Therefore, as soon as the pandemic is over, the patient will be likely to improve his situation.

Effect of Health on Quality of Life

It cannot be doubted that people’s health has a considerable effect on their lives. When a person is not healthy, experiences chronic or acute pain, or suffers from a disease that cannot be treated, he or she inevitably loses the opportunity to live a full life without any constraints. According to the World Health Organization’s definition, health is not only the absence of an ailment but also a state of full physical, psychological, and social welfare (Karimi & Brazier, 2016). The impact of health on one’s quality of life cannot be denied. Health influences the level of people’s functionality in social, physical, and psychological dimensions of existence (Karimi & Brazier, 2016). Therefore, it is crucial to analyze patients’ health in relation to their quality of life due to the existence of a close link between these two notions.

It is viable to note that the patient’s health has a moderate effect on his quality of life. The patient reports developing low back pain and headaches after working long shifts. At the same time, spending some extra hours at work is his only chance to improve his family’s financial situation since he is the only employed member of the family of six. Thus, it can be stated that the patient’s health prevents him from having a high quality of life and gaining the goals he could if he did not have such health issues. Additionally, the man has prediabetes and hypertension which, together with the family history of these illnesses, increase the likelihood for his health to deteriorate. The patient’s health formulates his quality of life to a great extent, so an effective care plan should be developed in order to minimize the risks and maximize the opportunities for enhancement.

Health Literacy

Health literacy is one of the most important public health goals. Health literacy presupposes people’s possibility to locate, comprehend, and utilize health information (Velardo, 2015). Health literacy is quite different from general literacy, which incorporates the ability to read and write. When a person is educated but does not use this education to learn about health care, there can be severe adverse outcomes. Individuals who do not possess health literacy can make wrong choices related to their own health care, as well as concerning their children’s health issues. People who do not know the true benefits of vaccination tend to focus on illusory drawbacks and refuse to take measures that could save their child’s life. Those who do not know the basics of first aid will not be able to provide timely help to someone in a public place before the ambulance arrives, which is also quite risky. Hence, understanding the basics and specifications of health literacy can save people’s health and lives.

The level of health literacy in the patient under assessment may be assessed as moderate to high. He realizes the risks to his health even though he may not be ready to mitigate them. For instance, the patient regrets not being able to reach a grocery store and buy fresh fruit and vegetables daily. However, at the same time, he admits that his level of income prevents him from buying healthy foods anyway. The factor of poor nutrition is the one that should be addressed first of all. The patient thinks that he can keep his carbohydrate diet and be healthy, but he is wrong thinking so.

Neighborhood and Environmental Impacts

The neighborhood in which one lives and the environment that prevails in this neighborhood are two crucial factors influencing one’s health, as well as access to it. Research indicates that people’s health condition is constituted not only by individual characteristics but also by the contexts to which they belong (Arcaya et al., 2016). Specifically, the following neighborhood characteristics have been identified as determining people’s health: locality, air pollution, level of poverty, access to food, and social connections. Apart from these causes, Arcaya et al. (2016) also emphasize the possibility of spending time outdoors (taking a walk or riding a bicycle) as a positive effect on the neighborhood. Finally, the level of crime is a significant factor on which one’s health depends. For the present patient’s health, neighborhood impacts are rather negative. The most severe adverse effect, according to the patient, is the high level of crime in the area. Also, the low-income status and poverty of many residents add to the generally negative situation.

Environmental effects play a no less serious role in people’s access to health than neighborhood ones. Air pollution, dangerous emissions from plants and factories, and other issues that may not be visible at first sight impact individuals’ health to a great extent (Eckelman & Sherman, 2016). The negative influence of ultraviolet radiation is another environmental factor on which people’s health depends. Whereas the patient does not report any severe environmental effects, it is crucial to pay attention to his refusal from sun blockers. Research indicates that the reluctance of dark-skinned people to apply sunscreen is not justified (Mancuso et al., 2017). Hence, it is necessary to educate the patient about the dangers posed by ultraviolet rays.

Health Care Received in Low-and-High Income Areas

Similarities

Irrespective of where a person lives, he or she can count on a certain number of services related to healthcare needs. Hence, whether it is a low- or high-income community, patients can expect that they will be provided with the necessary procedures in a clinic or hospital. The second similarity is that all healthcare institutions are regulated by the same guidelines (Agency for Healthcare Research and Quality, 2018). Thus, the patient, as well as other people living in his area, can expect to be treated equally to individuals living in high-income areas.

Differences

Whereas technically, all neighborhoods should provide their citizens with the same level of care, in practice, such unanimity does not exist. Many inequalities in health care emerge due to the level of people’s income and the general situation in the neighborhood. The first, and probably most crucial, the difference between low- and high-income populations is the possibility to obtain health insurance with a wide range of options covered by it (Sommers et al., 2017). Most commonly, people from low-income areas cannot afford insurance. Additionally, they are frequently unemployed, so they cannot count on support from their employers. In the case of the patient, he pays for insurance monthly, but he regrets having such a package since he does not visit doctors often and would rather save on insurance. However, his whole family depends on it, so he continues making payments.

The second difference is represented by the healthcare facilities’ outlook and their staffing. Typically, hospitals in low-income areas are understaffed and look dilapidated. They may not have the basic equipment, so they cannot offer the same range of services as high-income hospitals can. The patient acknowledges the effect of living in a low-income area on his healthcare opportunities. He has mentioned that he has not found a specialist whom he could trust and would address in case of an emergency.

Rural versus Urban Healthcare Access

Disparities in health care access occur not only in relation to populations’ incomes but also to the geographic location in which they live. Generally, healthcare options are more numerous and accessible in urban areas than in suburban or rural ones. The main difference between these types of locations is in the number of primary care providers. In rural America, there is a high level of such providers’ lack, which inevitably leads to poor prevention possibilities and increased mortality rates (Capriotti et al., 2020). The insufficient screening rate makes it impossible to prevent the development of such severe illnesses like cancer, stroke, cardiovascular disease, and diabetes (Capriotti et al., 2020). Additionally, people living in rural areas do not have access to proper hygiene practices. Frequently, they suffer from the lack of water or its poor quality, as well as from environmental pollution from plants and factories, which are typically located out of cities.

The patient lives in an urban area, which allows assuming that he has access to the necessary healthcare options. However, he admits that he finds it difficult to address a healthcare provider due to the poor condition of hospitals. Although his family lives in the city, it is only due to necessity and not because of their decision to do so. The patient’s example demonstrates that though generally, urban areas have better access to healthcare options, there are districts in cities that also lack proper attention from the government.

Neighborhood Healthy Food Options

Not only the environment impacts people’s health but also, and to a great extent, their access to fresh and healthy products. Neighborhood healthy food options play a crucial role in the arrangement of a healthy lifestyle of people. According to the study conducted by Barnes et al. (2016), the distance to food stores constitutes a crucial determinant of healthy food recognition. Hence, the further one has to walk or drive to a grocery store, the less likely one is to have fresh fruit and vegetables every day. The same concerns the assortment of products offered in such stores and the frequency of their delivery to the shop. The patient reports having difficulty purchasing fresh food due to the lack of grocery stores in the area. Since he works late hours, and his wife stays at home to look after their youngest children, there is no possibility for them to go to the store daily. Furthermore, the neighborhood is not a safe one, so the wife cannot take the kids for a walk and do shopping at the same time.

Discussion of Social Determinants

Social determinants of health constitute an essential component of health assessment. These factors explain the availability of resources to meet one’s health needs (Office of Disease Prevention and Health Promotion, n.d.). Social determinants encompass five major areas: health and health care, education, neighborhood, and built environment, economic stability, and social and community context. Each of these dimensions is important to analyze while assessing patients’ health conditions and unmet needs.

It is important to explore each of the social determinants of health in a comprehensive health assessment. Every component covers a significant area of a patient’s life, such as family, social support, work, environment, and others (Adler et al., 2016). A thorough analysis of these aspects enables a healthcare specialist to notice the gaps in healthcare access, as well as identify beneficial aspects of a person’s health care. Based on the analysis of social determinants, it is easier to create a plan of care.

Identification of Social Determinants

B1 Priority Social Determinants B2 Plan of Care B2a Implementation B2b Barriers B2c Individuals involved B3 Evaluation
1. Health and health care Educate the patient on the importance of taking better care of his health – instruct the patient about the necessity to diversify his diet, especially enrich it with fresh fruit and vegetables
– explain that sunscreen is needed for dark-skinned people due to its ability to prevent skin cancer and other serious illnesses
Patient’s unwillingness to follow the recommendations or the lack of time The nurse, the patient, and the patient’s wife An interview within several weeks (Möhler et al., 2015)
2. Neighborhood and built environment Reiterate the importance of home safety – instruct the patient on the need to keep his home safe by using an alarm system
– make sure he and his family know that the door should always be locked, and no strangers should be allowed
Patient’s lack of time or unwillingness to do the seemingly evident things The nurse, the patient, his wife, and older children A conversation with the patient in several weeks (Möhler et al., 2015)
3. Economic stability Encourage the patient to apply for a better job – help the patient to assess his strong points and experience as positive features on a resume
– empower the patient by showing positive examples of other people (anonymously)
Patient’s fear to lose his current position The nurse, the patient, and his wife (as the most crucial social support system) A face-to-face discussion of what has been done in a week and then in two more weeks (Möhler et al., 2015)

Impact of Social Determinants

Social determinants of health services as a crucial constituent of a comprehensive health assessment. A healthcare specialist should take into consideration each of the five determinants in order to receive the full picture of a patient’s health systems, accessibility to healthcare options, and the gaps existing in these spheres. Each of the five dimensions constituting social determinants impacts any person’s health to a great extent. Family and neighborhood, social support, educational and economic opportunities, and other factors make it easier for the healthcare professional to adequately evaluate the patient’s health and offer an effective plan of care.

References

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Arcaya, M. C., Tucker-Seeley, R. D., Kim, R., Schnake-Mahl, A., So, M., & Subramanian, S. V. (2016). Research on neighborhood effects on health in the United States: A systematic review of study characteristics. Social Science & Medicine, 168, 16-29. Web.

Barnes, T. L., Freedman, D. A., Bell, B. A., Colabianchi, N., & Liese, A. D. (2016). Geographic measures of retail food outlets and perceived availability of healthy foods in neighbourhoods. Public Health Nutrition, 19(8), 1368-1374.

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