Extent of Integration of Social Determinants of Health in Clinical Practice in Hospitals in Uganda

Abstract

The study determined the extent to which health workers in hospitals in Uganda integrate social determinants into clinical practice. This will provide a baseline for improvement interventions and act as a starting point for elucidating the factors influencing the integration of social determinants into clinical practice. This was a multi-method cross-sectional study conducted at 12 hospitals in Uganda. Data was collected between September and November 2021 involving 1042 health workers, 21 key informants, 2119 medical records, and six focus groups. The extent of integration was measured using an eight-item Likert scale for health workers (Cronbach’s alpha of 0.794, inter-item correlation 0.15 to 0.5;) 24-item Likert scale for key informants (Cronbach’s alpha was 0.973, inter-item correlation 0.18 to 0.936), and medical records. The study was approved by the research and ethics committee of Makerere University School of Health Sciences and by the Texila American University Faculty and registered by the National Council of Science and Technology. The aggregate extent of integration was 66%, computed as the average health workers score (66%), key informants score (65%), and medical records score (66%). There were variations across hospitals and social demographics of health workers. The extent of integration of social determinants into clinical practice was successfully determined. Further investigations are required to explain the variations across hospitals. The study did not take into consideration carry-over effects from health workers working in non-hospital healthcare settings. Keywords: Social determinants; Clinical practice; Integration; Factors; Hospitals; Uganda.