Incorporating social determinants of health into individual care—a multidisciplinary perspective of health professionals who work with people who have type 2 diabetes

Abstract

Social determinants of health (SDoH) and type 2 diabetes mellitus (T2DM) are interrelated. The prevalence of T2DM is increased amongst those with suboptimal SDoH. Poor SDoH can also negatively impact T2DM self-management. Social determinants of health are mostly considered at population and community levels, rather than individually or clinically. This qualitative study combines the perspectives of a multidisciplinary cohort of health professionals to identify and explore the impact of social determinants on self-management, and ways they could be incorporated into individual clinical care. Purposively selected participants chose to partake in an in-depth, semi-structured, one-on-one interview or focus group. Data were analysed, and themes identified using a combination of deductive and inductive thematic analysis. Fifty-one health professionals volunteered for the study. Two small focus groups (n = 3 and n = 4) and 44 one-on-one interviews were conducted. The identified themes were: 1) Support for incorporating SDoH into T2DM care, 2) Effect of SDoH on T2DM self-management, 3) Identifying and addressing social need, 4) Requirements for incorporating SDoH into T2DM individual clinical care. Health professionals reported that poor social determinants negatively affect an individual’s ability to self manage their T2DM. Person-centred care could be enhanced, and people with T2DM may be more likely to achieve self-management goals if SDoH were included in individual clinical care. To achieve successful and sustained self-management for people with T2DM, health professionals require a thorough understanding of T2DM and the effect of social determinants, respect for client privacy, client trust and rapport, effective communication skills, validated tools for assessing SDoH, team champions, teamwork, ongoing education and training, adequate resources, guiding policies and procedures, and management support. Incorporating SDoH into individual, clinical care for people with T2DM was strongly supported by health professionals. If embraced, this addition to care for individuals with T2DM could improve self-management capacity and enhance person-centred care.

Health centres and social determinants of health: an analysis of enabling services provision and clinical quality

“…Further, this research supports a broader view of clinical care that includes non-clinical solutions (ie, enabling services that address SDOH) for addressing self-management if true improvements in clinical outcomes are to be achieved. 30 As mentioned above, even when controlling for size differences, disproportionate representation of certain conditions, and sociodemographic differences in the patient population and surrounding communities across health centres, health centres with high utilisation of enabling services showed worse performance in controlling hypertension and diabetes. These findings suggest enabling services may have a stronger positive correlation with process measures than with outcome measures.…”

“…Further, this research supports a broader view of clinical care that includes non-clinical solutions (ie, enabling services that address SDOH) for addressing self-management if true improvements in clinical outcomes are to be achieved. 30 …”

What next for behaviour change professional development in general practice? Insights from an environmental scan and workshops

“…Moreover, complex societal determinants of health, such as income, housing, employment and public health policy may require specialist skills for priority populations (9,10).…”

Associação entre os determinantes da saúde e nutrição e o status sociodemográfico de um grupo de profissionais da saúde brasileiros, durante a pandemia de COVID-19

“…Os DSS contribuem com cerca de 55% dos parâmetros que avaliam resultados em saúde, como a morbimortalidade. 6 Nessa linha, muitos estudos sugerem o impacto da falta de garantia dos DSS no bem-estar [7][8][9] e na redução da expectativa de vida 3,10,11 . Para a Organização Mundial de Saúde (OMS), situação socioeconômica, educação e falta de apoio social se relacionam com o aumento de "morbimortalidade prematura" 12 .…”

“…Além dos infortúnios sociais já citados, outros implicados nas más condições relacionadas a transporte, renda, poluição, discriminação, violência, acesso a alimentos nutritivos, atividade física e habilidades de alfabetização, quando controlados, podem equalizar o acesso a condições mais dignas de saúde 8,9 . De forma similar, segregação por idade, sexo, escolaridade, renda e cobertura de saúde podem postergar a triagem de fatores de risco para doenças crônicas não transmissíveis (DCNTs), situação que tem o potencial de desacelerar o desenvolvimento da doença 13 .…”