Social determinants of recovery

Jain, Snigdha; Hauschildt, Katrina; Scheunemann, Leslie P.

doi:10.1097/mcc.0000000000000982

Cited by 10 publications

(8 citation statements)

References 69 publications

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“…To our knowledge, this study is the rst to integrate perspectives of such a diverse group of stakeholders across the post-ICU care continuum. Their perception of the range of survivors' biopsychosocial needs is consistent with current critical illness survivorship literature [2,15]. The study's main novel contribution is to show the power of a convergence science approach to post-ICU and transitional care research.…”

Section: Discussionsupporting

confidence: 64%

“…Further, transitional care interventions promote access and scalability while addressing social determinants of health. This focus aligns well with the post-ICU community's growing attention to health equity [15]. Finally, active ingredients of transitional care interventions address six common challenges among critical illness survivors: lack of patient and family engagement, inadequate patient and family education, communication problems, lack of collaboration among team members, poor continuity of care, and gaps in services between health care providers and across settings [5,14,[16][17][18].…”

Section: Introductionmentioning

confidence: 91%

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Conceptualizing Transitional Care After Critical Illness Using Stakeholder Perspectives: A Qualitative Content Analysis

Scheunemann

Motter

Kim

et al. 2023

Preprint

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Background Over half of critical illness survivors have new or worsened functional impairments. Yet, the United States lacks wide-scale transitional care infrastructure to promote wellbeing and prevent rehospitalization after critical illness. Evidence-based transitional care interventions urgently need to be adapted to address this gap. Thus, as a first step, we engaged diverse stakeholders to describe perspectives on transitional care delivery for critical illness survivors. Methods Qualitative content analysis of interviews with 11 critical illness survivors, 11 family caregivers, ten home health providers, nine primary care physicians and one primary care nurse practitioner; and focus groups with two home health teams, seven groups of inpatient providers and one group of administrators (total n = 69). Data collection took place in Western Pennsylvania between February 2020 and March 2022. We used pilot-tested interview guides to elicit perceived care needs, probing for barriers, facilitators, and social determinants of health. Five trained coders analyzed transcripts. We unified codes into themes and checked accuracy and completeness with participants. Results All stakeholders perceived that survivors’ unmet needs contributed to incomplete or unsatisfactory transitions. They identified barriers and facilitators of care that mapped easily to evidence-based transitional care intervention models. Social determinants of health were omnipresent factors in post-ICU care delivery. The data generated a hypothesis that strengths-based intervention models which target indicators of wellbeing (rather than deficit-based approaches managing symptoms) will improve outcomes among critical illness survivors. An additional hypothesis is that implementation strategies must design for health equity. Conclusions These findings suggest the need to adapt transitional care interventions to better foster wellbeing after critical illness. Six implementation strategies addressing administrative infrastructure and policy relevance (i.e. optimizing: incentives, record systems, quality monitoring, accountability, networking, and funding) could promote wide-scale dissemination of post-ICU transitional care delivery models.

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Section: Discussionsupporting

confidence: 64%

Section: Introductionmentioning

confidence: 91%

Conceptualizing Transitional Care After Critical Illness Using Stakeholder Perspectives: A Qualitative Content Analysis

Scheunemann

Motter

Kim

et al. 2023

Preprint

Self Cite

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“…To put our results into context, socio-demographic factors including income, isolation, social support, race/ethnicity, education and local area deprivation have also been found to be social determinants of recovery from mental illness [56,57], poor general physical health [58], and following hospitalisation in critical care [59]. Such results suggest that social factors likely play a significant role in recovery from illness in general, not only in the case of COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Social determinants of recovery from ongoing symptoms following COVID-19 in two UK longitudinal studies: a prospective cohort study

Cheetham,

Bowyer,

García

et al. 2023

Preprint

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BackgroundSocial gradients in COVID-19 exposure, illness severity, and mortality have been observed in multiple international contexts. Whether pre-existing social factors affect recovery from ongoing symptoms following COVID-19 and long COVID is less well understood.MethodsWe analysed data on self-perceived recovery following self-reported COVID-19 illness in two United Kingdom community-based cohorts, COVID Symptom Study Biobank (CSSB) (N = 2548) and TwinsUK (N = 1334). Composite variables quantifying socio-demographic advantage and disadvantage prior to the COVID-19 pandemic were generated from sex, ethnic group, education, local area deprivation and employment status. Associations between self-perceived recovery and composite variables were tested with multivariable logistic regression models weighted for inverse probability of study participation, adjusting for potential confounding by age, region and pre- pandemic health factors, and potential mediation by COVID-19 illness characteristics and adverse experiences during the pandemic. Further analyses tested associations between recovery and individual socio-demographic variables reflecting status prior to and during the COVID-19 pandemic.FindingsSocio-demographic gradients in recovery were observed, with unadjusted recovery rate varying between 50% and 80% in CSSB and 70% and 90% in TwinsUK based on composite socio-demographic variables. Likelihood of recovery was lower for individuals with more indicators of pre-pandemic social disadvantage in both cohorts (CSSB: odds ratio, OR = 0.74, 95% confidence interval, CI: 0.62-0.88, TwinsUK: OR = 0.79, 95% CI: 0.64-0.98 per disadvantage) and higher with more social advantages (CSSB: OR = 1.26, 95% CI: 1.08-1.47, TwinsUK: OR = 1.36, 95% CI: 1.09-1.70 per advantage). Associations were neither explained by differences in COVID-19 illness severity or timing, nor adverse social experiences during the pandemic, which were themselves inversely associated with recovery.InterpretationStrong social inequalities in the likelihood of recovery from COVID-19 were observed, with ongoing symptoms several months after coronavirus infection more likely for individuals with multiple indicators of social disadvantage. Work is needed to identify modifiable biopsychosocial factors to enable interventions that address inequalities.FundingChronic Disease Research Foundation, National Institute for Health and Care Research, Medical Research Council, Wellcome LEAP, Wellcome Trust, Engineering & Physical Sciences Research Council, Biotechnology and Biological Sciences Research Council, Versus Arthritis, European Commission, Zoe Ltd.Plain language summaryAcross the world acute COVID-19 illness has affected the most disadvantaged in society the most. However, we have not looked in detail whether people’s social circumstances affect their recovery from COVID-19. In our study, we asked people from two UK-based health studies if they still had symptoms after having COVID-19. We looked at how advantaged or disadvantaged they were at the start of the pandemic, based on information about their sex, ethnic group, education level, local area, and employment. In both studies, people who were more disadvantaged were more likely to still have symptoms long after having COVID-19. In contrast, more advantaged people were more likely to have fully recovered. We also saw that people who had negative experiences during the pandemic such as losing their job, being unable to afford their bills or not being able to access health & social care services were less likely to recover. More work is needed to understand how and why recovery was so different for people with different circumstances.Research in contextEvidence before this studyTo search for previous reports on associations between recovery from COVID-19 and socio-demographic factors, we screened abstracts identified from the PubMed search query on December 21, 2023: “((COVID-19) AND ((recovery) OR (convalescence) OR (“ ongoing symptoms”)) AND ((socioeconomic) OR (sociodemographic) OR (social) OR (gradient))) AND LitCLONGCOVID[filter]”, where LitCLONGCOVID is a filter for articles relating to long COVID (https://pubmed.ncbi.nlm.nih.gov/help/#covid19-article-filters), which returned 210 results published between July, 2020 and December, 2023.A small number (N = 11) of studies contained direct measures of recovery from COVID-19 in terms of presence/absence of ongoing symptoms relating to COVID-19 illness, either as perceived by the individual or inferred from current symptom reports. Of these, most focused on associations with COVID-19 illness factors such as severity and symptomatology, and prior health indicators. Socio-demographics were mostly used for sample description and adjustments in models rather than as exposures of interest. Of the few studies (N = 8) that tested associations with socio-demographic variables, the range of socio-demographics tested was limited and/or follow-up time typically restricted to 6-12 months since symptom onset. In these studies, associations with recovery were reported for age (N = 4), sex (N = 7), race/ethnicity (N = 2), local area deprivation (N = 1), and education level (N = 1). Associations between long-term symptoms and education or income have been reported in single separate studies. Monthly bulletins up to March 2023 from the UK Coronavirus Infection Survey highlighted prevalence of individuals reporting current effects on daily activities due to long COVID was associated with age, sex, race/ethnicity, local area deprivation and economic activity. No studies were identified that tested for associations of multiple socio-demographics in combination with the likelihood of recovery following COVID-19.Added value of this studyThis is the first study to testing the effects of multiple socio-demographics on self-perceived recovery in combination. Measures that attempt to quantify social advantage and disadvantage were generated from multiple known social determinants of health. We tested a wider range of socio-demographic factors than previous studies, including UK geographic region, educational qualification level, employment status and income. Our study has a longer follow-up time than previous comparable reports, with most participants assessed more than one year after infection onset. Detailed data on health before the coronavirus pandemic and COVID-19 illness allowed models to be adjusted extensively and mediation effects to be tested.Implications of all the available evidenceThe likelihood of full recovery following COVID-19 appears to follow a social gradient, higher for individuals with multiple indicators of social advantages and fewer disadvantages, and lower for those with multiple social disadvantages and fewer advantages prior to the coronavirus pandemic. This reflects and reaffirms the established cycle of social inequalities in health, between individuals’ status within social hierarchies and ill-health. More work is needed to understand the pathways through which this inequality operates so that interventions can be made.

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“…17 Likewise, many social factors are known to be related to recovery, where the consequences of illness, financial precariousness and caregiver burden can put a strain on essential social needs, representing barriers to recovery. 18 In relation to the area of care, the evidence points to certain nuances in the experience and meaning of the recovery process on behalf of people with mental health problems. People cared for in the community give special relevance to interpersonal and selfconnection in their recovery process, through inclusion in one's own community, receiving support when needed and being able to progress through loss.…”

Section: Introductionmentioning

confidence: 99%

“…These differences in how recovery is understood reflect the importance of framing the concept of personal recovery in relation to the local needs and contextual issues of each territory 17 . Likewise, many social factors are known to be related to recovery, where the consequences of illness, financial precariousness and caregiver burden can put a strain on essential social needs, representing barriers to recovery 18 …”

Section: Introductionmentioning

confidence: 99%

The meaning of the recovery process and its stages for people attending a mental health day hospital: A qualitative study

Ventosa‐Ruiz,

Moreno‐Poyato,

Lluch‐Canut

et al. 2024

Health Expectations

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IntroductionThis study sought to explore the meaning of the recovery process and its stages from the perspective of people attending a mental health day hospital.MethodsA descriptive exploratory qualitative study was carried out. Semi‐structured interviews were conducted with people attending a mental health day hospital. The data were analysed deductively by means of content analysis.ResultsThe participants described the recovery process as a process based on three pillars; the attitude towards recovery, hardship, and the effort required throughout the process. Regarding the stages of recovery, for the participants in the first stage of the process (Moratorium), the search for hope was the most important element. In the second stage (Awareness), the reestablishment of their identity, through the acceptance of the consequences derived from the mental health problem, together with being able to feel full and fulfilled, were the most outstanding elements. In the third stage (Preparation), participants highlighted the search for meaning in life, facing their fears and the process with an open mind. Finally, the last two stages (Rebuilding and Growth) were related to taking responsibility and empowerment for recovery.ConclusionsThe results of this study provide insight into the perception of the recovery process and its stages in people attending a mental health day hospital. These findings may contribute to aligning the nurse–patient perspective, helping nurses to understand the key elements of patients according to their stage of recovery, and thus be able to subsequently individualise interventions.Patient and Public ContributionThis study was based on interviews with 15 patients receiving treatment at an adult mental health day hospital. This study would not have been possible without their participation.

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Social determinants of recovery

Cited by 10 publications

References 69 publications

Conceptualizing Transitional Care After Critical Illness Using Stakeholder Perspectives: A Qualitative Content Analysis

Conceptualizing Transitional Care After Critical Illness Using Stakeholder Perspectives: A Qualitative Content Analysis

Social determinants of recovery from ongoing symptoms following COVID-19 in two UK longitudinal studies: a prospective cohort study

The meaning of the recovery process and its stages for people attending a mental health day hospital: A qualitative study

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