by Jacqueline Renfrow | Jun 10, 2019
8:25am
Individuals who are living with chronic or acute conditions have
a much different view of the social determinants of health (SDOH) compared with
researchers and the media, according to a new study (PDF) out of the Anthem Public
Policy Institute.
Individuals are focused on daily influences such as finding the
right doctor and nutritional food, while researchers focus on more structural
factors such as education and income level, according to the report. Partnered
with Quid, the report made these determinations by examining the conversations
in news articles and academic papers along with patient forums focused on
cancer, diabetes and mental health conditions.
“By better understanding how individuals view and talk about
social determinants, payers and providers alike can identify new and improved
ways to engage with them to more effectively improve their health and
well-being and the delivery of healthcare,” Jennifer Kowalski, vice president
of the Anthem Public Policy Institute, said in a statement.
Plus, she noted that individuals were more focused on food and
social support, which could be more easily modified by payers and providers
than big trends such as economic stability and education.
Looking at social media, the factors most discussed on patient
forums for cancer and mental health conditions were social support and
navigating the healthcare system. And food and nutrition were the most common
posts on forums for patients with diabetes.
The biggest factors for individuals included navigating the healthcare system, 44%; social support, 25%; food, 12%; economic stability, 10%; neighborhood, 5%; and education, 4%. These concerns seemed to widely differ from those of the media and researchers, which came out with economic stability almost as important as education, 20% and 22%, respectively. Almost a three-way tie for the next set of concerns included navigating the healthcare system, social support and neighborhood, 17%, 16% and 16%. Food only accounted for 9% of the overall concerns.
The biggest factors for individuals included navigating the healthcare system, 44%; social support, 25%; food, 12%; economic stability, 10%; neighborhood, 5%; and education, 4%. These concerns seemed to widely differ from those of the media and researchers, which came out with economic stability almost as important as education, 20% and 22%, respectively. Almost a three-way tie for the next set of concerns included navigating the healthcare system, social support and neighborhood, 17%, 16% and 16%. Food only accounted for 9% of the overall concerns.
Social support was a dominating part of the individual
discussions around SDOH comprising 25% of all conversations, but only 11% of
academic papers. And these individual posts—both positive and negative—were
highly shared on social media. Those in diabetes and cancer forums reported a
lot of positive support from family members, while those living with mental
health conditions were less likely to be receiving social support. In fact,
only 20% of all posts on social support for those with mental health conditions
were positive.
Almost half of the forum posts by individuals with mental health conditions and cancer
were around access to providers and care. The posts were just about split
between positive and negative reactions to finding providers. The study notes
that none of the posts raised the issue of access to linguistically appropriate
care, yet 12% of academic and media narrative did focus on this concern.
So why such a discrepancy in focus between patients and
academics?
"One possible hypothesis is that individuals are focused on
those social factors that they can more easily modify—such as finding the right
provider or eating healthy—and the impacts they can recognize on a day-to-day
basis," Kowalski told FierceHealthcare. "It follows that these are
the same issues that individuals might bring up in online patient forums as
well. In contrast, academics tend to focus on those things that are measurable
with data, and therefore structural factors like income and education level are
more easily studied. In turn, the findings from academic studies make up a
portion of the media coverage on social determinants of health, along with
notable new initiatives, such as local investment in new low-income housing
solutions."
The report does see opportunities to bridge the gaps between
individuals and the public view of SDOH. In fact, it states that increased
spending to address intermediary factors like food security and housing
stability improves health.
Plus, many of the discussions had overlapping challenges; for example, lack of social support could be related to access to transportation, and anxiety could also play a part for those with mental health issues.
Plus, many of the discussions had overlapping challenges; for example, lack of social support could be related to access to transportation, and anxiety could also play a part for those with mental health issues.
The paper also suggests that payers and providers invest in
access to food, transportation and social capital. Another suggestion is to
integrate clinical and social data and models of care to develop targeted
interventions. And finally, to support policy and funding that expand available
solutions
"A good first step is for payers to engage in their
communities—build partnerships, support community organizations that address
social needs, and expand their own capacity to identify and address social
needs among members," Kowalski said. "This will benefit members as
well as their communities broadly. From there, health plans—especially in the
Medicaid and Medicare Advantage programs—have more flexibility now than at any
time before to address SDOH through benefit design, models of care, and other
interventions."
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