Barriers and Facilitators to Integration of Social Determinants into Clinical Practice in Hospitals in Uganda

Abstract:
Integration
of social determinants into clinical practice is an emerging attractive phenomenon
because of its potential benefits to the health system and patients however inadequate
understanding of the barriers and facilitators poses immense challenges in designing
programs and interventions aimed at enhancing integration of social determinants
into clinical practice. This study investigated the barriers and facilitators to
integration of social determinants into clinical practice in hospitals in Uganda.
Data was collected from 21 key informants using a key informant guide that covered
various aspects of integration of social determinants into clinical practice. The
study identified barriers and facilitators at institutional and health-worker associated
barriers. These barriers were at patient, departmental and community levels. There
were similarities and differences in the barrier’s ad facilitators observed in this
study and those articulated in literature. More so this study revealed some unique
barriers and facilitators. The study confirmed existence of barriers and facilitators
to integration of social determinants into clinical practice in hospitals in Uganda.
Although in-depth interviews were conducted it was not possible to eliminate self-report
bias
References:
[1] Andermann, A., 2016.
Taking action on the social determinants of health in clinical practice: a framework
for health professionals. CMAJ, 188(17-18). doi:10.1503/cmaj.160177.
[2] Sara H., 2017. Using
Social Determinants of Health in Patient-Centered Care. https://patientengagementhit.com/news/using-social-determinants-of-health-in-patient-centered-care.
[3] James R. Hargreaves,
Delia Boccia, Carlton A. Evans, Michelle Adato, Mark Petticrew, and John D. H. Porter,
2011. The Social Determinants of Tuberculosis: From Evidence to Action. Am J Public
Health, 101(4): 654–662. doi: 10.2105/AJPH.2010.199505.
[4] Hugh Alderwick and
Laura M. Gottlieb, 2019. Meanings and Misunderstandings: A Social Determinants of
Health Lexicon for Health Care Systems. https://www.milbank.org/quarterly/articles/meanings-and-misunderstandings-a-social-determinants-of-health-lexicon-for-health-care-systems/.
[5] Leo Lopez; Louis H.
Hart; Mitchell H. Katz, 2021. Racial and Ethnic Health Disparities Related to Covid-19.
JAMA. 2021;325(8):719-720. doi:10.1001/jama.2020.26443.
[6] Michael J. Oakes,
2008. Macrosocial Determinants of Population Health: Edited by Sandro Galea. American
Journal of Epidemiology, Volume 167 (12), Pages 1518–1519, https://doi.org/10.1093/aje/kwn059,
https://academic.oup.com/aje/article/167/12/1518/88508.
[7] Allie F., 2020. Applying
Social Determinants of Health to Improve Care Coordination. https://hitconsultant.net/2020/05/26/applying-social-determinants-of-health-to-improve-care-coordination/#.YYiJWmBBw2w.
05/26/2020.
[8] Labib G., Gerald V.
Gurp, David Z., Anne A., 2018. Physician experiences and barriers to addressing
the social determinants of health in the Eastern Mediterranean Region: a qualitative
research study. BMC Health Services Research (2018) 18:614. https://doi.org/10.1186/s12913-018-3408-z.
[9] WHO, 2008. Social
determinants of health. Accessed 29/06/2020, from who.int: https://www.who.int/social_determinants/thecommission/finalreport/key_concepts/en.
[10] National Academies
of Sciencies, Engineering and Medicne, 2019. Integrating Social Care into the Delivery
of Health Care: Moving Upstream to Improve the Nation’s Health. Washington, DC:
The National Academies Press. doi: https://doi.org/10.17226/25467.
[11] American Academy of
Family Physicians, 2019. About/Policies. Accessed 04/07/2019, from www.aafp.org:
https://www.aafp.org/about/policies/all/social-determinants.html.
[12] Richard R. 2021. How
Social Determinants of Health Affect Medication Adherence. https://blog.cureatr.com/how-social-determinants-of-health-affect-medication-adherence.
[13] Samantha Artiga, a.
E., 2018. Beyond Health Care: The Role of Social Determinants in Promoting Health
and Health Equity. https://www.kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/.
[14] Rural Health Information
Hub, 2020. Tools for success. Accessed 10/11/2020: https://www.ruralhealthinfo.org/toolkits/sdoh/1/frameworks.
[15] Andermann, A., 2018.
Screening for social determinants of health in clinical care: moving from the margins
to the mainstream. Public Health Review, 39(19). doi: https://doi.org/10.1186/s40985-018-0094-7.
[16] HIMSS, 2019. Resource
Centre-Latest Resources. Retrieved from himss.org: https://www.himss.org/resources/social-determinants-health-can-zip-codes-influence-health-outcomes.
[17] Cecilia O. 2021. Government
Rushes to Procure More Hospital Beds. The New Vision, 07 July https://www.newvision.co.ug/articledetails/108087.
[18] UCLA Centre for Health
Policy Research, 2004. Section 4: Key informant Interviews. https://healthpolicy.ucla.edu/programs/health-data/trainings/Documents/tw_cba23.pdf.
[19] Dowhaniuk, N. Exploring
country-wide equitable government health care facility access in Uganda. Int J Equity
Health 20, 38 (2021). https://doi.org/10.1186/s12939-020-01371-5.
[20] Government of Uganda,
2017. Malnutrition in Uganda, Agriculture and Nutrition Fact Sheet. https://www.fantaproject.org/sites/default/files/resources/Uganda-Ag-Nutrition-FactSheet-Dec2017.pdf.
[21] Ssegujja, E., Mulumba,
Y., Guttmacher, S. et al., 2021. The role and attributes of social networks in the
provision of support to women after stillbirth: experiences from Uganda. BMC Women’s
Health 21, 352 (2021). https://doi.org/10.1186/s12905-021-01498-9.
[22] Dauner, K.N., Loomer,
L. A, 2021. Qualitative assessment of barriers and facilitators associated with
addressing social determinants of health among members of a health collaborative
in the rural Midwest. BMC Health Serv Res 21, 867 (2021). https://doi.org/10.1186/s12913-021-06859-6.
[23] Westerberg et, al
2009. Cross-sectional survey of hearing impairment and ear disease in Uganda. Journal
of otolaryngology - head & neck surgery = Le Journal d’oto-rhino-laryngologie
et de chirurgie cervico-faciale 37(6):753-8.
[24] The Republic of Uganda,
2015. The National Social Protection Policy. https://socialprotection.go.ug/wp-content/uploads/2016/07/National-Social-Protection-Policy-uganda.pdf.
[25] Hilary E. Rogers,
2014. Assessment Of the Capacity of Ugandan Health Facilities, Personnel, And Resources
to Prevent And Control Noncommunicable Diseases.