The social determinants of health (SDOH) represent factors that impact the health and effectiveness/compliance of a treatment plan for a patient. The SDOH include such factors as economic stability, education, home and community context, access to healthcare, neighborhood and built environment, and personal behavior. The purpose of this study is to determine the extent of collection and integration of SDOH into clinical practice, and the usefulness of this information in medical decision making. Following a thorough literature review, an online survey was deployed to physicians and administrators around the country, with the aim of answering the following questions: 1) Do provider practices collect information on a patient's social determinants of health? 2) If yes, how is that information being used, if at all? 3) If not, what is preventing them from doing so? 4) Do the answers to questions 1-3 differ based on the type of payment model (Fee-for-Service or Capitation) to which the practice is subject? The results of the study suggest that fee-for-service payment environments present less incentive to use a patient's SDOH in medical decision making.

The majority of trust research has focused on the benefits trust can have for individual actors, institutions, and organizations. This “optimistic bias” is particularly evident in work focused on institutional trust, where concepts such as procedural justice, shared values, and moral responsibility have gained prominence. But trust in institutions may not be exclusively good. We reveal implications for the “dark side” of institutional trust by reviewing relevant theories and empirical research that can contribute to a more holistic understanding. We frame our discussion by suggesting there may be a “Goldilocks principle” of institutional trust, where trust that is too low (typically the focus) or too high (not usually considered by trust researchers) may be problematic. The chapter focuses on the issue of too-high trust and processes through which such too-high trust might emerge. Specifically, excessive trust might result from external, internal, and intersecting external-internal processes. External processes refer to the actions institutions take that affect public trust, while internal processes refer to intrapersonal factors affecting a trustor’s level of trust. We describe how the beneficial psychological and behavioral outcomes of trust can be mitigated or circumvented through these processes and highlight the implications of a “darkest” side of trust when they intersect. We draw upon research on organizations and legal, governmental, and political systems to demonstrate the dark side of trust in different contexts. The conclusion outlines directions for future research and encourages researchers to consider the ethical nuances of studying how to increase institutional trust.

As 2020 unfolded, a new headline began taking over front pages: “COVID-19”. In the months that followed, waves of fear, sorrow, isolation, and grief gripped the population in the viruses’ wake. We have all heard it, we have all felt it, indeed because we were all there. Trailing a few months behind those initial headlines, more followed that only served to breed misinformation and ludicrous theories. Even with study after study, quality, scientific data about this new virus could not come fast enough. There was somehow both too much information and also not enough. We were scrambling to process the abundance of raw numbers into some semblance of an explanation. After those first few months of the pandemic, patterns in the research are beginning to emerge. These horrific patterns tell much more than just the pathology of COVID-19. As the number of sick, surviving, and deceased patients began to accumulate, it became clear that some populations were left devastated, while others seemed unscathed. The reasons for these patterns were present long before the COVID-19 Pandemic. Disparities in health care were highlighted by the pandemic – not caused by it. The roots of these disparities lie in the five Social Determinants of Health (SDOH): (1) economic stability, (2) neighborhood and built environment, (3) education, (4) social and community context, and (5) health and health care. Minority populations, namely Black Americans, Hispanic Americans, Native Americans, and Pacific Islanders consistently have higher diagnosis rates and poorer patient outcomes compared to their White American and Asian American counterparts. This is partly because minority populations tend to have jobs that pay lower, increase exposure risk, and provide little healthcare. When unemployment increased in the wake of the pandemic, minorities were the first to lose their jobs and their health insurance. In addition, these populations tend to live in densely populated neighborhoods, where social isolation is harder. Higher poverty rates encourage work DISPROPORTIONATE EFFECTS OF COVID-19 ON MINORITY POPULATIONS 3 rather than education, often perpetuating the cycle. The recent racial history and current aggressions towards minority people might produce a social attitude against healthcare Health care itself can be expensive, hard to find, and/or tied to employment, leading to poorly controlled comorbidities, which exacerbate poor patient outcomes in the case of COVID-19 infection. The healthcare delivery system plays little part in the SDOH, instead, public policy must be called to reform in order to fix these issues.

Endometriosis has created a public health crisis in the United States due to its high prevalence, and its severe health ramifications. Not only does endometriosis have a wide-ranging prevalence in the population, as it is predicted that 1 in 10 females of reproductive age suffer from this disease, but endometriosis significantly decreases this population's quality of life, productivity, and emotional well-being due to chronic pain and infertility issues. There have been several identified reasons behind the endometriosis diagnosis delay, including patient and provider-centered causes, which lead to the dismissal, stigmatization, and tolerance of symptoms. However, there is limited research about the social determinants influencing the United State's diagnosis delay. This study aimed to investigate the social determinants surrounding the endometriosis diagnosis delay by interviewing Endometriosis patients about their own diagnoses. Participants were also asked about their satisfaction about their endometriosis diagnosis. A thematic analysis was conducted using patient testimonials to reveal trends surrounding the endometriosis diagnosis delay. On average, 40 participants reported experiencing a diagnostic delay of 11.75 ± 7.94 years. Participants report significant dissatisfaction with the timeliness of the endometriosis diagnosis, the providers' ability to be communicative and receptive, and the providers' ability to diagnose endometriosis. Many social determinants were also associated with diagnosis delays - including gender, ethnic, racial, economic, geographical location, age, and sexual orientation factors. Not only do participant testimonials reveal the need for culturally competent care, validation, and patient-centered care during the endometriosis diagnosis process, but these testimonials also emphasize the need for diagnostic surgery and specialized care as endometriosis is a complex disease that can have systemic implications on a patient. The American College of Obstetricians and Gynecologists (AGOG) endometriosis care guidelines should be adjusted to reflect the needs of endometriosis patients.

Many would contend that the United States healthcare system should be moving towards a state of health equity. Here, every individual is not disadvantaged from achieving their true health potential. However, a variety of barriers currently exist that restrict individuals across the country from attaining equitable health outcomes; one of these is the social determinants of health (SDOH). The SDOH are non-medical factors that influence the health outcomes of an individual such as air pollution, food insecurity, and transportation accessibility. Each of these factors can influence the critical illnesses and health outcomes of individuals and, in turn, diminish the level of health equity in affected areas. Further, the SDOH have a strong correlation with lower levels of health outcomes such as life expectancy, physical health, and mental health. Despite having influenced the United States health care system for decades, the industry has only begun to address its influences within the past few years. Through exploration between the associations of the SDOH and health outcomes, programming and policy-making can begin to address the barrier to health equity that the SDOH create.

Bridging social capital describes the diffusion of information across networks built between individuals of different social identities. This project aims to understand if the bridging ties of economic connectedness (EC), measured by data from Facebook friends and calculated as the average share of high socioeconomic status friends that an individual from a low socioeconomic status has, can be a predictor of variations in COVID-19 infection risk across Arizona ZIP code tabulation areas (ZCTAs). Economic connectedness values across Arizona ZCTAs was examined in addition to the correlation of EC to various social and demographic factors such as age, sex, race and ethnicity, educational background, income, and health insurance coverage. A multiple linear regression model was conducted to examine the association of EC to biweekly COVID-19 growth rate from October 2020 to November 2021, and to examine the longitudinal trends in the association between these two factors. The study found that the bridging ties of economic connectedness has a significant effect size comparable to that of other demographic features, and has implications in being used to identify vulnerabilities and health disparities in communities during the pandemic.

This thesis addresses the global and national health landscape of disparities to provide insight into the social factors such as education, socioeconomic status, and environment that impact marginalized groups. A positive correlation between race, residency, and lower socioeconomic status among global and national landscapes was made with oral health disparities demonstrating poorer health outcomes among these groups. Through a multistep approach this thesis aimed to provide solutions to contribute to the efforts of developing effective policies and interventions that aim to promote oral health equity.

Interprofessional collaboration (IP) is an approach used by healthcare organizations to improve the quality of care. Studies examining effects of IP with patients with type 2 diabetes mellitus (T2DM) have shown improvement in A1C, blood pressure, lipids, self-efficacy and overall greater knowledge of disease process and management. The purpose of this project was to evaluate the impact of IP with attention to identifying and addressing social needs of patients with T2DM. Participants at least 18 years of age with an A1C >6.5% were identified; Spanish speaking patients were included in this project. The intervention included administration of Health Leads questionnaire to assess social needs. Monthly in person or phone meetings were conducted during a 3-month period.

The patient had the option to meet with the doctor of nursing practice (DNP) student as well as other members of the team including the clinical pharmacist and social work intern. Baseline A1C levels were extracted from chart at 1st monthly meeting. Post A1C levels were drawn at the 3 month follow up with their primary care provider. Study outcomes include the difference in A1C goal attainment, mean A1C and patient satisfaction. Pre A1C levels in participants ranged from 7.1% to 9.8% with a mean of 8.3%. Post A1C levels ranged from 6.9% to 8.6% with a mean of 7.7%. Two cases were excluded as they did not respond to the intervention. A paired-samples t test was calculated to compare the mean pre A1C level to the post A1C level. The mean pre A1C level was 8.24 (sd .879), and the post A1C level was 7.69 (sd .631). A significant decrease from pre to post A1C levels was found (t (6) = 2.82, p<.05).

The prevalence of Type 2 Diabetes is on the rise, as are the costs. This nation’s healthcare system must promote interprofessional collaboration and do a better job of addressing SDOH to more effectively engage patients in the management of their disease.