Addressing social determinants of noncommunicable diseases in primary care: a systematic review

Allen, Luke; Smith, Robert; Simmons-Jones, Fiona; Roberts, Nia; Honney, Rory; Currie, Jonny

doi:10.2471/blt.19.248278

Cited by 30 publications

(26 citation statements)

References 36 publications

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“…There is a substantial and growing body of evidence linking interventions on social determinants of health to a broad range of health outcomes (Table 3) [4,38,39,[62][63][64][65][66][67][68]. In primary care studies, there are multiple ways in which social determinants of health are increasingly being addressed (e.g., screening for social risk factors, linking patients with local resources) [69]. In addition, it is important to consider social determinants as potential moderators of health behavior change [70].…”

Section: Improving the Evidence Base Link Social Determinants With Hementioning

confidence: 99%

Implementation science should give higher priority to health equity

et al. 2021

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Background There is growing urgency to tackle issues of equity and justice in the USA and worldwide. Health equity, a framing that moves away from a deficit mindset of what society is doing poorly (disparities) to one that is positive about what society can achieve, is becoming more prominent in health research that uses implementation science approaches. Equity begins with justice—health differences often reflect societal injustices. Applying the perspectives and tools of implementation science has potential for immediate impact to improve health equity. Main text We propose a vision and set of action steps for making health equity a more prominent and central aim of implementation science, thus committing to conduct implementation science through equity-focused principles to achieve this vision in U.S. research and practice. We identify and discuss challenges in current health disparities approaches that do not fully consider social determinants. Implementation research challenges are outlined in three areas: limitations of the evidence base, underdeveloped measures and methods, and inadequate attention to context. To address these challenges, we offer recommendations that seek to (1) link social determinants with health outcomes, (2) build equity into all policies, (3) use equity-relevant metrics, (4) study what is already happening, (5) integrate equity into implementation models, (6) design and tailor implementation strategies, (7) connect to systems and sectors outside of health, (8) engage organizations in internal and external equity efforts, (9) build capacity for equity in implementation science, and (10) focus on equity in dissemination efforts. Conclusions Every project in implementation science should include an equity focus. For some studies, equity is the main goal of the project and a central feature of all aspects of the project. In other studies, equity is part of a project but not the singular focus. In these studies, we should, at a minimum, ensure that we “leave no one behind” and that existing disparities are not widened. With a stronger commitment to health equity from funders, researchers, practitioners, advocates, evaluators, and policy makers, we can harvest the rewards of the resources being invested in health-related research to eliminate disparities, resulting in health equity.

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Section: Improving the Evidence Base Link Social Determinants With Hementioning

confidence: 99%

Implementation science should give higher priority to health equity

et al. 2021

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“…Our findings provide new evidence on drivers of the use of PHC services by patients with chronic conditions, and thus contributes to the international debate for moving toward Universal Health Coverage (2,17,22,42,43).…”

Section: Discussionmentioning

confidence: 67%

“…There is consistent international commitment to reducing the burden of NCDs ( 2 , 19 , 42 ). Multiple declarations have been made regarding the importance of the role PHC services play in preventing and controlling NCDs, especially in low and middle-income countries (LMIC).…”

Section: Introductionmentioning

confidence: 99%

“…This is also true for SEE countries, whose healthcare systems are in transition after having been previously focused on curative rather than preventive measures, and on infectious rather than non-communicable diseases ( 9 ). Unlike many other studies in the western context, where both NCDs and PHC services are well-investigated, most healthcare systems in SEE countries have limited access to, and use of, quality data for informing policy ( 2 , 42 ).…”

Section: Introductionmentioning

confidence: 99%

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Health Seeking Behavior Among Adults and Elderly With Chronic Health Condition(s) in Albania

Gabrani

Schindler

Wyss

2021

Front. Public Health

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Aim: Assess the use of different health care service providers by adults (aged 18–59) and elderly (aged > =60) who suffer from non-communicable disease (NCD) and explore relationships between sociodemographic variables and care-seeking behaviors.Methods: A cross-sectional survey was conducted in the districts of Diber and Fier in December 2018, using random cluster sampling. Descriptive statistics were used to compare the care-seeking behaviors of adults and elderly people. We employed binary and multinomial logistic regression to assess factors associated with the type of health service provider used. Analyses were adjusted for clustering within districts of residence.Results: Out of 3,799 respondents, 1,116 (29.4%) suffered from an NCD. Of these, 95% sought to obtain care for their chronic condition through public healthcare providers. The elderly were more likely to use primary healthcare services (PHC) to initiate care when facing health problems (56%), compared to those aged 18–59 years (49%, p < 0,001). Over the last 8 weeks, 82% (914/1,116) of participants sought care. Binary and multinomial logistic regression analyses, adjusted for socio-demographic variables, showed that the elderly were more likely to choose PHC services (OR 1.56; 95% CI: 1.04; 2.35). Moreover, individuals who suffered from hypertension used PHC services more frequently than hospitals (OR 1.94; 95% CI: 1.32; 2.85). A positive association was found between living in an urban area and seeking care for NCDs at polyclinics (OR 10.1; 95% CI: 2.1; 50.1). There was no significant gender difference observed with regard to the type of provider consulted.Conclusion: Public facilities were reported as the main providers for initiating care and the main providers used in the 8 weeks prior to the interview. While a majority of elderly people visited a PHC to initiate treatment (and follow up) on their chronic conditions, a substantial proportion of adults (aged 18–59) initiated and sought regular NCD care at a hospital. Educating patients and caregivers on active participation in NCD prevention, management, and control through the PHC level should be a long-term effort, along with the establishment of well-structured referral mechanisms and integrated care systems.

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“…Insurance is an important factor in improving access to healthcare. Access to healthcare is also influenced by socioeconomic circumstances, such as education and income [ 2 ]. However, few previous studies on social inequalities in oral health have considered the effects of insurance.…”

Section: Introductionmentioning

confidence: 99%

Inequalities in Periodontal Disease According to Insurance Schemes in Thailand

Srinarupat

Oshiro

Zaitsu

et al. 2021

IJERPH

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Few studies have considered the effects of insurance on periodontal disease. We aimed to investigate the association between insurance schemes and periodontal disease among adults, using Thailand’s National Oral Health Survey (2017) data. A modified Community Periodontal Index was used to measure periodontal disease. Insurance schemes were categorized into the Universal Coverage Scheme (UCS), Civil Servant Medical Benefit Scheme (CSMBS), Social Security Scheme (SSS), and “others”. Poisson regression was applied to estimate the prevalence ratios (PRs) of insurance schemes for periodontal disease, with adjustment for age, gender, residential location, education attainment, and income. The data of 4534 participants (mean age, 39.6 ± 2.9 years; 2194 men, 2340 women) were analyzed. The proportions of participants with gingivitis or periodontitis were 87.6% and 25.9%, respectively. In covariate adjusted models, lowest education (PRs, 1.03; 95% CI, 1.01–1.06) and UCS (PRs, 1.05; 95% CI, 1.02–1.08) yielded significantly higher PRs for gingivitis, whereas lowest education (PRs, 1.20; 95% CI, 1.05–1.37) and UCS (PRs, 1.17; 95% CI, 1.02–1.34) yielded substantially higher PRs for periodontitis. Insurance schemes may be social predictors of periodontal disease. For better oral health, reduced insurance inequalities are required to increase access to regular dental visits and utilization in Thailand.

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Addressing social determinants of noncommunicable diseases in primary care: a systematic review

Cited by 30 publications

References 36 publications

Implementation science should give higher priority to health equity

Implementation science should give higher priority to health equity

Health Seeking Behavior Among Adults and Elderly With Chronic Health Condition(s) in Albania

Inequalities in Periodontal Disease According to Insurance Schemes in Thailand

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