About this poster

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Panel information
Panel 1. Context: Cross-Cultural, Neighborhood, and Social

Abstract

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Objectives: Patients’ and providers’ experience of race can influence patient-provide relationship and patients’ utilization of social welfare services that address their social determinant of health needs. Healthy People 2030 defines Social Determinant of Health (SDOH) as the following 5 domains where people are born, live, work, worship and play: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context (U.S. Department of Health and Human Services). The existing healthcare system may be structurally designed to address patient SDOH needs, but fails to actually meet patient needs. This structural failure was heightened in marginalized, immigrant low-resourced communities during the Covid-19-pandemic (Fracci et al., 2022, Brakefield et al., 2022. Sharma et al., 2020). Our objective was to explore and develop strategies to address the under-utilization of Social Determinant of Health (SDH) screening and service seeking gaps that have not been systematically developed and tested among Chinese-American caregivers.

Methods: The study was guided by human-centered design and implementation science frameworks using a qualitative study design. Quality improvement interviews with eight healthcare providers (i.e. pediatricians, family practice doctors and social service workers) who serve a predominantly Chinese-American patient population were conducted in the Sunset Park neighborhood of Brooklyn, New York. Providers also completed the IAT implicit bias questionnaire. Six in-depth interviews were conducted with Mandarin speaking Chinese-American caregivers to understand their SDH needs, SDH service seeking beliefs, behaviors, and experiences post Covid-19. Interviews were transcribed and coded in Mandarin, and then translated into English. Codes were developed both a priori based on interviewer notes, and applied grounded theory approach by a Mandarin speaker. We then applied user-journey mapping, to identify individual knowledge, belief, and behavior gaps, key influencers in caregiver ecosystem, and health service structural gaps. And lastly, we applied journey mapping and implementation science framework to unpack gaps and inform the development of a behavior intervention.

Results: Preliminary findings indicate caregivers had SDH needs in mental health (e.g. depression, anxiety, and childcare stress), food and financial security, but they tend not to utilize services because of beliefs of not wanting to burden others. Caregivers would rely upon their own social networks before going to providers. If caregivers seek out services, their experiences with providers are contingent on ethnic concordance, language and cultural affinity to share needs and receptivity to available services. Provider interviews elucidated key areas of need, gaps and strategies for addressing caregiver patient social determinant of health needs. Service gaps related to screening and gaps related to service referral and patient actually getting services needed, centered around the following service gaps: 1. Short staff, 2. Patient intake forms in print form only provided in English, and 3. No way to close the loop. IAT results taken by providers indicated higher bias among White/White Hispanic providers, compared to Asian-American or Black providers.

Conclusion: Patient-centered approaches that leverage journey mapping aid in developing solutions that resonate with caregiver needs to increase likelihood of use and meet patient needs.

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