Prior research has focused on linking social determinants of health (SDH) to the distribution of chronic diseases such as Heart failure (HF) within community groups. These studies reflect that racial, ethnic, and socioeconomic minority groups are the most burdened by HF. While adequate self-care in HF patients is known to significantly prevent exacerbations, reduce readmissions, improve quality of life and overall wellbeing, little is known about the relationship between SDH and HF self-care. Specifically, investigators are unsure of patients' fundamental situational needs that serve as operational mechanisms through which SDH limit the self-care choices of HF patients. These mechanisms may be the pathway through which SDH lead to the unequal distribution and inequity in HF burden among disparate population groups. Only by assessing the specific patient-identified needs that influence self-care behavior can interventions be targeted to improve health among vulnerable groups who suffer the negative effects of SDH. Therefore, this proposed research intensive application will prepare the applicant to conduct a mixed methods study to understand the relationship between SDH and HF self-care in hospitalized community dwelling patients with HF. This goal will be achieved through three specific aims: 1) Quantitatively assess the relationship between SDH and HF self-care in 145 community dwelling participants hospitalized for exacerbation of HF by testing 7 SDH core domains (Race, Income, Education, Employment, Neighborhood, Housing status/stability, and Social integration/support), as predictors of HF self-care (maintenance, monitoring, management and confidence) using backward elimination regression analyses, 2) Qualitatively explore the perceptions, beliefs and experiences of extreme cases (poor and excellent self-care maintenance, N=40) within the quantitative sample surrounding SDH and their self-care choices using the Gibb's reflective cycle in one-on-one interviews. This way, we will identify fundamental situational needs that are salient to participants and serve as operational mechanisms through which SDH limit the self-care choices of HF patients.
In aim 3, we will describe differences in the self-reported SDH in relation to participants' self-care behavior by integrating the qualitative and quantitative data obtained from the extreme cases to identify patterns of differences or congruence in SDH and self-care behavior. The proposed study is first to use a mixed methods approach to explore the relationship between SDH and HF self-care and identify patient specific fundamental needs as operational mechanisms through which SDH influence self-care. The proposed study aligns with the strategic plan of the National Institute of Nursing Research of promoting health, preventing illness, improving the health of individuals and advancing health equity.
The burden of heart failure is inequitably distributed among population groups who suffer the negative effects of social determinants of health. It is critically important to assess patient-identified needs that influence self- care behavior among population groups in low resourced areas to aid in developing targeted interventions.
