N. C. English1,2, B. P. Smith2, L. Wood2, W. Oslock2, B. Jones2, R. H. Hollis2, G. Kennedy2, D. J. Gunnells2, M. Morris2, K. Hardiman2, J. Cannon2, D. I. Chu2 1University of Cape Town, Department Of General Surgery, Cape Town, WESTERN CAPE, South Africa 2University Of Alabama at Birmingham, Division Of Gastrointestinal Surgery, Department Of Surgery, Birmingham, Alabama, USA
Introduction: Socioecological determinants of health (SEDOHs) influence surgical outcomes. However, SEDOHs are challenging to measure, especially in disparity areas such as rural settings, limiting our ability to address these disparities. Therefore, using the SEDOH-88 survey, we aimed to measure and characterize SEDOHs in three rural communities in Alabama. We hypothesized that each community experiences unique SEDOHs and measuring them would be acceptable and feasible.
Methods: This is a retrospective review of prospectively collected data from 08/2021 to 07/2023, involving surgical patients recruited from three rural hospitals in the Deep South: Demopolis (DM), Alexander City (AC), and Greenville (GV). The SEDOH-88 was developed using a modified-Delphi method by experts in sociology, surgery, and social determinants of health. It captures individual, structural, and environmental health-related factors including acceptability and feasibility data of survey administration. Analyses compared demographics, survey responses, and measures of acceptability and feasibility across the three hospitals.
Results: The 107 participants comprised 48 from DM, 27 from AC, and 32 from GV. The median age was 64 years and 65.6% were female. When comparing DM, AC and GV in terms of individual factors, DM had the largest Black population (78.7% vs. 22.2% vs. 48.3%, p<0.001), lowest employment rate (11.1% vs. 44.4% vs. 44.8%, p=0.016), and whilst 51.1% were high school graduates, DM had the lowest bachelors, masters, and doctorate graduates (4.4% vs. 37% vs. 20.7 %, p=0.007). Comparing structural and environmental factors, DM had the largest proportion of active church members (84.1% vs. 48.2% vs. 71.4% p=0.009), the largest proportion with no neighborhood recreational facilities (50% vs. 18.5% vs. 28.6%, p=0.042), and the lowest proportion of fresh fruit and vegetables in their community (18.2% vs. 26% vs. 39.3%, p=0.033). Whilst 80% had access to the Internet across all three sites, 36.4% at DM did not (p<0.001). DM also had the largest proportion that always asked for assistance when reading hospital materials (20.5% vs. 3.7% vs. 10.3%, p=0.007), and the lowest proportion that felt extremely confident to complete medical forms independently (34.1% vs. 66.7% vs. 42.4%, p=0.043). The SEDOH-88 had an overall 93.2% positive score for all domains of acceptability and feasibility. 87.4% found it easy to complete and 98.2% felt it captured important health-related aspects.
Conclusion:The SEDOH-88 assessed SEDOHs for surgical populations in rural Alabama with high acceptability and feasibility. DM had significantly worse individual, structural, and environmental factors pertaining to their health compared to AC and GV. These included the lowest rates of employment, neighborhood recreational facilities and Internet access, in addition to the highest need for assistance reading hospital materials. These findings provide targets for future disparity-reducing interventions.