Researchers in the Duke Department of Medicine (DOM) are shedding new light on the intersection of social needs and medical care in a new study on social determinants of health (SDOH) — disparate social conditions — that impact recovery from acute illnesses like COVID-19.
Supported by a COVID-19 research grant from the DOM, researchers in a recently published qualitative study of patients recovering from COVID-19 and their caregivers, identified distinct themes that cross-cut SDOH domains, and may help explain mechanisms of the COVID-19 syndemic and patients’ disparate experiences of recovery.
In 24 interviews with patients and patient-caregiver dyads, participants noted that innovative mobilization of social resources (e.g. policies to secure income during time away from work) supported recovery from COVID-19 illness. In contrast, destabilization and change introduced by illness (e.g. disrupted social support networks) and mistrust of previously established institutions (e.g. public health misinformation) hindered recovery.
“Our patient population was very severely affected by the (COVID-19) pandemic, then particularly after they became well again and we were seeing them in the ambulatory setting with a lot of persistent debility,” said Dr. Deepshikha Ashana, who led the research along with corresponding author, Dr. Neelima Navuluri, both assistant professors in the Division of Pulmonary, Allergy and Critical Care. Dr. Nrupen Bhavsar, associate professor in the Department of Surgery, also helped lead the study and is a co-author on the paper.
Diving Deeper into the Patient Experience
“We are interested in disparities that exist in healthcare, especially within our field of pulmonary and critical care, as well as why those disparities exist and what can be done about it,” Dr. Navuluri said. “This study offered us an opportunity to dive deeper into the experiences of our patients by talking with patients and their caregivers, to gain some first-person perspectives and hear their stories. That was really wonderful.”
The team recruited 24 subjects to interview about SDOH domains — as defined by the U.S. Centers for Disease Control and Prevention— from a post-COVID-19 Duke clinic between November 2022 and March 2023, and studied how SDOH influenced their recovery from COVID-19.
“One of the things that we found was there were common ideas or themes that came up and cross-cut all the different SDOH domains. These themes highlighted the interconnectedness of the domains and provides an additional way of thinking about the impact SDOH can have on health,” Dr. Navuluri said.
While study participants described many negative impacts of social drivers on their health, an interesting data point emerged around patients’ access to innovative social resources mobilized during times of illness to meet their new and evolving needs, Dr. Ashana pointed out.
Social Resource Innovation
“During COVID, there was just incredible creativity. People were willing to think in a different way and there was an innovative mobilization of social resources, things like grocery delivery services and telemedicine, that became very popular,” she said. “We were in a moment where we were able to respond in these really innovative, flexible ways that really served patients’ needs by meeting them where they are. The takeaway is how do we sustain that?”
“With COVID there was a recognition of various needs and a community level push for accessing resources, helping people get care, and things moved faster,” said Dr. Navuluri. “We talked about how quick the rate of policy change for telehealth practices or being able to mobilize and adapt resources and services to meet population needs was really unique. There’s a lot we can learn from that.”
The issue of trust with regard to established health institutions also got their attention. Patients in the study expressed the opinion that established institutions they trusted and looked to for information in the past are not as stable as they once were.
“Hospitals serve as a community anchor, as trusted places people know they can rely on for education and health so we should think about what our role in this community is and how we establish strong, trustworthy bonds,” Dr. Ashana added. “Duke is already doing a lot of investing there with entire offices devoted to community engagement and community partnerships. We should continue building on this.”
The research also presents the question of how clinicians will apply data from SDOH screening —which is increasingly required of health systems — to inform patient care and long-term recovery in the future, Dr. Navuluri pointed out.
Study findings also speak to the importance of qualitative data in understanding the differential effects of these factors as SDOH are often quantified using static measures, often obscuring how the same social factors may be associated with a positive outcome for one individual and a negative outcome for another.