How Can Conspicuous Omni-Signaling Fulfil Social Needs and Induce Re-Consumption?

This study investigated consumer behaviors in conspicuous omni-signaling—its internal motivations and its consequences on social needs fulfilment and re-consumption intention in the context of luxury fashion. A phenomenon of conspicuous consumption is identified with the consumption and display of conspicuous goods to signal status, wealth, and prestige. Digital development has made conspicuous signaling radically emerge in social media through the posting of photos, videos, or stories of luxury goods. This drives an emerging phenomenon of conspicuous omni-signaling, the use of both offline and online media to signal conspicuous consumption hybridlike. As a new phenomenon, little is known of consumer behaviors related to conspicuous omni-signaling. To facilitate the investigation, an online survey was conducted to collect data from 474 valid respondents across eight cities representing various conspicuous consumption characteristics of Indonesian consumers. Veblen's conspicuous consumption and Maslow's hierarchy of needs theories were employed as the main lens for analysis. PLS-SEM technique was employed as the research model uses mixed reflective and formative constructs. WarpPLS 7.0 was then used for data analysis. The results indicated that luxury values and fashion consciousness positively affect conspicuous omni-signaling. This study also found that conspicuous omni-signaling affects conspicuous re-consumption both directly and indirectly through social needs fulfilment. This study contributes to extend the concept of conspicuous offline consumption and conspicuous online consumption to conspicuous omni-signaling. This study also confirms conflicting results in the effect of conspicuous consumption on social needs fulfilment, and conflicting results in the effect of conspicuous consumption on conspicuous re-consumption.

A Needs Assessment of Older Bangladeshi Immigrants in New York During the COVID-19 Pandemic.

Though immigrants from Bangladesh are a fast-growing and under-resourced immigrant community in the United States, little has been studied about their overall health and social needs. Older immigrant adults from Bangladesh are at increased risk for adverse effects from the COVID-19 pandemic, as they have existing risk factors for isolation including language barriers and more recent immigration. This study examined measures of health and connectedness amongst 297 South Asian adults in New York City who were 60 years or older using a phone-based survey instrument. Surveys were conducted from August 2021 to April 2022. We found that immigrants from Bangladesh were more likely to report a higher effect of the COVID-19 pandemic on financial and food insecurity and faced significantly higher levels of loneliness than South Asian immigrants from other countries. Our findings suggest that older immigrants from Bangladesh disproportionally face social isolation compared to older immigrants from other South Asian countries and our study encourages further research and intervention for this immigrant subgroup.

Health and social needs of older adults in slum communities in Ghana: a phenomenological approach used in 2021.

Slum-dwellers lack several essential amenities (such as water, sanitation, and electricity) which make them more vulnerable than non-slum dwellers. As there is limited to no access to health and social care services in slums, the slum environment is expected to be an even more dangerous environment for older adults, negatively impacting their quality of life (QoL). To provide an overview of the perceived (unmet) health and social care needs and how it affects the QoL, this study aims to explore the self-perceived health and social needs of older adults in urban slums in Ghana. Using a phenomenological approach, 25 semi-structured interviews were conducted between May and June 2021, in the homes of older adults in two slums in Ghana. After coding and analysing the transcripts, five main themes emerged: (a) perception of health; (b) (de)motivators of health service use; (c) perception of social care, (d) social needs, and (e) influence of phenomena on QoL. It appeared that older adults believed that spiritual powers were causing illnesses and influenced their use of formal health services. Other factors such as expired insurance cards and the attitude of healthcare workers served as demotivators for using health services.Perceived health needs were mainly current disease conditions (arthritis, diabetes, hypertension, vision/hearing challenges), challenges with health insurance, the behaviour of some health professionals, the proximity of health facilities, and unnecessary queues at major health facilities. Unmet social needs identified by this study were a sense of neglect by family (need for companionship), requiring assistance with activities of daily living, and the need for financial support. Participants had more health needs than social needs. Health providers do not usually prioritize the care of slum-dwelling older adults. Most participants still have challenges with the National Health Insurance Scheme (NHIS). Their social needs were mainly related to financial difficulties and help with some activities of daily living. Participants expressed that they desired companionship (especially the widowed or divorced ones) and the lack of it made them feel lonely and neglected. Home visits by health professionals to older adults should be encouraged to monitor their health condition and advocate for family members to keep older adults company. Healthcare providers should exhibit positive attitudes and educate older patients on the advantages of formal health services use, as well as the need to seek early treatment as this will influence their QoL to a large extent.

The Role of Community Health Workers in the Health and Well-Being of Vulnerable Older Adults during the COVID Pandemic.

The COVID-19 pandemic disrupted social support networks as well as resource access for participants. The purpose of this study was to: analyze the experiences of older adults enrolled in a geriatric-focused community health worker (CHW) support program, to gain a better understanding of how CHWs might enhance care delivery, and to further understand how COVID-19 affected the social and emotional needs and well-being of older adults during the first 18 months of the pandemic. Qualitative analysis was performed on notes entered by CHWs based on 793 telephone encounters with 358 participants between March 2020 and August 2021. Analysis was performed by two reviewers independently coding the data. Weighing the benefits of seeing family against the risks of COVID exposure was a source of emotional distress for participants. Our qualitative analysis suggests that CHWs were effective in providing emotional support and connecting participants to resources. CHWs are capable of bolstering the support networks of older adults and carrying out some of the responsibilities conventionally fulfilled by family supports. CHWs addressed participant needs that are frequently unmet by healthcare team members and provided emotional support to participants contributing to health and well-being. CHW assistance can fill gaps in support left by the healthcare system and family support structures.

Addressing the unmet social needs of gynecologic oncology patients as identified by a universal screening tool in a safety net hospital

Objectives: To identify the unmet, actionable social needs of gynecologic oncology patients using a self-administered social needs assessment tool and quantify the interventions subsequently provided to our patients. Method(s): This is a study of data collected in an ongoing performance improvement initiative in a gynecologic oncology clinic at a safety net hospital and was determined to be exempt from review by the institutional IRB. Eligible patients completed the social needs screening tool from October 2021 to March 2022. The following social needs domains were assessed: food insecurity, utility insecurity, housing insecurity, transportation insecurity, need for childcare, exposure to violence, lack of companionship, difficulty reading, or difficulty accessing medical care due to fear of losing job. Patients were asked if they desired to speak with a social worker and if any needs were urgent. Data from the screening tool was collected and supplemented by data from the EMR. Univariate descriptive statistics were used to report the patient demographic information, prevalence of social needs, and referral rates for social needs identified. Result(s): There were 475 patients seen in the gynecologic oncology clinic since October 2021. 286 (60%) patients completed the screening tool. 139 (49%) screened positive for at least 1 social need;of those 98 (70%) were Hispanic with a median age of 56 years. 27 (6%) patients were receiving treatment for a gynecologic malignancy, of whom 19 (70%) had at least 1 social need. 25 (92%) patients were insured through Medi-Cal. 12 (44%) patients were being treated for endometrial cancer, followed by ovarian (7, 26%) and cervical (4, 15%). The social needs identified in all patients and in patients actively receiving cancer treatment are summarized in Fig. 1. Patients reporting lack of companionship were referred to mental health or cancer support groups through the American Cancer Society or the Los Angeles County Department of Public Health. Those needing transportation or utility services were linked with services available through their insurance or LA County, ride share vouchers, low-income energy assistance programs, COVID rent/mortgage relief programs. Patients with food and housing insecurity were assisted in applying for public housing or food stamps;local food banks were provided. Patients were assisted with applying for disability insurance as needed. To date, all actively treated patients reporting lack of companionship, need for transportation, avoiding medical care for fear of losing their job, and utility insecurity were provided resources;80% received resources for food insecurity. Conclusion(s): Universal screening for social needs in gynecologic cancer patients identifies a high rate of unmet needs within a safety net hospital. Cancer care navigators can successfully provide these patients community-based resources tailored to their individual social needs. Our next steps will be to determine if and how these resources impact our patients' experiences and treatment outcomes.[Formula presented]Copyright © 2022 Elsevier Inc.

Factors Influencing Car Buyers Purchase Decision During COVID-19 in Malaysia

Consumer behaviours are largely regulated by multiple factors from need recognition to search for products that would satisfy their requirements. The study in context to car purchase behaviour among the Malaysian consumer highlights increased car buying trends among the Malaysian consumers during the pandemic. Social distancing along with prohibiting the usage of public transport has increased difficulties of consumers thereby resulting in an increased tendency to opt for personal cars. Products features such as fuel consumption, reliability, comfort and performance that provide value and upgraded functionality plays a big role in purchase decision-making. Derived from the the product features leads to brand trust and inspired the decision to buy from the same brand. Affordable and acceptable ownership costs and the consequence purchase power plays important factors in influencing car purchase decision. Higher income people favouring more expensive cars and the subsequent high ownership costs. At the same time, social needs during the pandemic situation has prohibited individuals from close contacts and gatherings that further requires the consumers to purchase cars. COVID-19 pandemic that was known to be airborne and transmittable diseases had truly fundamental impact on purchase decision especially for car buyers. The research examine the correlation of consumer behaviour towards purchase decision specifically in Malaysian context. This research can be used as guidance to map the consumer behavior while providing future and practical insights for carmakers towards reviving car industry that being one of the hardest hit by the pandemic. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

Social Risks, Social Needs, and Attitudes Toward Social Health Screening 1 Year Into the COVID-19 Pandemic: Survey of Adults in an Integrated Health Care Delivery System.

Introduction Information about demographic differences in social risks, needs, and attitudes toward social health screening in non-highly vulnerable adult populations is lacking. Methods The authors analyzed data for 2869 Kaiser Permanente Northern California non-Medicaid-covered members aged 35 to 85 who responded to a 2021 English-only mailed/online survey. The survey covered 7 social risk and 11 social needs domains and attitudes toward social health screening. The authors used data weighted to the Kaiser Permanente Northern California membership to estimate prevalence of risks, needs, and screening receptivity in the overall population, by race/ethnicity (White, Black, Latinx, Asian American/Pacific Islander) and age (35-65 years old, 66-85 years old). Multivariable regression was used to evaluate differences between groups. Results Overall, 26% of adults were financially strained, 12% food insecure, 12% housing insecure, and 5% transportation insecure. Additionally, 7%, 8%, and 17% had difficulty paying for utilities, medical expenses, and dental care, respectively. Over 40% of adults wanted help with ≥ 1 social need. Dental care, vision/hearing care, paying for medical expenses and utilities, and managing debt/credit card repayment surpassed food, housing, and transportation needs. Prevalence of social risks and needs was generally higher among middle-aged versus older and Black and Latinx versus White adults. Among the 70% of adults receptive to screening, 85% were willing to complete a questionnaire and 40% were willing to have staff ask questions; 18% did not want to be screened. Conclusion When implementing social health screening in diverse patient populations, the prevalence of social risks and needs, as well as the acceptability of social health screening and screening modalities, will vary among demographic subgroups.

Winds of change due to global lockdowns: Refreshing digital social entrepreneurship research paradigm

Digital technologies have a significant potential for collaboration, designing, and implementing better business initiatives. COVID-19 global lockdowns have increased the emergence of the Digital Social Entrepreneurship (DSE) phenomenon, which has been key in responding to social needs using digital technologies. The DSE scholarly discussion has been limited to a few studies. Therefore, little is known about theoretical foundations that explain the intersection between digital, social, and entrepreneurship. Based on an integrative literature review and a thematic case study, this study theorizes the micro-foundations of digital-social value-creation and explores the flourishment of the DSE phenomenon during/after the global lockdowns. Our findings contribute to the literature by extending the DSE definition and identifying the fostering (micro, meso, and macro) conditions involved in the digital-social value-creation process. Several implications emerged from the DSE learning, adaptation, and co-creation strategies/practices. © 2023 Elsevier Inc.

Evaluating a social risk screening and referral program in an urban safety-net hospital emergency department.

Objective: The emergency department (ED) is an opportune venue to screen for unmet social needs and connect patients with social services. This quality improvement study incorporates both qualitative and quantitative data to examine unmet social needs among ED patients and program implementation. Methods: From September 2020 to December 2021, an urban safety-net hospital adult ED implemented a social needs screening and referral program. Trained emergency staff screened eligible patients for 5 social needs (housing, food, transportation, utilities, employment), giving resource guides to patients who screened positive (THRIVE+). We collected screening data from the electronic health record, conducted semi-structured interviews with THRIVE+ patients and clinical staff, and directly observed discharge interactions. Results: Emergency staff screened 58.5% of eligible patients for social risk. Of the screened patients, 27.0% reported at least 1 unmet social need. Of those, 74.8% requested assistance. Screened patients reported housing insecurity (16.3%) as the most prevalent unmet social need followed by food insecurity (13.3%) and unemployment (8.7%). Among interviewed patients, 57.1% recalled being screened, but only 24.5% recalled receiving resource guides. Patients who received guides reported little success connecting with resources and supported universal guide dissemination. Staff expressed preference for warm handoff to social services. Of 13 observed discharge interactions, clinical staff only discussed guides with 2 patients, with no positive endorsement of the guides in any observed interactions. Conclusions: An ED social needs screening program can be moderately feasible and accepted. We identified housing as the most prevalent need. Significant gaps exist between screening and referral, with few patients receiving resources. Further training and workflow optimization are underway.

Health and social needs of asylum seekers and Ukrainian refugees in Lithuania: A mixed-method protocol.

Refugees, asylum seekers, and migrants often do not end up in the places they expected. Because of the pandemic impacts, their exposure to COVID-19 may be increased as a result of crowded camps and detention centers. A total of 4,537 undocumented migrants entered Lithuania via Belarus from June 2021 to November 30, 2022. In the period 24 February 2022 to 30 November 2022, Lithuania's Immigration Department registered 71,386 Ukrainian refugees. This study investigates the healthcare and social needs of recent asylum seekers who have crossed the Belarusian border and Ukrainian refugees in Lithuania. This is a study protocol for a mixed-methods study which will involve qualitative interviews with asylum seekers who crossed from Belarus in June 2021 and Ukrainian refugees. During a quantitative phase, refugees and asylum seekers will be asked to complete questionnaires. In this study, validated questionnaires will be used, including the Hopkins Symptom Checklist (HSCL-25), the Harvard Trauma Questionnaire (HTQ), and the Short Form 36 (SF-36). Participants will also be asked to self-report sociodemographic information. As a result of the findings of this study, it is possible to provide guidelines for improving access to health care services, including prevention (i.e., vaccination programs) and treatment of chronic and acute illnesses, through primary and secondary healthcare delivery, thereby reducing negative health outcomes. This study may shed light on the social needs of asylum seekers and refugees in Lithuania. In addition, this may provide insight into how they are integrating into the community, such as what their employment and educational prospects are.

Accelerating integration of social needs into mainstream healthcare to achieve health equity in the COVID-19 era.

It is known that social inequities result in health disparities in outcomes, highlighted in the coronavirus disease 2019 (COVID-19) pandemic. This commentary discusses the actionable initiatives that have been implemented to address social inequities in healthcare in the United States. The publicly available social needs screening tools and International Classification of Disease Systems-10 Z codes for social determinants of health are introduced. In this context, policies, health system strategies and the larger role of implementation science in recognizing and alleviating the social needs are discussed.

Preferences for social risk factor screening among breast and prostate cancer survivors in the Washington DC region: A qualitative study

Despite improvements in cancer outcomes over time, significant disparities remain between Black and White cancer survivors. Medical care is estimated to account for 10-20% of health outcomes, while other modifiable factors explain as much as 80-90% of outcomes. These disparities may thus be driven by multiple factors including social determinants of health, differences in treatment or follow up, or attitudes and behaviors of care teams. As part of a larger project, we conducted a qualitative study to understand cancer survivor preferences for and experiences with social needs screening and referrals. The results of this assessment will inform the delivery of social risk screening for breast and prostate cancer survivors in the multi-site study. Semi-structured interviews were conducted in English between March and April 2022 with breast and prostate cancer survivors from two cancer institutes in Washington DC. Patients were purposively recruited to ensure diversity in age, race, and cancer stage (I-III). Each interview lasted 60 minutes. Transcripts were reviewed for consensus and preferences for social needs screening. Thirteen survivors participated in the interviews. Participants were mostly breast cancer survivors (n=10), African American (n=6), were equal in stages I and II at time of diagnosis (n=5), and ranged in age from 34 to 81 with a median age of 64. Most patients (n=7) did not report social needs screening during their treatment, though all patients welcomed having these conversations with their care team. The majority of patients (n=9) desired face-to-face conversations as opposed to on paper (n=1) or through the patient portal (n=1). Similarly, most patients (n=7) did not mind who on their care team held the conversations. There was difference in opinion on how often social needs should be discussed, with four participants suggesting every appointment to another patient suggesting once at diagnosis. When asked about the needs patients experienced during treatment, food insecurity and nutrition were most cited (n=6), followed by transportation (n=4) and emotional resources (n=4). Only one patient reported not desiring social needs referrals during treatment. Other avenues for seeking out social resources included self-initiated research online or through books (n=2), and another patient described utilizing their local church (n=1). Finally, patients also spoke about challenges in receiving treatment and transitioning to survivorship due to the COVID-19 pandemic, including hospital staff turnover and care team inconsistency (n=1), bringing loved ones to appointments (n=1), and transportation challenges for individuals who relied on public transport to and from the clinic (n=1). This research reveals important insight to the perspective on social needs screening among a group of breast and prostate cancer survivors in the Washington DC region and highlights the ways in which patients have experienced and desire screening for social needs. In future work we will expand the number of interviews and apply these findings into practice.

COVID-19 and Changes in Reported Social Risk Factors at a Primary Care Practice in the South Bronx.

INTRODUCTION: Historically, Black and Hispanic patient populations in the Bronx Borough of New York City have experienced the highest rates of social risk factors, and associated poor health outcomes, in New York State. During the pandemic, Bronx communities disproportionately experienced high rates of COVID-19 illness and death. To date, little is known regarding the COVID-19 pandemic's impact on social risk factors in urban, at-risk communities. This study aimed to determine how social risk factors changed during the pandemic in a Bronx-based patient population. METHODS: Study participants were adult patients seen at a Federally Qualified Health Center in the South Bronx. Using a paired longitudinal study design, 300 participants were randomly selected for telephonic outreach during the pandemic from a sample of 865 participants who had been offered a social risk factor screener in the year prior to the pandemic. The outreach survey used included the social risk factor screener and questions regarding COVID-19 illness burden and prior engagement in social services. The McNemar test was used to analyze trends in reported social risks. RESULTS: Housing quality needs, food insecurity, and legal care needs significantly increased during the pandemic. Participants who reported COVID-19 illness burden were 1.47 times more likely to report a social risk factor (P = .02). No significant relationship was found between prior enrollment in clinic-based social services and degree of reported social risk (P = .06). CONCLUSION: Housing quality needs, food insecurity, and legal care needs increased during the COVID-19 pandemic in a predominantly Black and Hispanic identifying urban patient population. Urgently addressing this increase is imperative to achieving health equity in ongoing COVID-19 mitigation efforts.

Are conspiracy theorists psychotic? A comparison between conspiracy theories and paranoid delusions

Introduction: Conspiracy theories are popular during the COVID- 19 pandemic. Conspiratorial thinking is characterised by the strong conviction that a certain situation that one sees as unjust is the result of a deliberate conspiracy of a group of people with bad intentions. Conspiratorial thinking appears to have many similarities with paranoid delusions. Objective(s): To explore the nature, consequences, and socialpsychological dimensions of conspiratorial thinking, and describe similarities and differences with paranoid delusions. Method(s): Critically assessing relevant literature about conspiratorial thinking and paranoid delusions. Result(s): Conspiratorial thinking meets epistemic, existential, and social needs. It provides clarity in uncertain times and connection with an in-group of like-minded people. Both conspiratorial thinking and paranoid delusions involve an unjust, persistent, and sometimes bizarre conviction. Unlike conspiracy theorists, people with a paranoid delusion are almost always the only target of the presumed conspiracy, and they usually stand alone in their conviction. Furthermore, conspiracy theories are not based as much on unusual experiences of their inner self, reality, or interpersonal contacts. Conclusion(s): Conspirational thinking is common in uncertain circumstances. It gives grip, certainty, moral superiority and social support. Extreme conspirational thinking seems to fit current psychiatric definitions of paranoid delusions, but there are also important differences. To make a distinction with regard to conspiratorial thinking, deepening of conventional definitions of delusions is required. Instead of the strong focus on the erroneous content of delusions, more attention should be given to the underlying idiosyncratic, changed way of experiencing reality.

Interdisciplinary social needs response team: A community case study in social needs targeted care during the COVID-19 pandemic and beyond.

This case study illustrates the role and value of a social needs response team during times of crisis and beyond. The COVID-19 pandemic resulted in two simultaneous crises-the infectious disease crisis and the socioeconomic crisis. Unemployment and lost wages, housing and food insecurity, and increased childcare needs are just a few examples of the socioeconomic needs that skyrocketed during the COVID-19 pandemic. At the start of the pandemic, the University of Pennsylvania Health System (UPHS) formed an interdisciplinary team of physicians, social workers, nurse practitioners and students of these professions to reimagine social needs screening in a way that could reach people during the pandemic and provide sustainable support for individual's evolving social needs. The Social Needs Response Team (SNRT) at UPHS utilized various secure platforms to keep members of the team connected with each other and their patients. Orientations for participating students included training on how to employ principles of crisis intervention theory, empathetic inquiry, and patient-led and family-centered care to best uncover and serve the needs of their patients. Alongside the illustrative case study, this piece details guiding principles and concepts that are essential to integrating social needs targeted care.

"It Made Me Feel like Things Are Starting to Change in Society:" A Qualitative Study to Foster Positive Patient Experiences during Phone-Based Social Needs Interventions.

Many healthcare organizations are screening patients for health-related social needs (HRSN) to improve healthcare quality and outcomes. Due to both the COVID-19 pandemic and limited time during clinical visits, much of this screening is now happening by phone. To promote healing and avoid harm, it is vital to understand patient experiences and recommendations regarding these activities. We conducted a pragmatic qualitative study with patients who had participated in a HRSN intervention. We applied maximum variation sampling, completed recruitment and interviews by phone, and carried out an inductive reflexive thematic analysis. From August to November 2021 we interviewed 34 patients, developed 6 themes, and used these themes to create a framework for generating positive patient experiences during phone-based HRSN interventions. First, we found patients were likely to have initial skepticism or reservations about the intervention. Second, we identified 4 positive intervention components regarding patient experience: transparency and respect for patient autonomy; kind demeanor; genuine intention to help; and attentiveness and responsiveness to patients' situations. Finally, we found patients could be left with feelings of appreciation or hope, regardless of whether they connected with HRSN resources. Healthcare organizations can incorporate our framework into trainings for team members carrying out phone-based HRSN interventions.

Social determinants of health in pulmonary arterial hypertension patients in the United States: Clinician perspective and health policy implications.

Social determinants of health (SDoH) can impact the vulnerable pulmonary arterial hypertension (PAH) population, especially during the COVID-19 pandemic. Providers' understanding of SDoH at the point of care and their impact is unknown. We conducted semi-structured virtual interviews with US clinicians at 17 pulmonary hypertension (PH) centers and one patient advocate from the Pulmonary Hypertension Association. We sought participants' perspective on SDoH in PAH and their impact. Transcripts were developed and analyzed for key themes to assess potential policy implications. Participants served a large PAH population and demonstrated high awareness of SDoH and its impact on treatment and outcomes. They reported that patients' SDoH, including socioeconomic status, health insurance, access to health care, education levels, health literacy, employment status, and insecurities associated with housing, food, transportation, and family support, impacted health and well-being. COVID-19-related social isolation, mental health, and substance abuse contributed to significant inequities in care provision and outcomes. While telemedicine helped clinicians manage patients remotely during the pandemic, there was a concern for patients with limited access to this medium. Participants reported no formal screening for SDoH at the point of care. With the recognition and the desire to act upon health inequities associated with SDoH, participants felt that it was vital for their centers to have a dedicated PH social worker and support staff to optimize care and outcomes. An approach that integrates SDoH in PAH care management, streamlined through institutional policy, could address health disparities leading to improved healthcare access, outcomes, and quality of care.

The evolving role of social determinants of health to advance health equity

Efforts are steadily increasing to address social determinants of health (SDH) within healthcare delivery systems. Policies and practices in nonhealth sectors impact health and health equity. Therefore, the crux of health policies and interventions is a clear and accurate understanding of how and why the social determinants differentially impact health, healthcare, and health outcomes. The fundamental drivers of health inequities are the fundamental drivers of social inequities. The concept that health and health inequities are driven by social determinants is increasingly the focus of nursing articles, conferences, courses, vision statements, toolkits, research, and scholarly projects. Addressing social conditions that impact health is not new to nursing but, an upstream perspective that focuses on (1) systems and structures, (2) policy and politics, (3) historical drivers of disparities, and (4) structural racism as a root cause of health inequities is new. Historical and contemporary policies have created the structures that shape the SDH and have profound and enduring effects on our patients' health, healthcare, and health outcomes. Nurses can lead social change but only with a clear understanding of SDH and its evolving role in advancing health equity. © 2022 Elsevier Inc. All rights reserved.

Social Determinants of Health in Children with Severe and Non-severe sars-cov-2 Infection

Background: The COVID-19 pandemic has been shown to have a compounding effect on families across various social and healthcare needs. However, the impact of social determinants of health (SDOH) on COVID-19 disease severity in children is unknown. Our objectives were to describe the SDOH in children with SARS-CoV-2 infection and determine their association with severity of the infection Methods: This prospective observational study was supported by the National Institutes of Health RADx program and conducted in the emergency department (ED) of two large children's hospitals. Children ≤ 18 years of age with symptoms due to SARS-CoV-2 infection (positive RT PCR test, serology or epidemiological link) were enrolled between 03/29/2021 and 05/30/2021. Data collected from electronic medical records included demographics, clinical features, treatment, disposition, and outcomes. Severe cases were defined as the following within 30 days of test positivity: diagnosis of Multisystem inflammatory syndrome in children or Kawasaki disease, requirement for oxygen > 2L, inotropes, mechanical ventilation, extracorporeal membrane oxygenation (ECMO), or death. Following informed consent, caregivers were surveyed via an electronic device on previously validated PhenX questions. Aligned with the Healthy People 2020 SDOH framework, caregivers reported on economic stability, education, social and community context, health and health care, and neighborhood and built environment. Stata was used to analyze descriptive statistics, and unadjusted comparisons between groups were assessed using two sample t-tests for continuous variables and Fisher's exact test for categorical variables due to small sizes. Results: A total of 107 children (mean age 6.9 (±5.9) years, 44.9% males), with SARS-CoV-2 infection were enrolled, and 85 caregivers (79.4%) completed the survey (71.4% Black). In this sample, 97% of children were RT PCR positive, 3% had an epidemiological link, and 23 (27.1%) were categorized as severe. Almost half of caregivers (47.6%) reported employment or income loss due to COVID-19. The three most common SDOH needs identified were that of childcare (22.0%), housing instability (22.0%), and food insecurity (21.7%). Children with severe COVID-19 were significantly more likely to have a caregiver who was single, including never married, separated/divorced, and widowed (82.6% vs. 52.5%;Table 1). Although not statistically significant, children with severe COVID-19 tended to have higher levels of social needs including housing instability, poor caregiver mental health, and lower levels of social support compared to children with nonsevere infection (Table 2). Conclusion: Our preliminary data on SDOH suggest that among children with SARS-CoV-2 infection, housing instability, food insecurity and childcare needs are particularly prevalent. Children with severe SARS-CoV-2 infection were more likely to have single caregivers. Family structure may influence severe COVID-19 in children and programming and supports for single parent households should be considered. Larger studies in the ED setting will help confirm these findings and to direct resources to address these social needs.

Implementing health-related social needs screening in western Colorado primary care practices: Qualitative research to inform improved communication with patients.

Social determinants profoundly impact health. Many primary care practices now seek to screen their patients for health-related social needs (HRSN) and refer them to resources in the community. However, there is little empirical evidence to guide communication with patients in order to ensure their comfort with the process and increase the likelihood that it results in positive outcomes. This paper describes the first phase of the Improving Messaging Around Gaps in Needs and rEfferals (IMAGINE) study-a multi-phase study aiming to develop and test patient-centred messages about screening and referral for HRSN. In this initial qualitative phase, our objective was to identify communication strategies that might make western Colorado primary care patients more comfortable with the HRSN screening and referral process. From May to July 2020 we interviewed 10 staff members responsible for HRSN screening from primary care practices participating in the western Colorado Accountable Health Communities (AHC) initiative and 20 patients from 2 of these practices. We used a rapid qualitative analysis process that involved summarising interview transcripts across key domains of interest and then identifying emergent themes within each domain using a data matrix. Through this process, we examined current communication about HRSN screening, as well as suggestions for messages and other strategies that could improve communication. In most practices, the AHC Screening Tool was handed to patients by front desk staff at check-in with little explanation as to its purpose. Patients and staff alike recommended that patients be provided with information that: normalises the screening and referral process; assures privacy; clarifies that the purpose is to help and support rather than judge or report; emphasises community benefits; and respects patient autonomy. Interviewees also suggested broader strategies to support more effective communication, such as practice staff and clinicians building trusting relationships with patients and understanding and acknowledging the complex structural barriers that often prevent patients from accessing meaningful assistance. These findings provide actionable suggestions for improving communication about HRSN screening and referral in primary care settings. The next steps include developing specific messages based on these findings and testing their impact on screening tool completion rate, referral uptake, and patient-reported comfort with the process.