Reyes Ana M, Akanyirige Precious W, Wishart Danielle, Dahdouh Rabih, Young Maria R, Estrada Araceli, Ward Carmenisha, Cruz Alvarez Cindy, Beestrum Molly, Simon Melissa A
Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
Center for Health Equity Transformation, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.
Health Equity. 2021 Mar 4;5(1):100-118. doi: 10.1089/heq.2020.0051. eCollection 2021.
Health is impacted by a wide range of nonmedical factors, collectively termed the social determinants of health (SDoH). As the mechanisms by which these factors influence wellness and disease continue to be uncovered, health systems are beginning to assess their roles in addressing patient's social needs. This study seeks to identify and analyze clinic-based interventions aimed at addressing patients' social needs in perinatal care, including prenatal, antepartum, and postpartum care. We conducted a search of six databases through May 2020 for articles describing screening or intervention activities addressing social needs in at least one SDoH domain as defined by Healthy People 2020. We required that studies include pregnant or postpartum women and be based in a clinical setting. Thirty-one publications describing 26 unique studies were identified. Most studies were either randomized-controlled trials (=10) or observational studies (=7) and study settings were both public and private. The mean age of women ranged from 17.4 to 34.1 years. Most studies addressed intimate partner violence (=19). The next most common need addressed was social support (=5), followed by food insecurity (=3), and housing (=2). Types of interventions varied from simple screening to ongoing counseling and case management. There was wide heterogeneity in outcomes investigated. Most IPV interventions that included counseling or ongoing support resulted in reduced IPV recurrence and severity. No intervention with only screening showed a reduction in rate of IPV. This systematic review shines light on several avenues to support pregnant and postpartum women through interventions that embed acknowledgment of social needs and actions addressing these needs into the clinical environment. The results of this review suggest that interventions with counseling or ongoing support may show promise in alleviating social risk factors and improving some clinical outcomes. However, the strength of this evidence is limited by the paucity of studies. More rigorous research is imperative to augment the knowledge of social needs interventions, especially in domains outside of IPV.
健康受到广泛的非医学因素影响，这些因素统称为健康的社会决定因素（SDoH）。随着这些因素影响健康和疾病的机制不断被揭示，卫生系统开始评估其在满足患者社会需求方面的作用。本研究旨在识别和分析以诊所为基础的干预措施，这些措施旨在满足围产期护理（包括产前、产时和产后护理）中患者的社会需求。我们检索了六个数据库，截至2020年5月，查找描述在《健康人民2020》定义的至少一个SDoH领域中满足社会需求的筛查或干预活动的文章。我们要求研究包括孕妇或产后妇女，并以临床环境为基础。共识别出31篇描述26项独特研究的出版物。大多数研究要么是随机对照试验（=10），要么是观察性研究（=7），研究环境包括公立和私立。女性的平均年龄在17.4至34.1岁之间。大多数研究涉及亲密伴侣暴力（=19）。其次最常见的需求是社会支持（=5），其次是粮食不安全（=3）和住房（=2）。干预类型从简单筛查到持续咨询和病例管理不等。所调查的结果存在很大异质性。大多数包括咨询或持续支持的亲密伴侣暴力干预措施导致亲密伴侣暴力复发率和严重程度降低。仅进行筛查的干预措施未显示亲密伴侣暴力发生率降低。这项系统评价揭示了通过将对社会需求的认识和满足这些需求的行动纳入临床环境的干预措施来支持孕妇和产后妇女的几种途径。该评价结果表明，有咨询或持续支持的干预措施可能在减轻社会风险因素和改善一些临床结果方面显示出前景。然而，这一证据的力度受到研究匮乏的限制。必须进行更严格的研究，以增加对社会需求干预措施的了解，特别是在亲密伴侣暴力之外的领域。
