Innovation, Implementation & Clinical Translation (IIMPACT) in Health, Kaurna Country, University of South Australia, Adelaide, South Australia, Australia..
Innovation, Implementation & Clinical Translation (IIMPACT) in Health, Kaurna Country, University of South Australia, Adelaide, South Australia, Australia.
J Pain. 2022 Sep;23(9):1461-1479. doi: 10.1016/j.jpain.2022.04.001. Epub 2022 Apr 14.
Developing a greater understanding of the social and environmental factors that are related to differential outcomes for individuals who experience persistent pain and disability is important for achieving health equity. In this study, we aimed to develop insights into the role of the social determinants of health (SDH) in care experiences and health status for socio-economically disadvantaged adults who experience persistent low back pain or persistent pain following spinal cord injury. Our objectives were to investigate 1) relationships between the SDH and health outcomes, 2) care experiences, and 3) perceived barriers and facilitators to optimal pain care. We conducted a mixed-methods convergent parallel study involving an online survey and semistructured interviews. We analyzed the data from each method separately and integrated the findings. One hundred sixty-four adults completed the survey and 17 adults completed the semistructured interviews. We found large or moderate-sized correlations between greater selfreported social isolation and poorer health outcomes. Experiencing a higher number of adverse SDH was moderately correlated with lower quality of life and was significantly correlated with all other outcomes. We generated 5 themes from the qualitative analysis: active strategies are important for well-being; low agency; facilitators of optimal care; barriers to optimal care; and health inequities, and derived meta-inferences that highlight the complex inter-relationships between the SDH and health outcomes in this cohort. The findings of our study can importantly inform endeavors to improve equity of pain care for adults with low back pain or spinal cord injury and persistent pain. PERSPECTIVE: This study illustrates the complex interplay between adverse social determinants of health and poorer health status for adults with persistent pain and provides evidence to support the important role of social isolation. Developing an understanding of the life-contexts of those seeking care is a vital step towards addressing health inequities.
了解与经历持续性疼痛和残疾的个体相关的结果差异有关的社会和环境因素对于实现健康公平至关重要。在这项研究中，我们旨在深入了解健康的社会决定因素（SDH）在社会经济处于不利地位的成年人的护理体验和健康状况中的作用，这些成年人经历持续性腰痛或脊髓损伤后的持续性疼痛。我们的目标是调查 1）SDH 与健康结果之间的关系，2）护理体验，以及 3）对最佳疼痛护理的感知障碍和促进因素。我们进行了一项混合方法的收敛平行研究，包括在线调查和半结构化访谈。我们分别分析了每种方法的数据，并整合了研究结果。164 名成年人完成了调查，17 名成年人完成了半结构化访谈。我们发现，自我报告的社会隔离程度越大，健康结果越差，两者之间存在较大或中等大小的相关性。经历更多的不利 SDH 与生活质量较低中度相关，与所有其他结果显著相关。我们从定性分析中生成了 5 个主题：积极的策略对幸福感很重要；低能动性；最佳护理的促进因素；最佳护理的障碍；以及健康不公平，并且得出了元推论，强调了这一队列中 SDH 与健康结果之间的复杂相互关系。我们研究的结果可以为改善腰痛或脊髓损伤和持续性疼痛的成年人的疼痛护理公平性提供重要信息。观点：本研究说明了不利的健康社会决定因素与持续性疼痛成年人较差的健康状况之间的复杂相互作用，并提供了支持社会隔离重要作用的证据。了解寻求护理者的生活背景是解决健康不公平问题的重要一步。
