Athletic Trainers' Observations of Social Determinants of Health in the Secondary School Setting: A Card Study.

CONTEXT

Athletic trainers (ATs) are in a unique position to mitigate the negative influences of social determinants of health (SDH) in their patients. In the secondary school setting, understanding common SDH may inform strategies that reduce these influences. However, little is known about the types of SDH that ATs observe in patients in this setting.

OBJECTIVE

To investigate SDH observed by ATs at the point of care in the secondary school setting.

DESIGN

Descriptive, observational card study.

SETTING

Secondary schools.

PATIENTS OR OTHER PARTICIPANTS

Twenty-seven ATs (average age = 29.9 ± 5.6 years, 23 [85.2%] female).

MAIN OUTCOME MEASURE(S): Athletic trainers recorded SDH on a standardized observation card during patient interactions. Cards provided instructions for completion and had a 4-column table with a list of 19 predetermined SDH, a checkbox for observed SDH, a checkbox for perceived negative influence of observed SDH on patient health, and an open box to write in actions taken to address the observed SDH.

RESULTS

Overall, 676 cards with 748 observed SDH were collected from 27 secondary schools. Of those, 46.9% (351/748) were perceived to have a negative influence on patient health. The top 3 observed SDH were academic stressors (14.2%, 106/748), access to social media (12.6%, 94/748), and lack of health literacy (11.4%, 85/748). The ATs reported acting on 37.7% of negatively perceived SDH through counseling and education (48.6%, 137/282), additional resources (20.6%, 58/282), referral to others (17.4%, 49/282), and communication with others (13.5%, 38/282).

CONCLUSIONS

Our results indicated ATs in the secondary school setting were observing and acting to mitigate the negative influence of SDH. However, these ATs should be prepared to provide resources for patients negatively influenced by academic stressors, social media, and lack of health literacy. Resources, referrals, and additional education for patients may support a healthier community and positively influence athlete health and well-being.