Audio file
File
A. Braaten1, C. Hanebuth1, H. McPherson1, D. Smallwood1, D. Basirico1, D. Clewley1, Z. Rethorn1, S. Kaplan2
1Duke University, Doctor of Physical Therapy, Durham, North Carolina, United States, 2Duke University, Durham, United States
Background: The World Health Organization (WHO) defines the conditions in which people are born, grow, live, work, and age as social determinants of health (SDH). Individuals with social needs are at a greater risk for mortality and morbidity, as long standing structural and social determinants can impede access to healthcare and lead to poor health. Without knowledge of the SDH-physical therapy usage relationship, the ability to understand and improve access to physical therapy services across populations will be limited.
Purpose: The purpose was to examine the association between social determinants of health (SDH) and physical therapy health usage. Though an established relationship between Social Determinants of Health (SDH) and healthcare access exists, research related to SDH and physical therapy usage is lacking.
Methods: Three databases (MEDLINE, EMBASE, Scopus) were queried for available literature from inception to January 2020. Eligible studies included observational, experimental, and qualitative studies examining social determinants of health (SDH) as they related to adult usage of physical therapy services. Data was extracted using a predetermined, standardized data extraction form. The Newcastle-Ottawa Quality Assessment Scale was used to assess the quality of each study. Data from 35 studies meeting the inclusion criteria was qualitatively synthesized in relation to the association between SDH and physical therapy usage.
Results: Thirty-five studies from eight different countries involving 2,689,413 participants were included. Data from the eligible studies revealed that female gender, non-Hispanic white race/ethnicity, increasing educational attainment, urban environment, access to transportation, employment, high socioeconomic status, and private insurance coverage were associated with a higher odds and/or likelihood of using physical therapy.
Conclusion(s): The findings in the systematic review indicate that predisposing and enabling SDH including socioeconomic status, education, and environment are positively associated with physical therapy use. The systematic review highlights disparities in physical therapy usage among adults in different countries and physical therapy settings related to individual and structural level factors. Future research should consider the SDH as they relate to health seeking care to address inequities in healthcare and implement policies to reduce health inequities.
Implications: Physical therapy usage is associated with modifiable and non-modifiable SDH. Modifiable determinants included higher income, higher educational attainment, and environmental locations. Non-modifiable factors included non-Hispanic white race/ethnicity and female gender. Whether or not a social determinant is “modifiable,” or “non-modifiable,” it is important to recognize that health equality does not mean health equity, and future efforts should focus on increasing health equity. As the Robert Wood Johnson Foundation states, “Health equity means that everyone has a fair and just opportunity to be as healthy as possible. This requires removing obstacles, such as poverty, discrimination, and their consequences, including powerlessness and lack of access to good jobs with fair pay, quality education and housing, safe environments, and health care.” The results of our study have larger implications than individuals simply not using physical therapy services. These individuals will require systemic changes outside the realm of healthcare to increase their odds of using physical therapy.
Funding, acknowledgements: This work was unfunded.
Keywords: social-determinants, healthcare-usage, health-disparities
Topic: Globalisation: health systems, policies & strategies
Did this work require ethics approval? No
Institution: Duke University School of Medicine, Doctor of Physical Therapy Division
Committee: N/A
Reason: No ethical approval was needed because data from previous published studies in which informed consent was obtained by primary investigators.
All authors, affiliations and abstracts have been published as submitted.
