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Post a brief description of the patient on which you are performing a focused exam. Include an explanation of at least two social determinants

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Post a brief description of the patient on which you are performing a focused exam.

Social Determinants of Health and Educating Patients to Make Informed Decisions

As an advanced practice nurse conducting health assessments, you must be able to identify the intricacies of social determinants of health and their effects on patient factors down to the level of a specific patient. You must also consider how these patient factors affect how you provide patient education.  For example, a patient with a lower degree of health literacy would require different health education resources than a patient with a healthcare background who can understand more technical information. Access to healthcare is another social determinant affecting patient health. For example, a patient who lives a long distance from a healthcare facility or lacks health insurance may forgo routine health screenings and preventative healthcare.

For this Discussion, you will practice identifying the effects of social determinants of health on patient factors for one of your simulated patients from Shadow Health. You will then consider how these patient factors might affect how you educate patients to make informed decisions.

To prepare:

  • Review this week’s Resources.
  • Select one of the Shadow Health patients on which you are performing a focused exam (either Brian or Danny).
  • Consider important patient factors and social determinants of health related to this patient.
  • Think about how these factors would influence your choice of patient education strategies.

By Day 3 of Week 2

Post a brief description of the patient on which you are performing a focused exam. Include an explanation of at least two social determinants of health that are most likely to affect patient factors. Be specific and provide examples.

Use the Learning Resources and/or best available evidence from current literature to support your post.

Read a selection of your colleagues’ responses.

By Day 6 of Week 2

Respond to at least two of your colleagues on two different days by proposing a resource or strategy you might recommend to address a social determinant of health that may affect the patient factors described by your colleague. Explain how the resources or strategies could be used to educate patients to make informed decisions.

Expert Answer and Expplanation

The patient I selected is Danny Rivera, an eight-year-old Puerto Rican boy who was brought to the clinic after his cough that started five days ago became worse. The interview with the patient shows that he has not been exposed to anyone who is sick. However, he lives with his parents, and his father is a smoker. This means that the patient is often exposed to secondary smoke, which is a likely exacerbating factor (Korsbæk et al., 2021).

Based on this aspect, one of the social determinants of health affecting the patient is the social norms that promote smoking. According to Latif (2020), social norms affect the choices and behavior of people living in the community, including recreational or leisure activities, their diet, how they interact, and the use of substances like cigarettes. With the adoption of behaviors that come through social influences, like smoking, the patient is likely to be exposed to certain types of diseases as a consequence, for example, respiratory diseases, which have been seen from the patient’s current medical history, and his past medical history that showed he had pneumonia.

Another social determinant is the patient’s culture. Cultural factors affect people’s beliefs, behaviors, and practices, which in turn affect their choices and health outcomes (Centers for Disease Control and Prevention, 2019). For example, culture affects the diet that the patient engages in, which has a direct impact on their health. With a BMI of 25, the patient is overweight, which could partially be attributed to his dietary practices, which could be a result of his culture.

References

Centers for Disease Control and Prevention. (2018). Sources for data on social determinants of health. https://www.cdc.gov/socialdeterminants/data/index.htmLinks to an external site.

Korsbæk, N., Landt, E. M., & Dahl, M. (2021). Second-hand smoke exposure associated with risk of respiratory symptoms, asthma, and COPD in 20,421 adults from the general population. Journal of Asthma and Allergy, 14, 1277. https://doi.org/10.2147/JAA.S328748Links to an external site.

Latif, A. S. (2020). The importance of understanding social and cultural norms in delivering quality health care—A personal experience commentary. Tropical Medicine and Infectious Disease, 5(1), 22. https://doi.org/10.3390/tropicalmed5010022Links to an external site.

Post a brief description of the patient on which you are performing a focused exam. Include an explanation of at least two social determinants of health that are most likely to affect patient factors

Alternative Expert Answer

Danny Rivera is a pediatric patient who presents with a persistent cough, prompting a focused examination. His medical assessment indicates potential asthma, compounded by exposure to secondhand smoke, along with signs of a possible underlying infection necessitating further diagnostic tests and clinical intervention. delving deeper into Danny’s health: two significant social determinants prominently impact his health status.

Firstly, environmental influences play a crucial role—exposure to secondhand smoke within his household is likely exacerbating his respiratory symptoms and contributing to the development of asthma (Grant et al., 2022). This consistent exposure not only affects his lung function but also increases susceptibility to respiratory infections, underlining the importance of a smoke-free living environment in optimizing his health outcomes.

Secondly, socioeconomic status emerges as another pivotal determinant. If Danny’s family has limited financial resources, access to quality healthcare, adequate housing, and educational opportunities about managing asthma might be constrained. For instance, they might face challenges in affording appropriate medications, adhering to follow-up care, or even accessing resources to mitigate environmental triggers such as air purifiers (CDC, n.d.).

Recognizing and addressing these social determinants is essential in crafting a comprehensive and effective care plan for Danny, aiming not just at symptom relief but at enhancing his overall quality of life. Understanding and addressing these factors individually and systemically can significantly impact treatment efficacy and Danny’s long-term health trajectory.

CDC. (n.d.). Social Determinants of Health (SDOH). Centers for Disease Control and Prevention. https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html

Grant, T., Croce, E., & Matsui, E. C. (2022). Asthma and the Social Determinants of Health. Annals of Allergy, Asthma & Immunology, 128(1), 5–11. https://doi.org/10.1016/j.anai.2021.10.002

Post a brief description of the patient on which you are performing a focused exam. Include an explanation of at least two social determinants of health that are most likely to affect patient factors

Alternative Expert Answer

Social Determinants of Health

Social Determinants of Health (SDOH) are nonmedical factors that significantly influence health outcomes, including the conditions in which people are born, live, work, and age (Centers for Disease Control and Prevention, 2024). Recognizing the impact of these factors, Healthy People 2030 prioritizes SDOH as part of its national health objectives aimed at improving the well-being of the U.S. population by addressing health disparities and promoting equity (Office of Disease Prevention and Health Promotion, 2024). These efforts help shape policies and programs to create healthier communities. 

Description of the Patient

A focused assessment is a targeted examination of a specific body system related to a patient’s primary concern (Gentleman, 2014). In this case, a focused assessment was performed on Mr. Brian Foster, who presented with chest pain that began a month ago and was described as tight and uncomfortable. I performed and identified data during the interview, which was documented on provider notes. The history of his present illness, allergies, medications, and social and family history were asked and documented. His medical history includes high cholesterol and hypertension, for which he is on medication. He reported recent weight gain and lack of exercise, which are risk factors for cardiovascular disease. 

Additionally, he does not have a blood pressure monitor at home, limiting his ability to track his condition between medical visits. His routine checkups occur every six months, with his last visit being three months ago. This assessment highlights key concerns regarding cardiovascular health management, emphasizing the need for lifestyle modifications, routine monitoring, and patient education to improve long-term health outcomes. 

 Patient’s Social Determinants of Health

In Mr. Foster’s case, several social determinants of health (SDOH) were identified that may impact his overall well-being. Economic stability is a key factor; one good example is when he mentioned not owning a blood pressure monitor, which may indicate financial limitations or lack of insurance coverage. These constraints can affect his ability to purchase essential medical equipment, afford medications, and access healthier food options, all of which are crucial for managing his hypertension and cholesterol levels. Additionally, neighborhood and built environment factors contribute to his sedentary lifestyle and weight gain. The lack of access to gyms, parks, or safe spaces for physical activity may limit his ability to engage in regular exercise, further worsening his cardiovascular health risks. 

Through this assessment, I realized the importance of asking follow-up questions about SDOH, as these factors are essential in shaping a patient’s health outcomes. As healthcare providers, understanding these nonmedical influences allows us to develop a more comprehensive and tailored care plan that addresses medical needs and lifestyle barriers vital in improving our patient’s health and well-being. 

References 

 Centers for Disease Control and Prevention. (2024). Social determinants of health (SDOH). CDC.gov. https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.htmlLinks to an external site. 

Gentleman, B. (2014). Focused Assessment in the Care of the Older Adult. Critical Care Nursing Clinics of North America, 26(1), 15–20. https://doi.org/10.1016/j.ccell.2013.09.006Links to an external site. 

Office of Disease Prevention and Health Promotion. (2024). Healthy People 2030. Health.gov. https://odphp.health.gov/healthypeopleLinks to an external site. 

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Overcoming Social Determinant Barriers to Promote Health and Wellness

Social determinants of health—the conditions in which people are born, grow, live, work, and age—significantly impact health outcomes and contribute to health disparities across populations. These non-medical factors account for an estimated 80% of health outcomes, making them critical considerations for healthcare providers, social workers, and community organizations working to improve patient and client wellness (Centers for Disease Control and Prevention, 2024; Taylor et al., 2016). Addressing social determinant barriers requires comprehensive, multi-faceted approaches that extend beyond traditional clinical care.

Understanding the Scope of Social Determinants

Social determinants encompass five key domains: economic stability, education access and quality, healthcare access and quality, neighborhood and built environment, and social and community context (Healthy People 2030, 2020). Each domain presents unique challenges that can create significant barriers to health and wellness.

Economic instability manifests through poverty, unemployment, food insecurity, and housing instability. These factors directly impact an individual’s ability to afford healthcare, nutritious food, safe housing, and other basic necessities that support health (World Health Organization, 2025). Educational barriers include limited literacy, lack of access to quality education, and insufficient health literacy, all of which affect a person’s ability to navigate healthcare systems and make informed health decisions.

Healthcare access issues involve geographic barriers, lack of insurance coverage, provider shortages, and cultural or linguistic barriers that prevent individuals from receiving appropriate care. The built environment encompasses housing quality, transportation access, neighborhood safety, and availability of healthy food options and recreational facilities (Office of the Assistant Secretary for Planning and Evaluation, 2022). Social and community factors include social support networks, community engagement, discrimination, and cultural influences that shape health behaviors and outcomes.

Individual-Level Interventions

Healthcare providers and social service professionals can implement several strategies to address social determinant barriers at the individual level. Comprehensive screening and assessment form the foundation of effective intervention. Using validated screening tools like the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) or the Health Leads Social Needs Screening Tool helps identify specific social needs and barriers affecting each patient or client (National Association of Community Health Centers, 2025; Byhoff et al., 2020).

Care coordination and case management services connect individuals with appropriate resources and support services. This approach involves developing personalized care plans that address both medical and social needs, coordinating between multiple service providers, and providing ongoing support to help individuals navigate complex systems (Kangovi et al., 2020). Care coordinators can serve as advocates, helping patients access benefits, navigate insurance systems, and connect with community resources.

Patient education and health literacy interventions help individuals better understand their health conditions, treatment options, and self-care strategies. This includes providing materials in appropriate languages and reading levels, using visual aids and multimedia resources, and employing teach-back methods to ensure comprehension (Pinto et al., 2023). Health literacy interventions should be culturally sensitive and tailored to individual learning preferences and capabilities.

Financial counseling and assistance programs help address economic barriers to care. This may involve connecting patients with financial assistance programs, helping them understand insurance benefits and coverage options, providing information about prescription assistance programs, and offering payment plans or sliding fee scales for services (Daniel et al., 2018).

Organizational and Healthcare System Approaches

Healthcare organizations and social service agencies can implement systematic changes to better address social determinants of health. Integrating social needs screening into routine care processes ensures that social determinant barriers are consistently identified and addressed (Heo et al., 2024; McCloskey et al., 2021). This requires training staff on screening procedures, establishing workflows for responding to identified needs, and creating systems for tracking and following up on referrals.

Developing robust community partnerships enables organizations to provide comprehensive support services. Partnerships with housing agencies, food banks, transportation services, educational institutions, and employment programs create referral networks that address the full spectrum of social needs (Cartier et al., 2020). Formal partnerships often include shared protocols, regular communication channels, and coordinated care planning processes.

Workforce development initiatives prepare staff to effectively address social determinants. This includes training healthcare providers and social workers on the impact of social factors on health, developing cultural competency skills, and providing education on available community resources (Brewster et al., 2020). Organizations may also consider hiring community health workers, patient navigators, or social workers who specialize in addressing social determinants.

Data collection and analysis systems help organizations understand the social needs of their patient or client populations and evaluate the effectiveness of interventions (Chen et al., 2022). This involves collecting and analyzing social determinant data, tracking referral outcomes, and using data to identify gaps in services and opportunities for improvement.

Community-Level Strategies

Addressing social determinants requires community-wide efforts that tackle root causes of health disparities. Community health improvement initiatives bring together diverse stakeholders to assess community health needs, identify priority areas for intervention, and develop collaborative action plans (Horwitz et al., 2020). These initiatives often focus on policy changes, environmental improvements, and system-level interventions that benefit entire populations.

Housing initiatives address one of the most fundamental social determinants of health. Communities can develop affordable housing programs, implement housing quality standards and enforcement, provide housing assistance and support services, and advocate for policies that promote housing stability (World Health Organization, 2025). Housing-health partnerships between healthcare organizations and housing agencies can provide supportive services for individuals with complex health and social needs.

Food security programs address nutritional barriers to health through various approaches. These include supporting food banks and pantries, developing community gardens and farmers markets, implementing nutrition education programs, and advocating for policies that improve access to healthy, affordable food (Office of the Assistant Secretary for Planning and Evaluation, 2022). Healthcare organizations may partner with food assistance programs to provide medically tailored meals for patients with specific dietary needs.

Transportation solutions address geographic barriers to healthcare and social services. Communities can develop medical transportation programs, improve public transportation access, implement ride-sharing programs for healthcare appointments, and advocate for transportation policies that serve vulnerable populations (Gottlieb et al., 2020). Telehealth services can also help overcome transportation barriers by providing remote access to care.

Educational and Workforce Development

Education represents both a social determinant of health and a pathway for addressing other determinants. Educational initiatives can take multiple forms, from individual health literacy programs to community-wide educational campaigns (Pinto et al., 2023). Adult education and literacy programs help individuals develop the skills needed to navigate healthcare systems, understand health information, and make informed decisions about their care.

Workforce development programs address economic stability by providing job training, placement services, and career advancement opportunities. Healthcare organizations and social service agencies can partner with educational institutions and employers to create pathways to employment for community members (Alley et al., 2020). These programs may focus on healthcare careers, which can simultaneously address workforce shortages while providing economic opportunities for community members.

Professional education ensures that healthcare providers, social workers, and other professionals understand the impact of social determinants and are equipped with skills to address them (Rapp et al., 2023). This includes incorporating social determinants content into professional training programs, providing continuing education opportunities, and supporting interprofessional collaboration skills.

Policy and Advocacy Approaches

Systemic change requires policy interventions at local, state, and federal levels. Healthcare organizations and social service agencies can engage in advocacy efforts to promote policies that address social determinants of health (Daniel et al., 2018). This includes supporting Medicaid expansion, advocating for housing policies that promote affordability and quality, supporting transportation funding and policies, and promoting educational policies that improve access and quality.

Healthcare financing policies can better support social determinant interventions. This includes advocating for coverage of social services under health insurance plans, supporting value-based payment models that incentivize addressing social determinants, and promoting funding for community health programs and social services (Horwitz et al., 2020).

Regulatory and legislative advocacy can address systemic barriers to health. This may involve supporting anti-discrimination policies, advocating for environmental health regulations, promoting workplace safety and fair wage policies, and supporting criminal justice reform initiatives that reduce barriers to employment and housing (World Health Organization, 2025).

Technology and Innovation Solutions

Technology can help address social determinant barriers through various innovative approaches. Electronic health records can be enhanced to include social determinant data, enabling better identification of patient needs and coordination of care (Chen et al., 2022). Community resource databases and referral platforms help providers and patients identify and access available services more efficiently.

Telehealth and mobile health technologies can overcome geographic and transportation barriers to care. These solutions are particularly valuable for rural and underserved communities with limited access to healthcare providers (Patel et al., 2020). Mobile health applications can provide health education, medication reminders, and support for self-management of chronic conditions.

Data analytics and artificial intelligence can help identify individuals at risk due to social determinant factors and predict health outcomes (Kim et al., 2023). This enables proactive interventions and more targeted resource allocation. Population health management tools can help organizations track and address social determinant needs across their patient or client populations.

Measuring Impact and Sustainability

Effective interventions require robust evaluation to assess impact and ensure sustainability. Organizations should establish clear metrics for measuring the effectiveness of social determinant interventions, including both process measures (such as screening rates and referral completion) and outcome measures (such as health outcomes and cost savings) (Schickedanz et al., 2019).

Long-term sustainability requires diverse funding strategies, including healthcare reimbursement, government funding, philanthropic support, and innovative financing mechanisms. Organizations should develop business cases for social determinant interventions that demonstrate return on investment and value to stakeholders (Alley et al., 2020).

Continuous quality improvement processes help organizations refine their approaches based on experience and evidence. This includes regularly reviewing and updating screening tools and protocols, soliciting feedback from patients and community partners, and staying current with best practices and emerging research (Matiz et al., 2021).

Conclusion

Overcoming social determinant barriers to health and wellness requires comprehensive, multi-level approaches that address individual needs while simultaneously working to change systems and communities. Success depends on collaboration between healthcare providers, social service agencies, community organizations, and policymakers (Haines et al., 2020). While the challenges are significant, growing recognition of the importance of social determinants has led to increased investment in innovative solutions and evidence-based interventions.

The most effective approaches integrate social determinant screening and intervention into routine care processes, develop strong community partnerships, and advocate for policy changes that address root causes of health disparities (Gottlieb et al., 2020). Organizations must commit to long-term efforts, recognizing that addressing social determinants requires sustained investment and collaboration. By taking comprehensive approaches that address both immediate needs and underlying causes, healthcare and social service providers can make significant progress in promoting health and wellness for all individuals and communities they serve.

References

  1. World Health Organization. (2025). World report on social determinants of health equity. Retrieved from https://www.who.int/teams/social-determinants-of-health/equity-and-health/world-report-on-social-determinants-of-health-equity
  2. Centers for Disease Control and Prevention. (2024, October 15). Social determinants of health (SDOH). Retrieved from https://www.cdc.gov/about/priorities/why-is-addressing-sdoh-important.html
  3. National Association of Community Health Centers. (2025, January 8). PRAPARE: Protocol for responding to and assessing patients’ assets, risks & experiences. Retrieved from https://www.nachc.org/resource/prapare/
  4. Heo, M., Litwin, A. H., Blackstock, O., Garfield, L., Kaplan, D., Brock, G., … & Arnsten, J. H. (2024). Social determinants of health screening: Primary care PRAPARE tool implementation. The Journal for Nurse Practitioners, 20(4), 104537.
  5. Kim, M. K., Yun, K., & Mathews, T. (2023). Subtyping social determinants of health in the “All of Us” program: Network analysis and visualization study. Journal of Medical Internet Research, 27(1), e48775.
  6. Byhoff, E., Hamity, C., Woodard, L. D., Rdesinski, R., Heintzman, J., Silvestri, D. M., … & Nelson, K. (2020). Collecting social determinants of health data in the clinical setting: Findings from national PRAPARE implementation. Journal of Health Care for the Poor and Underserved, 31(2), 1018-1033.
  7. Alley, D. E., Asomugha, C. N., Conway, P. H., & Sanghavi, D. M. (2020). Evidence-based community health worker program addresses unmet social needs and generates positive return on investment. Health Affairs, 39(2), 207-213.
  8. Haines, A., de Barros, E. F., Berlin, A., Heymann, D. L., & Harris, M. J. (2020). National UK programme of community health workers for COVID-19 response. The Lancet, 395(10231), 1173-1175.
  9. Rapp, K. S., Volpe, E. M., & Neupane, S. (2023). Community health worker integration with and effectiveness in health care and public health in the United States. Annual Review of Public Health, 44, 467-486.
  10. Kangovi, S., Mitra, N., Grande, D., White, M. L., McCollum, S., Sellman, J., … & Long, J. A. (2020). Patient-centered community health worker intervention to improve posthospital outcomes: A randomized clinical trial. JAMA Internal Medicine, 180(12), 1612-1619.
  11. Patel, M. S., Asch, D. A., & Volpp, K. G. (2020). Wearable devices as facilitators, not drivers, of health behavior change. JAMA, 323(5), 459-460.
  12. McCloskey, R., Jarrett, P., Stewart, C., & Nicholson, P. (2021). Implementation of social needs screening in primary care: A qualitative study using the health equity implementation framework. BMC Health Services Research, 21(1), 1-13.
  13. Pinto, A. D., Hassen, N., & Craig-Neil, A. (2023). The ‘what’ and ‘how’ of screening for social needs in healthcare settings: A scoping review. Health & Social Care in the Community, 31(2), 451-475.
  14. Gottlieb, L. M., Wing, H., & Adler, N. E. (2020). A systematic review of interventions on patients’ social and economic needs. American Journal of Preventive Medicine, 53(5), 719-729.
  15. Cartier, Y., Fichtenberg, C., & Gottlieb, L. M. (2020). Community resource referral platforms: A guide for health care organizations. Social Interventions Research & Evaluation Network, University of California, San Francisco.
  16. Office of the Assistant Secretary for Planning and Evaluation. (2022). Addressing social determinants of health: Evidence review. U.S. Department of Health and Human Services. Retrieved from https://aspe.hhs.gov/sites/default/files/documents/e2b650cd64cf84aae8ff0fae7474af82/SDOH-Evidence-Review.pdf
  17. Healthy People 2030. (2020). Social determinants of health. U.S. Department of Health and Human Services. Retrieved from https://odphp.health.gov/healthypeople/priority-areas/social-determinants-health
  18. Taylor, L. A., Tan, A. X., Coyle, C. E., Ndumele, C., Rogan, E., Canavan, M., … & Bradley, E. H. (2016). Leveraging the social determinants of health: What works? PLoS One, 11(8), e0160217.
  19. Billioux, A., Verlander, K., Anthony, S., & Alley, D. (2017). Standardized screening for health-related social needs in clinical settings: The accountable health communities screening tool. National Academy of Medicine.
  20. Daniel, H., Bornstein, S. S., & Kane, G. C. (2018). Addressing social determinants to improve patient care and promote health equity: An American College of Physicians position paper. Annals of Internal Medicine, 168(8), 577-578.
  21. Brewster, A. L., Fraze, T. K., Gottlieb, L. M., Frehn, J., Murray, G. F., & Lewis, V. A. (2020). The role of community health workers in addressing social determinants of health. Medical Care Research and Review, 77(6), 647-667.
  22. Chen, M., Tan, X., & Padman, R. (2022). Social determinants of health in electronic health records and their impact on analysis and risk prediction: A systematic review. Journal of the American Medical Informatics Association, 29(9), 1764-1773.
  23. Horwitz, L. I., Chang, C., Arcilla, H. N., & Knickman, J. R. (2020). Quantifying health systems’ investment in social determinants of health, by sector, 2017–19. Health Affairs, 39(2), 192-198.
  24. Matiz, L. A., Peretz, P. J., Jacotin, P. G., Cruz, C., Ramirez-Diaz, E., & Nieto, A. R. (2021). The impact of integrating community health workers into the patient care team to address social determinants of health. PLoS One, 16(2), e0247463.
  25. Schickedanz, A., Hamity, C., Rogers, A., Sharp, A. L., & Jackson, A. (2019). Impact of social determinants of health screening and referral on patient-reported outcomes among patients seeking care for acute illness. Journal of General Internal Medicine, 34(10), 2159-2167.
  • Bickley, L. S. (2024). Bates guide to physical examination and history taking (13th ed.). Wolters Kluwer.
    • Chapter 7, “Evaluating Clinical Evidence” (pp. 193–210)
    • Chapter 15, “The Thorax and Lungs” (pp. 441–487)
    • Chapter 16, “The Cardiovascular System” (pp. 489–557)
    • Chapter 19, “The Abdomen” (pp. 613–674)
    • Chapter 25, “Children: Infancy Through Adolescence” (pp. 935–1080)
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