National Agenda for Disparities Research in Hand Surgery: Validation of Social Determinant of Health Domains and Measurement Constructs

Abstract

Background: Social determinants of health (SDOH) encompass various factors of one's environment and have been shown to strongly influence patient health. The effect of SDOH has been evaluated in various medical specialties; however, a paucity of literature exists investigating the effects of SDOH on outcomes in hand surgery. As such, we completed a RAND/University of California Los Angeles (UCLA) Delphi Appropriateness process for the purpose of guiding the inclusion of SDOH domains and measurement constructs in hand surgery clinical research.

Methods: A consortium of 9 academic upper-limb surgeons completed a RAND/UCLA Delphi Appropriateness process to evaluate the importance, feasibility, usability, and scientific acceptability of collecting SDOH domains and measurement constructs in hand surgery clinical research. The domains and measurement constructs were collated from frameworks and tools from the U.S. Department of Health and Human Services, the Centers for Medicare and Medicaid Services, and Cochrane. Panelists rated each domain/measurement construct on an ordinal scale between 1 (definitely not important/feasible/usable/supported) and 9 (definitely important/feasible/usable/supported) in 2 rounds with an intervening face-to-face discussion. Agreement and validity were determined according to previously validated and pre-defined criteria.

Results: The consortium achieved agreement on the inclusion of 5 SDOH domains (Education Access and Quality, Health care Access and Quality, Neighborhood and Built Environment, Social and Community Context, and Economic Stability) and 21 measurement constructs.

Conclusions: As there is growing evidence that SDOH can differentially impact patient health, these validated domains and constructs can help prioritize and guide hand surgery research to evaluate and better inform interventions related to SDOH and outcomes.

Keywords: hand; health disparities; health policy; research & health outcomes; social determinants of health; surgery.

Figure 1.

The U.S. Department of Health and Human Services’ healthy people 2030 initiative categorizes SDOH into 5 discrete domains: Education access and quality, health care access and quality, neighborhood and built environment, social and community context, and economic stability. Note. SDOH measurement constructs, collated from the Centers for Medicare and Medicaid Services’ Accountable Health Communities Health-Related Social Needs Screening Tool and the Cochrane Equity PROGRESS-Plus health opportunities and outcomes framework, were subdivided into these domains based on definitions provided by the Healthy People 2030 Initiative for each of the 5 domains. SDOH = Social determinants of health.

Figure 2.

The American Cancer Society highlights various SDOH and specifies potential interventions to address each. Reprinted with permission from the American Cancer Society.