Bringing Maternal and Infant Health to Life: Provider Perspectives on the Social Determinants of Health Framework

 

Background: Maternal and infant health disparities are an ongoing social welfare issue in the United States. Women of color, particularly those who are low-income, fare worse than their white, higher-income counterparts in nearly every aspect of maternal and infant health including maternal mortality, preterm birth, and low birthweight. Major organizations such as the National Association of Social Workers embrace the social determinants of health (SDOH) framework in order to understand the interlocking factors producing maternal and infant health disparities as well as how to address them. Presently, we lack basic information regarding the implementation of this framework, especially in maternal and infant health and related social services. The current study aims to address this gap by a) examining maternal and infant health and social service provider perspectives on the SDOH and b) identifying facilitators and barriers to implementing the SDOH in their setting.

Methods: The current study draws on ethnographic field work (August 2018-February) at a West Coast city’s family resource center that provides a range of maternal and infant health and social services to low-income women of color and their families, informed by the SDOH framework. Data include semi-structured interviews with health and social services workers from the field site (n=30). Eligibility criteria included being employed at the field site, being over 18 years old, and being fluent in English. Participants included health educators (n=8), project managers (n=3), social work case managers (n=8), community health workers (n=8), mental health clinicians (n=3) as well as one public health nurse. Interviews probed for providers’ experiences of facilitators and barriers to achieving positive maternal and infant health outcomes, intra-and inter-professional collaboration strategies, and responses a visual model of the SDOH. The study utilized directed content analysis, with a priori codes drawn from SDOH literature. Any uncoded data were coded for emergent categories using conventional content analysis, with new categories derived directly from the data. Coded data were entered into a spreadsheet and read repeatedly to achieve immersion; subsequently transcriptions were repeatedly read to derive themes.

Results: Three themes emerged from the analysis. First, resonance: all providers except one endorsed the SDOH as resonant with established professional best practices. Second, priorities: providers saw some determinants (i.e., racial discrimination in medical settings, housing) as more important to maternal and infant health than other determinants (e.g., education). Finally, collaboration as workload: providers understood the SDOH as helpful framework but also understood the framework as one that demanded more sophisticated collaboration on their part.

Conclusions: Health and social services must address maternal and infant health disparities in order to ensure true health equity. The SDOH is a framework that may help health and social service providers understand and address the interlocking factors producing such disparities. This study sheds light on how a range of providers implement the SDOH as well as the facilitators and barriers to implementation. It also enhances the knowledge-base from which providers, policy-makers, and educators create social determinants of maternal and infant health programming, to advance the relevancy of these programs.