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Defined as an individual's perception of their position in life within the context of the culture and value systems in which they live, quality of life (QOL) has become an important metric in health care. QOL is widely used to assess perceived health status across multiple domains and among diverse populations with varying cultural backgrounds. For individuals experiencing physical health conditions, their perceptions of QOL may be uniquely shaped by non-medical factors that influence health outcomes, collectively referred to as the Social Determinants of Health (SDOH). However, limited research has explored the relationship between QOL and SDOH among individuals with limitations in activities of daily living (ADL), particularly those residing in underserved communities. This study aims to examine how various components of SDOH are associated with different domains of QOL among individuals with ADL limitations living in underserved areas.
Methods:
A total of 290 patients were recruited from a Midwestern hospital in 2021–2022 through multiple outreach methods (e.g., online, mail, and phone). Eligible participants were at least 19 years old, had limitations in ADL, and resided in two underserved cities in a Midwestern state. SDOH was measured across five domains: education (educational attainment); economic instability (food insecurity, low income, housing concerns); healthcare access (limited access to medical services, type of insurance); neighborhood environment (physical barriers in the community, neighborhood safety, transportation access); and social context (emotional support, social isolation, caregiving assistance). Linear regression analyses examined the associations between these SDOH components and four QOL domains: physical health, psychological health, environmental health, and social relationships.
Results:
Social context, specifically receiving emotional support during COVID-19, was positively associated with all four QOL domains (β=0.80 for physical health, 0.65 for psychological health, 0.66 for environmental health, and 0.53 for social relationships). In contrast, feelings of isolation were negatively associated with psychological health (β=-0.63), environmental health (β=-0.45), and social relationships (β=-0.26). Within the neighborhood environment domain, the presence of physical barriers was negatively associated with physical (β=-0.24) and psychological health (β=-0.24), while perceived neighborhood safety was positively related to environmental health (β=1.40). Economic instability, such as food insecurity (β=-2.15), low income (β=-1.47), and housing concerns (β=-3.64), was significantly associated with lower environmental QOL. Limited access to medical services also showed a significant association with environmental QOL at a trend level (β=-0.83, p= 0.052).
Conclusions and Implications:
Health-related QOL exhibited distinct relationships with various SDOH components. Although the link between physical QOL and environmental barriers may be expected, the association with psychological QOL highlights the broader impact of inaccessible environments on mental well-being among individuals with ADL limitations. The study, conducted during the COVID-19 pandemic, also underscored the critical role of social support and connectedness in shaping overall quality of life. Additionally, environmental QOL was closely tied to economic hardship and healthcare access, suggesting that perceptions of environmental quality are influenced by financial and systemic stability. These findings emphasize the need for comprehensive, multidimensional interventions that target social, economic, and environmental determinants to enhance QOL among individuals in underserved communities.