Session: Understanding Financial Hardship As a Multi-Factorial Social Determinant of Health: Implications for Research and Interventions (Society for Social Work and Research 30th Annual Conference Anniversary)

Socioeconomic factors represent the single-largest category of social determinants of population health (Magnan, 2021). The Social Work Grand Challenges recognize the multi-factorial role these determinants play in limiting financial opportunities and sustaining public institutions and policies that are inherently unjust to members of minoritized populations and those at-risk for financial exploitation and harm (Sherraden et al., 2015; Lein et al., 2016). In the context of healthcare, socioeconomic-related inequities often manifest as financial hardships when personal finances/resources are insufficient to cover the burgeoning direct and indirect costs of care. The resulting financial strain has grave proximal consequences for patients' and caregivers' mental/physical health, healthcare utilization, and treatment adherence (Greenfield et al., 2018); these relationships have been well-documented in the extent literature. Yet, financial strain is not limited to the immediate costs associated with diagnosis and treatment. Rather, this strain insidiously exerts a financial toxicity over distal health and wellness outcomes through maladaptive financial coping strategies and long-term impacts on familial economic opportunities and financial security (Lentz et al., 2019; Smith et al., 2022). In response to this body of evidence, interventions for managing financial toxicity range from financial navigation, online education, to financial assistance programs and medical financial partnerships (Beck et al., 2019; Smith et al., 2022; Aery et al., 2017; Knight et al., 2022; Edward et al., 2022; Coughlin et al., 2021). However, multiple considerable questions remain unresolved when considering financial strain and health. In particular, mandates and expectations regarding financial toxicity screening are limited; pathways and protocols have only been recently implemented, and further evidentiary support is needed regarding different intervention approaches. Moreover, protective factors or proximal, socio-contextual, or distal mechanisms that can be modified or intervened upon to alleviate the burden of financial strain have been marginally considered. This symposium provides four papers that examine important aspects of finances critical to healthcare hardship access.

First, Deferred healthcare among lower-wage workers with medical debt and chronic health conditions examines the intersection of chronic health conditions, medical debt, and healthcare access among lower-wage workers.

The second paper Financial Toxicity and Mental Health in Young Breast Cancer Survivors: The Moderating Role of Dyadic Coping Behaviors illustrates proximal and intermediate factors associated with greater vulnerability and provides new insights about intervening targets that account for the interdependence of patients and caregivers.

The third paper, Food security and Medical Delay among Low-Income Cancer Survivors on Disability Insurance examines the limitations of federal disability programs in mitigating financial insecurity and promoting access to healthcare.

Lastly, Co-Creation of a Digital Intervention to Enhance Financial Capability among Young Adult Cancer Survivors describes the development of a digital intervention that aims to improve financial capability in cancer survivors.

Together, these papers advance our understanding of the intersection of finances, health care utilization, and mental health outcomes of individuals coping with a variety of health conditions, and they provide the audience with critical evidence to inform interventions.