Applying a socioecological framework to chronic disease management: implications for social informatics interventions in safety-net healthcare settings

Kim Hanh Nguyen; Anupama G Cemballi; Jessica D Fields; William Brown; Matthew S Pantell; Courtney Rees Lyles

doi:10.1093/jamiaopen/ooac014

Applying a socioecological framework to chronic disease management: implications for social informatics interventions in safety-net healthcare settings

JAMIA Open. 2022 Mar 25;5(1):ooac014. doi: 10.1093/jamiaopen/ooac014. eCollection 2022 Apr.

Authors

Kim Hanh Nguyen^{1

2

3}, Anupama G Cemballi^{1

2}, Jessica D Fields^{1

2

3}, William Brown^{1

3

4

5}, Matthew S Pantell^{6

7}, Courtney Rees Lyles^{1

2

3

5}

Affiliations

¹ Department of Medicine, Center for Vulnerable Populations, University of California, San Francisco, California, USA.
² Division of General Internal Medicine, Zuckerberg San Francisco General Hospital, San Francisco, California, USA.
³ Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
⁴ Division of Prevention Science, Department of Medicine, Center for AIDS Prevention Studies, University of California, San Francisco, California, USA.
⁵ Bakar Computational Health Science Institute, University of California, San Francisco, California, USA.
⁶ Department of Pediatrics, University of California, San Francisco, California, USA.
⁷ Department of Family and Community Medicine, Center for Health and Community, University of California, San Francisco, California, USA.

Abstract

Objective: Vulnerable populations face numerous barriers in managing chronic disease(s). As healthcare systems work toward integrating social risk factors into electronic health records and healthcare delivery, we need better understanding of the interrelated nature of social needs within patients' everyday lives to inform effective informatics interventions to advance health equity.

Materials and methods: We conducted in-depth interviews, participant-led neighborhood tours, and clinic visit observations involving 10 patients with diabetes in underserved San Francisco neighborhoods and 10 community leaders serving those neighborhoods. We coded health barriers and facilitators using a socioecological framework. We also linked these qualitative data with early persona development, focusing on patients' experiences in these communities and within the healthcare system, as a starting place for our future informatics design.

Results: We identified social risk and protective factors across almost every socioecological domain and level-from physical disability to household context to neighborhood environment. We then detailed the complex interplay across domains and levels within two critical aspects of patients' lives: housing and food. Finally, from these data we generated 3 personas that capture the intersectional nature of these determinants.

Conclusion: Drawing from different disciplines, our study provides a socioecological approach to understanding health promotion for patients with chronic disease in a safety-net healthcare system, using multiple methodologies. Future digital health research should center the lived experiences of marginalized patients to effectively design and implement informatics solutions for this audience.

Keywords: chronic disease management; diabetes; electronic health records; health promotion; persona methodology; qualitative methods; safety-net patients; social determinants of health; social informatics; socioecological model; user-centered design; vulnerable populations.

Abstract

Grants and funding