Athletic Trainers’ Observations of Social Determinants of Health in the Collegiate Setting: A Card Study

Abstract

Context: Addressing social determinants of health (SDH) in all populations improves patient outcomes, leading to better patient-centered care. Despite known influences of SDH, little is known about the ability of athletic trainers (ATs) to observe SDH in practice. Objective: To explore ATs’ observations of SDH and describe actions taken at the point-of-care in college/university settings. Design: Descriptive via an observational card study. Setting: Athletic training facilities. Participants: ATs (23 participants across 20 institutions) employed in the college/university setting. Data Collection and Analysis: ATs used a modified observation card to document observations of SDH during patient encounters in the college/university setting. Cards contained instructions for completion and a table with 4 columns: (1) a list of 19 predetermined SDH, (2) checkbox for observed SDH, (3) checkbox for perceived negative influence of observed SDH on patient health, and (4) open box to write in what actions, if any, were taken to address the observed SDH. Results: Overall, 424 cards were collected. Of 725 observed SDH, access to social media (153/725, 21.1%), academic stressors (131/725, 18.1%), and behavioral health issues (71/725, 9.8%) were the most commonly observed. Nearly 39% (281/725) had a perceived negative 16.4%), and transportation issues (32/281, 11.4%) were most common. For the 23.0% (166/725) of SDH acted on, ATs used counseling and education (73/166), provided additional resources (60/166), referred to others (29/166), or communicated with others (4/166). Conclusions: Because ATs are positioned to accurately assess SDH, they can promote better patient-centered care and improve patient outcomes. Our results suggested many SDH observed by ATs in the college/university setting had a negative influence on patient health. Better support for patients with behavioral health issues and academic stressors is important because these SDH were commonly perceived to negatively influence health and well-being.