Role of Social Determinants of Health in COVID-19 Recovery: A Qualitative Study.

IMPORTANCE: Health systems are increasingly required to conduct health-related social needs screening. However, how social resources negatively and positively affect recovery from acute illnesses, such as COVID-19, is incompletely understood. OBJECTIVE: To examine how social determinants of health (SDOH) influence recovery from COVID-19. DESIGN, SETTING, AND PARTICIPANTS: In this qualitative study, patients were recruited for semistructured interviews from a post-COVID-19 pulmonary clinic at a southeastern US academic medical center between November 2022 and March 2023. Caregivers were included in dyadic interviews when available. Interviews queried participants about SDOH domains, as defined by the US Centers for Disease Control and Prevention, and their relationship with COVID-19 recovery. MAIN OUTCOME AND MEASURES: Phenomenologic analysis identified themes characterizing participant perspectives on the influence of SDOH on COVID-19 recovery. RESULTS: A total of 24 interviews were conducted: 10 (42%) with patient-caregiver dyads, 13 (54%) with patients alone, and 1 (4%) with 2 patients who also served as each other's caregiver. Most participants were female (18 patients [72%] and 6 caregivers [60%]). The median age of patients was 57 years (IQR, 44-61 years) and of caregivers was 47 years (IQR, 39-62 years). Three cross-cutting themes that overlapped SDOH domains were identified. Participants noted that innovative mobilization of social resources (eg, policies to secure income during time away from work) supported recovery from COVID-19 illness, but destabilization and change introduced by illness (eg, disrupted social support networks) and mistrust of previously established institutions (eg, public health misinformation) hindered recovery. CONCLUSIONS AND RELEVANCE: Participants identified 3 distinct SDOH domains positively and negatively influencing recovery from COVID-19 illness. The findings suggest that longitudinal, multidomain data on SDOH are needed to best address barriers and identify resources for patients recovering from acute illness and may help determine opportunities for system- and policy-level interventions that can mitigate the influence of long-standing structural inequities on health.

Duke Scholars

Author Deepshikha Ashana Medicine, Pulmonary, Allergy, and Critical Care Medicine

Author Laura Jane Fish Family Medicine and Community Health, Prevention Research

Author Nrupen Bhavsar Surgery, Surgical Sciences

Author Christina Makarushka