Social determinants of health among African Americans in a rural community in the Deep South: an ecological exploration.
Introduction: African Americans living in rural USA experience multiple health disparities as a result of both race and rural geography. An increasing literature suggests that social determinants of health, the social contexts in which people live their lives, are key contributors to these health di...
| Publicado en: | Rural & Remote Health Vol. 11; no. 1; pp. 1 - 13 |
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| Autores principales: | , |
| Formato: | research tables/charts Journal Article |
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James Cook University, Rural Health Research Unit
Jan-Mar2011
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=59412119&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 59412119 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 14456354 1D30 jtl: Rural & Remote Health issn: 14456354 maglogo: N pubinfo: dt: Jan-Mar2011 vid: 11 iid: 1 pid: 69464 pub: James Cook University, Rural Health Research Unit artinfo: ui: 59412119 59412119 104850088 59412119 ppf: 1 ppct: 12 formats: tig: atl: Social determinants of health among African Americans in a rural community in the Deep South: an ecological exploration. aug: au: Scott, A. J. Wilson, R. F. affil: Jiann Ping Hsu College of Public Health, Georgia Southern University, Statesboro, Georgia, USA sug: subj: African Americans Psychosocial Factors Health Psychosocial Factors Rural Areas Social Behavior Evaluation Social Behavior Ethnology Health Services Accessibility Ecological Research Conceptual Framework Models, Theoretical Qualitative Studies Georgia Interviews Purposive Sample Interview Guides Content Analysis Human Male Female Adult Middle Age Aged Snowball Sample Social Capital Communities Psychosocial Factors Intergenerational Relations Social Environment Economics Politics Poverty Churches Racism Exploratory Research Socioeconomic Factors Race Factors Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Introduction: African Americans living in rural USA experience multiple health disparities as a result of both race and rural geography. An increasing literature suggests that social determinants of health, the social contexts in which people live their lives, are key contributors to these health disparities. Ecological theory provides a valuable conceptual framework for exploring social determinants of health in communities, but few US rural health community-based studies have utilized this approach, or engaged ecological theory to explore rural contexts. This exploratory study blended a community-based, qualitative approach with ecological theory with the objective of identifying potential social determinants of health among African Americans in a rural community in the Deep South, from the perspectives of participants. Methods: In-depth interviews were conducted with rural, Deep South African Americans participants who were purposefully sampled to incorporate a range of perspectives. Interview guides structured around five ecological levels (individual, relational, environmental, structural, and superstructural) were used to frame interviews. Iterative content analysis of interview transcripts and field notes identified potential social determinants of health. An 'editing' approach to content analysis was used. Data and analysis quality was tested by triangulation at the level of the researcher, and by member checking with community members. Results: Potential determinants of health were identified at all five levels of the ecological framework. At the individual level, lack of engagement with personal health and health promotion was a recurring theme. Participation in preventive health activities and education was minimal, even when offered in community settings. At the relational level, lack of social capital emerged as another potential social determinant of health, with estrangement between the younger and elder generations as one source, and fractiousness among churches (key institutions in the community) representing another. At the environmental level, the community built environment was an area of concern as it lacked opportunities for physical activity and access to healthy foods. The local job environment was identified as a potential social determinant of health, given the strong ties between income and health. At the structural level, participants complained of cronyism and nepotism favoring Whites in access to jobs, including those where local policies and funding allocations were made (eg funding for the local health department). In education, school system tracking policies were perceived to discourage African Americans from university education. At the superstructural level, high rates of poverty and racism emerged as potential social determinants. Poverty directly limited many African Americans' access to quality health care, and subtle racism was perceived in some delivery of care. Persistent stress from poverty and racism was reported, which creates health risks through physiologic pathways. Conclusion: This study identified potential social determinants of health, at multiple ecological levels, among African Americans in a rural community in the Deep South. The social determinants identified had the ability to impact a variety of health behaviors and health outcomes. The results demonstrate the value of this approach to conducting rural, community-based research. This descriptive and exploratory study highlights the need for quantitative exploration of these issues, as well as the development of context-appropriate, community-based health interventions that address multiple ecological levels. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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