Interventions Addressing Social Needs in Perinatal Care: A Systematic Review.
Interventions Addressing Social Needs in Perinatal Care: A Systematic Review.
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DOI：
10.1089/heq.2020.0051
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发表时间：
2021
期刊：
影响因子：
2.7
通讯作者：
Simon MA
中科院分区：
文献类型：
--
作者：
Reyes AM;Akanyirige PW;Wishart D;Dahdouh R;Young MR;Estrada A;Ward C;Cruz Alvarez C;Beestrum M;Simon MA
健康受到广泛的非医学因素的影响，统称为健康的社会决定因素（SDoH）。随着这些因素影响健康和疾病的机制不断被发现，卫生系统开始评估其在解决患者社会需求方面的作用。本研究旨在识别和分析临床干预措施，旨在解决围生期护理患者的社会需求，包括产前、产前和产后护理。方法：截至2020年5月，我们对6个数据库进行了检索，以获取描述《健康人2020》定义的至少一个SDoH领域的社会需求的筛查或干预活动的文章。我们要求研究包括孕妇或产后妇女，并以临床环境为基础。结果：31篇出版物描述了26项独特的研究。大多数研究要么是随机对照试验（n=10），要么是观察性研究（n=7），研究环境既有公共的，也有私人的。女性的平均年龄为17.4岁至34.1岁。大多数研究涉及亲密伴侣暴力（n=19）。其次最常见的需求是社会支持（n=5），其次是粮食不安全（n=3）和住房（n=2）。干预措施的类型多种多样，从简单的筛查到持续的咨询和病例管理。调查结果存在广泛的异质性。大多数IPV干预措施包括咨询或持续支持，可减少IPV复发和严重程度。没有干预，只有筛查显示IPV率降低。结论：本系统综述揭示了支持孕妇和产后妇女的几种途径，通过将社会需求和解决这些需求的行动纳入临床环境的干预措施。本综述的结果表明，咨询或持续支持的干预措施可能在减轻社会风险因素和改善某些临床结果方面显示出希望。然而，这一证据的强度受到研究缺乏的限制。必须进行更严格的研究，以增加对社会需求干预措施的了解，特别是在IPV以外的领域。
Introduction: Health is impacted by a wide range of nonmedical factors, collectively termed the social determinants of health (SDoH). As the mechanisms by which these factors influence wellness and disease continue to be uncovered, health systems are beginning to assess their roles in addressing patient's social needs. This study seeks to identify and analyze clinic-based interventions aimed at addressing patients' social needs in perinatal care, including prenatal, antepartum, and postpartum care. Methods: We conducted a search of six databases through May 2020 for articles describing screening or intervention activities addressing social needs in at least one SDoH domain as defined by Healthy People 2020. We required that studies include pregnant or postpartum women and be based in a clinical setting. Results: Thirty-one publications describing 26 unique studies were identified. Most studies were either randomized-controlled trials (n=10) or observational studies (n=7) and study settings were both public and private. The mean age of women ranged from 17.4 to 34.1 years. Most studies addressed intimate partner violence (n=19). The next most common need addressed was social support (n=5), followed by food insecurity (n=3), and housing (n=2). Types of interventions varied from simple screening to ongoing counseling and case management. There was wide heterogeneity in outcomes investigated. Most IPV interventions that included counseling or ongoing support resulted in reduced IPV recurrence and severity. No intervention with only screening showed a reduction in rate of IPV. Conclusion: This systematic review shines light on several avenues to support pregnant and postpartum women through interventions that embed acknowledgment of social needs and actions addressing these needs into the clinical environment. The results of this review suggest that interventions with counseling or ongoing support may show promise in alleviating social risk factors and improving some clinical outcomes. However, the strength of this evidence is limited by the paucity of studies. More rigorous research is imperative to augment the knowledge of social needs interventions, especially in domains outside of IPV.