Ethnographic investigation of factors affecting conceptualization and provision of social prescribing in outpatient primary care clinics in the United States

项目总结/文摘

Project Summary/Abstract The proposed fellowship plan is an interdisciplinary research project integrating training in anthropology, medicine, and implementation science. This project is supervised by Drs. Adrienne Strong, Clarence Gravlee (Dept. of Anthropology), Ramzi Salloum (Dept. of Health Outcomes and Bioinformatics), and Grant Harrell (Dept. of Community Health and Family Medicine) with the resources and support of the University of Florida (UF) College of Liberal Arts and Sciences, the UF College of Medicine and the UF Clinical Translational Sciences Institute. The proposal is designed to equip the trainee with the skills necessary to become a physician-scientist who bridges the divide between the social sciences and clinical medicine. Social Determinants of Health (SDH) are known to impact a wide array of physical and mental health outcomes. However, little is known about how physicians identify and interpret patient social information, and act upon this information in support of their patient’s health and wellbeing. This proposal will focus on US outpatient primary care clinics for two reasons: primary care prioritizes holistic well-being of patients through the life course and there has been a significant push in recent years to incorporate SDH interventions into primary care clinics. Previous investigations have focused primarily on development of screening tools and limited interventions focused on special populations or specific SDH. Such investigations pay little attention to the informal methods providers and primary care clinics have developed to identify and address clinically relevant social conditions in day-to-day practice, activities here collectively termed “social prescribing”. Thus, an investigation grounded in interdisciplinary health services and implementation science literature, with an exploratory component to allow for the description and analysis of these as yet uninvestigated practices and beliefs relating to social prescribing is warranted. The overarching hypothesis is that patient, provider, and clinic level factors affect primary care provider conceptualization and implementation of social prescribing practices. The specific aims will lead to greater understanding of knowledge translation of social science research to clinical medicine in primary care through (1) identification of factors affecting social prescribing conceptualization among diverse primary care providers and (2) identification of factors affecting social prescribing implementation among diverse primary care providers. Successful completion of these studies will enhance understanding of factors affecting development, implementation, and outcomes of social prescribing interventions across diverse care contexts. This research directly targets multiple Clinical and Health Service Research Interest Areas defined by the National Institute of Minority Health and Health Disparities.