SOCIAL DETERMINANTS OF HEALTH AND ACCESS TO PUBLIC SERVICES FOR PERSONS WITH SICKLE CELL DISEASE

Author

Eunice Agyeiwah Yeboah, Southern Illinois University Carbondale

Date of Award

12-2022

Degree Name

Doctor of Philosophy

Department

Rehabilitation

First Advisor

Nichols, Jane

Second Advisor

McDaniel, Justin

Third Advisor

Flowers, Carl

Abstract

Using the indicators of Social Determinants of Health (SDoH), the research intended to investigate the experiences of individuals with SCD and their interactions with public services. The research used a mixed method approach. Sixty (60) members of the Sickle Cell Association in St. Louis, Missouri participated in an online survey. This research examined the experiences of patients with SCD and identified patterns; evaluated the six SDoH indicators that had the most impact on the interactions between persons with SCD and essential community services.Research questions and hypotheses that were measured included ‘Which of the six indicators of SDoH exerts the most influence on the interaction with the essential community services for persons with SCD?’ ‘What are the barriers to accessing public services for persons with SCD?’ and 'what are the KSAs identified by respondents through qualitative analysis that healthcare professionals should be aware of to assure adequate support for persons with SCD?’ The null hypothesis tested in this study was that “there is no relationship between the SDoH indicators and access to public services for persons with SCD,” and the alternative hypothesis was “there is a relationship between SDoH indicators and access to public services for persons with SCD. Multiple linear regression was used to test the hypotheses of this study. The results indicated that the predictors (SDoH Indicators) explained 70.9% of the variance (R2 =0.734, F(5,54)=29.75, P< 0.001). SDoH indicators significantly predicted access to public services except for Community and Social Context SDoH indicator. The result further indicated a positive strong correlation (R=0.709) between Access to Public Services and SDoH Indicators. The null hypothesis was therefore rejected. For research question one, findings showed the Food SDoH exerts the most influence on the interaction with essential community services for persons with SCD. Findings for research question two revealed transportation, difficulty in obtaining and maintaining jobs, access to a regular supply of food, accommodations in school and community service participation, and access to healthcare specialists as barriers to access to public services. Additionally, findings for research question 3 showed that most of the participants complained about the KSAs of professionals as they seem to know better than their providers do. It was discovered by the researcher from this study that participants’ expectations of their healthcare providers included a lot more medical specialists for SCD in healthcare facilities, continuity of care from childhood to adulthood, encouraged the training of all healthcare professionals to understand the disease, educate the public to eliminate stigma, and referrals must be a part of the healthcare services offered to this population for vocational rehabilitation counseling services. The researcher further recommended that policymakers need to make policies that will make it easy for this population to access benefits to reduce financial difficulties, as well as policies that will enhance obtaining and maintaining jobs with work flexibility. It was however recommended by the researcher that rehabilitation counselors should assist persons with SCD in this area. This can be made possible through referrals by primary care providers to vocational rehabilitation counselors or they may otherwise not know about their services. This study has added to the already existing knowledge of persons with SCD and their access to public services. It has given us theories to further explore to benefit persons with SCD, their caregivers, healthcare providers as well as all stakeholders which includes policymakers. Nevertheless, the sample size and time used to conduct the study were not adequate to generate widely generalizable findings. Therefore, future longitudinal studies with a bigger sample size are needed to elaborate on these findings and recommendations to investigate how they can be effective in improving access to public services for persons living with SCD.