SDOH and Social Change

Identification of Organization and Practice Issue

The facility chosen is a correctional facility that experiences the challenge of a lack of inmate response to the prescribed medication regimens. This problem affects both inmates who have chronic illnesses, including diabetes and psychiatric patients: SDOH and Social Change.

Non-adherence to medication results in poorer health outcomes, chronic diseases skipping treatment and being managed poorly, and cases of mental illnesses being dealt with inadequately. This not only adversely affects the health of prisoners but also burdens the healthcare system of the facility, leading to more external medical attention and affecting the overall operations of the facility.

How SDOH Relates to the Issue

Social determinants of health (SDOH) play an important role in the area of medication non-compliance in correctional facilities. Difficulty in accessing healthcare beyond the facility, lack of health literacy, and congestion prevent inmates from understanding their conditions and the relevance of taking medicines. Psychiatric inmates are prone to opposing drugs because of stigma and a lack of trust in care providers (Ruksakulpiwat et al., 2023). Moreover, the unfriendly atmosphere and social isolation also lead to low adherence to medication, and, therefore, inmates are unable to remain active in the process of treatment.

Addressing SDOH

Some of the SDOH met by the facility included introducing health education programs that are capable of enhancing health literacy among inmates. These interventions were designed to raise the knowledge of chronic illnesses and medication compliance. Moreover, mental health counseling was created to decrease stigma and to accompany inmates with mental illness (Waqas et al., 2020).

Nonetheless, systematic problems like overcrowding and a shortage of staff members were not tackled comprehensively, which posed a barrier to the program. These obstacles did not allow the facility to support every inmate comprehensively.

Social Change

Although individual prisoners’ understanding and compliance changes were positive, society as a whole did not change. The participants experienced gains because of the interventions. Yet, system challenges, such as overcrowding and a lack of healthcare personnel, did not allow the programs to extend to all prisoners. These concerns made the facility less capable of promoting long-term positive change because structural barriers should have been addressed, and others would not have achieved greater success.

Steps Followed in the Organization’s Approach

The facility used the procedures provided in Appendix A of the Johns Hopkins Evidence-Based Practice for Nurses and Healthcare Professionals (Dang et al., 2021). The facility hired an interprofessional team to address the problem of medication non-compliance and formulated the practice question (enhancing adherence).

The facility included evidence-based practice, which is health education and counseling. Nevertheless, such interventions as the involvement of the responsible stakeholders, including correctional officers and outside healthcare providers, and official evaluation procedures were absent or incomplete, which restricted the overall efficacy of the interventions.

Outcomes

Mixed results emerged. Some prisoners who participated in health education and counseling initiatives developed a better perception and adherence to medicines. Nevertheless, the general results were adverse since systemic barriers, including overcrowding, staff shortage, and resource insufficiency, challenged the facility to operate such interventions on a large scale (Sartini et al., 2022). Such persistent challenges resulted in the fact that it was not able to yield positive outcomes in all cases among the inmates.

Doing Things Differently for a Better Outcome

In a bid to achieve better performance, the facility could expand the health personnel workforce to offer more personalized care and frequent follow-ups. Overcrowding would be reduced to reduce stress so that the inmates can cope with their nursing better (Sartini et al., 2022). Moreover, the involvement of family members and external healthcare providers would help the inmates stick to their medication better. The establishment of a formal evaluation system would be useful in the evaluation and improvement of programs to make them successful in the long run.

Key Actions that Led to the Positive Outcome

Implementation of health education programs and mental health counseling services was done, and these were key steps that resulted in positive results. These programs informed inmates more about their health status and reasons to live in accordance with their medications. The facility has managed to reduce the issue of mental health stigma and enhance health literacy, thus becoming a friendlier environment, which contributed to better adherence to medication by the individuals who attended the programs.

Change Measurement and Outcomes Evaluation

This change was gauged using feedback given by the inmates through surveys or interviews, and this was in relation to their knowledge of their conditions. Adherence with medications was followed, and such outcomes as control of chronic conditions were observed (Oliveira et al., 2024). Nonetheless, the facility was not characterized by a formal evaluation process and could not, hence, assess the interventions continuously or refine them to achieve greater effectiveness. A more organized method of evaluation would give more inferences and enhance the effect of the program.

References

Dang, D., Dearholt, S., Bissett, K., Ascenzi, J., & Whalen, M. (2021). Johns Hopkins evidence-based practice for nurses and healthcare professionals: Model & guidelines (4th ed.). Sigma Theta Tau International.

Oliveira, C. J., Maria, H., & Martins, I. (2024). Medication adherence in adults with chronic diseases in primary healthcare: A quality improvement project. Nursing Reports, 14(3), 1735–1749. https://doi.org/10.3390/nursrep14030129

Ruksakulpiwat, S., Benjasirisan, C., Ding, K., Phianhasin, L., Thorngthip, S., Ajibade, A. D., Thampakkul, J., Zhang, A. Y., & Voss, J. G. (2023). Utilizing social determinants of health model to understand barriers to medication adherence in patients with ischemic stroke: A systematic review. Patient Preference and Adherence, 17, 2161–2174. https://doi.org/10.2147/PPA.S420059

Sartini, M., Carbone, A., Demartini, A., Giribone, L., Oliva, M., Spagnolo, A. M., Cremonesi, P., Canale, F., & Cristina, M. L. (2022). Overcrowding in emergency department: Causes, consequences, and solutions—A narrative review. Healthcare, 10(9), 1625. https://doi.org/10.3390/healthcare10091625

Waqas, A., Malik, S., Fida, A., Abbas, N., Mian, N., Miryala, S., Amray, A. N., Shah, Z., & Naveed, S. (2020). Interventions to reduce stigma related to mental illnesses in educational institutes: A systematic review. Psychiatric Quarterly, 91(3), 887–903. https://doi.org/10.1007/s11126-020-09751-4

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WK8 SDOH AND SOCIAL CHANGE
The U.S. Department of Health and Human Services (HHS) has identified five areas that impact one’s social determinants of health (SDOH), which include economic stability, education, social and community context, health and healthcare, and neighborhood and surrounding environment (ODPHP, 2020).

And although the United States spends more money on healthcare than other highly industrialized countries, according to the National Academies of Sciences, Engineering, and Medicine (2021), it has some of the poorest health outcomes of other developed countries.

As nurses, we identify the inequities that affect our patients outside of medical care, such as lack of money to purchase needed medications, transportation, food insecurity, poor housing, and fear of safety in the neighborhood. Because of these factors, understanding the impact of the SDOH, in shaping one’s health, is critical to today’s nursing workforce.

As noted in the introductory quote from Thomas Edison, addressing SDOH and developing strategies with good intentions and a bad approach, to promote positive social change, may not help the patient, the community, nor the organization. Planning for change by using a translation model, instead, assists the organization and ensures that a variety of stakeholders have plan input, implementation time is decreased, and outcomes are clearly identified.

To Prepare

• Review the Week 8 Learning Resources. Pay particular attention to Chapter 10 and Appendix A in the Dang, et al. text. Also, review the three exemplars provided in the White et al. text.
• Select an organization with which you are familiar that went through a practice change to address a practice or organization issue. Note: You may reuse organizations and/or issues that you selected earlier in this course. Or you may select new ones.
• Consider how SDOH and positive social change relate to the issue you selected.
• Consider how the approaches used by the organization to address the practice or organization issue were decided upon and received, as well as if the outcome was satisfactory or not.

By Day 3 Of Week 8
Post the following:

• Identify the organization you selected. Describe the practice or organization issue you selected.
• Explain how SDOH relates to the issue you selected. Be specific and provide examples.
  • Were SDOH addressed? If so, in what ways?
  • Did positive social change occur? Why or why not?
• Using Appendix A from the Dang et al. text. Briefly describe the steps that were followed and/or missing in the organization’s approach to the practice or organization change.
  • Were the outcomes positive or negative?
    • If the outcome was less than satisfactory, what could have been done differently to achieve a better outcome? Be specific and provide examples.
    • If the outcome was satisfactory, what key actions were taken that led to this positive outcome? Be specific and provide examples.
  • How was the change measured, if at all? In what ways were the outcomes evaluated? Be specific and provide examples.

Note: Your posts should be substantial (500 words minimum), supported with scholarly evidence from your research and/or the Learning Resources, and properly cited using APA Style. Personal anecdotes are acceptable as part of a meaningful post but cannot stand alone as the entire post.