Social determinants of health, adversity and resilience (SOAR) Factors

Principal Investigators:
Danielle Hessler, PhD | Family and Community Medicine | UCSF School of Medicine
Dayna Long, MD | UCSF Benioff Children’s Hospital Oakland

Background

Preterm birth (PTB) is defined as an infant born before 37 weeks and is a prevalent problem in the U.S. with 1 in every 10 infants being born premature. A growing body of evidence highlights the importance of addressing social and environmental factors to prevent PTB and improve quality of life for families who experience PTB. This study uses the abbreviation “SOAR” to define the main social stressors that cause preterm birth, including (1) Social Determinants of Health (e.g., food insecurity, housing instability or homelessness), (2) areas of Adversity or experience of Adverse Childhood Events (e.g., experiencing abuse, caregiver substance use, caregiver mental health), as well as (3) areas of Resilience that can be further supported. 

Objective

Pregnancy care can serve as a natural point for addressing SOAR factors for women at risk of PTB. Our study aimed to examine existing practices and standards for screening and responding to these factors in pregnancy care settings, and develop recommendations to increase screening and response to SOAR factors in Oakland and Alameda County.

Method

Interviews were conducted with 25 providers across 10 clinic sites.

Results

Provider interviews revealed barriers to increased screening and response including understaffing, patients’ level of trust in providers, stigma related to “getting help,” and the structure of the Comprehensive Perinatal Services Program (CPSP), which is often utilized by clinics. Potential opportunities include addressing challenges in workflow and documentation, developing on-site social services, providing incentives for patient attendance to visits, as well as improved follow-up and care coordination.