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The Relationship Between Social Determinants of Health and Flourishing Among Medical, Physician Assistant, and Nurse
Stephanie Neary1,2,3,4, Benjamin Doolittle1,2,3,4, Martina Mueller1,2,3,4
1Stephanie Neary, PhD, MPA, PA-C, is an assistant professor adjunct and the director of Didactic Education in the Yale University Physician Assistant Online Program, New Haven, Connecticut, and is a recent PhD in Nursing Science program graduate at the Medical University of South Carolina, Charleston, South Carolina.
Introduction:
Individuals with higher social and economic needs are less likely to complete higher education, including medical and graduate nursing training. The purpose of this study was to explore the relationship between social determinants of health (SDOH) and perceptions of flourishing among medical (MD), physician assistant/associate (PA), and nurse practitioner (NP) students.
Methods:
This study consisted of a single online survey using a cross-sectional design. Current MD, PA, and NP students from 2 academic medical centers in the United States were recruited between August 6 and October 9, 2023. Survey questions included demographics and multiple validated instruments including the Secure Flourish Index (SFI; flourishing) and WellRx (SDOH). Students were categorized into 3 groups based on SDOH needs determined by the WellRx score. Descriptive statistics, chi-square, and ANOVA testing were performed (alpha = 0.05).
Results:
A total of 301 of 1820 (16.5%) eligible students participated. Students had an average of at least 1 unmet SDOH need (M 1.1, standard deviation [SD] 1.2). Over 35% of students (n = 111/301, 36.9%) needed to work, 14.0% (n = 42/301) reported difficulty paying for utilities, and 9.3% (n = 28/301) reported food insecurity. Some students (15.3%, n = 45/294) had seriously considered leaving training in the prior 6 months, citing personal mental health (66.7%, n = 30/45) and financial stress (55.6%, n = 25/45) as contributing factors. Total SFI scores were almost 16 points higher among low SDOH risk group students (M 88.2, SD 14.0) than high-risk group students (M 72.7, SD 13.5; P < .001).
Discussion:
Students' social and economic needs are intertwined with their ability to flourish and their considerations for leaving training.
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