Social Determinants of Health and Preventive Service Utilization in a U.S. Community Health Center: An Application of...

To examine how social determinants of health (SDOH) influence the utilization of preventive health services at a Federally Qualified Health Center (FQHC) in Erie, Pennsylvania, using the Andersen and Aday behavioral model (Andersen, 1995; Aday & Andersen, 1974).

A cross-sectional, descriptive correlational study was conducted among adults (≥18 years) receiving primary care at Community Health Net from March through October 2018. The data was collected via a self-administered questionnaire, classifying variables as predisposing, enabling, or need factors, per the Andersen and Aday model. The Protocol for Responding to & Assessing Patients' Assets, Risks & Experiences (PRAPARE) tool was used to assess SDOH. Mental health status was measured using the Patient Health Questionnaire-9 and Generalized Anxiety Disorder 7-item scale. Logistic regression identified predictors of preventive service utilization.

Of the 274 participants, 65.8% were over 50 years old, 50.2% had low annual incomes (≤$15,000), 71.0% had public insurance, 58.8% were unemployed, and 10.0% were homeless. A total of 78.8% of the participants reported experiencing emotional or physical problems that affected their social life; 16.1% reported having transportation barriers and 13.9% reported a lack of social support. Preventive service utilization was high (75.1%). Multivariable analysis showed that low incomes (≤$15,000) (odds ratio [OR] = 1.82, 95% CI [1.15, 2.89]), unemployment (OR = 2.10, 95% CI [1.30, 3.40]), and mental health conditions (OR = 3.05, 95% CI [1.80, 5.18]) were significant predictors of utilization. Homelessness showed a positive but not statistically significant association (OR = 1.68, 95% CI [0.92, 3.06). The most frequently reported unmet needs among participants were mental health care (24.8%), transportation (16.1%), and social support (13.9%).

Socioeconomic disadvantage and mental health needs are strongly associated with preventive service utilization in this FQHC population, consistent with the Andersen and Aday model and international evidence (Braveman & Gottlieb, 2014; Marmot et al., 2008; Magnan, 2021). Addressing SDOH-including poverty, unemployment, mental health, and access barriers-remains essential for advancing health equity in high-risk communities (World Health Organization, 2008; Artiga & Hinton, 2022).