Social Determinants of Health: A Concept Analysis

Background and Purpose: Social determinants of health (SDOH) significantly affect health care outcomes on an individual, community, national, and global level. Clinicians must fully appreciate their impact and need standardized information defining the concept and its application in health care settings. Clarification is necessary to integrate the concept of SDOH into health care workplace mission statements, continuing education, formal academic institutions, and government guidelines. No formal concept analysis of SDOH exists using a standard nursing theory framework, despite growing awareness of the concept and the critical need for clinicians to apply it to theory-guided practice. This article provides the first formal nursing theory concept analysis using Walker and Avant's methodology. Methods: A literature review was conducted using the CINAHL Ultimate, PubMed Central, and Web of Science databases for peer-reviewed academic journal articles from the last 5 years. Walker and Avant's concept analysis method was applied. The concept of SDOH was explored along with antecedents, consequences, defining attributes, and limitations. Implications for practice and relevance to nursing were presented, and a case example was provided. No Institutional Review Board review was required. Results: A concept analysis was conducted using Walker and Avant's (2019) eight-step method. The concept analysis established the following defining attributes of SDOH: (a) neighborhood and physical environment, (b) economic stability, (c) education access and quality, (d) community, safety, and social context, (e) health care access and quality, and (f) planetary conditions. Implications for Practice: A clearly defined concept of SDOH allows for the standardization of educational materials, the creation of risk assessment screening tools, and integration into theory-guided practice and government practice guidelines. Recognizing SDOH can reduce clinician burnout and depersonalization in the presence of repeated poor outcomes, increase empathy for patients facing external obstacles, and foster humanizing health care interactions. Health care interventions can be better tailored to patient needs, improving evidence-based practice. Increasing policymakers' and clinicians' awareness of SDOH will decrease health care inequalities, promote social justice, and strengthen praxis, applying emancipatory knowledge into practice.