Healing beyond the wound: social determinants in chronic vascular care. Perspectives from clinical practice

Chronic vascular wounds are increasingly recognized as complex conditions shaped not only by vascular pathology but also by social determinants of health (SDHs). While research has focused primarily on patient outcomes, limited attention has been paid to how providers experience socially contextualized wound chronicity.

To explore how wound care professionals understand, experience, and respond to SDHs influencing chronic vascular wound healing, and how these dynamics affect professional identity, moral distress, and workforce sustainability.

A qualitative study was conducted using semi-structured interviews with 22 wound care professionals (home care nurses and hospital-based specialist nurses) in Calabria, Italy. Participants held post-graduate training in wound care and at least 1 year of clinical experience. Interviews were analyzed using reflexive thematic analysis following Braun and Clarke's six-phase approach.

Five interrelated themes emerged: recognition of upstream social inequalities; structural barriers embedded in clinical practice; invisible advocacy and emotional labor; moral distress linked to constrained professional agency; and implications for professional identity and retention. Providers reframed non-adherence as structurally produced and described chronic wounds as embodied expressions of inequality.

Chronic vascular wounds function as visible markers of social inequality. Addressing healing disparities requires integrating SDHs into clinical frameworks and supporting providers facing structurally generated moral and organizational strain.