RT Journal Article
SR Electronic
T1 The Role of Community-Based Organizations in Improving Chronic Care for Safety-Net Populations
JF The Journal of the American Board of Family
                Medicine
JO J Am Board Fam Med
FD American Board of Family Medicine
SP 698
OP 708
DO 10.3122/jabfm.2021.04.200591
VO 34
IS 4
A1 Kim Hanh Nguyen
A1 Jessica D. Fields
A1 Anupama G. Cemballi
A1 Riya Desai
A1 Anjali Gopalan
A1 Tessa Cruz
A1 Aekta Shah
A1 Antwi Akom
A1 William Brown III
A1 Urmimala Sarkar
A1 Courtney Rees Lyles
YR 2021
UL http://www.jabfm.org/content/34/4/698.abstract
AB Introduction: Social determinants of health (SDoH) influence health outcomes and contribute to disparities in chronic disease in vulnerable populations. To inform health system strategies to address SDoH, we conducted a multi-stakeholder qualitative study to capture the multi-level influences on health for those living in socio-economically deprived contexts.Methods: Varied qualitative inquiry methods – in-depth interviews, participant-led neighborhood tours, and clinic visit observations – involving a total of 23 participants (10 patients with chronic illnesses in San Francisco neighborhoods with high chronic disease rates, 10 community leaders serving the same neighborhoods, and 3 providers from San Francisco's public health care delivery system). Qualitative analyses were guided by the Chronic Care Model (CCM).Results: Several key themes emerged from this study. First, we enumerated a large array, neighborhood resources such as food pantries, parks/green spaces, and financial assistance services that interact with patients' self-management. Health service providers leveraged these resources to address patients' social needs but suggested a clear need for expanding this work. Second, analyses uncovered multiple essential mechanisms by which community-based organizations (CBOs) provided and navigated among many neighborhood health resources, including social support and culturally aligned knowledge. Finally, many examples of how structural issues such as institutional racism, transportation, and housing inequities are intertwined with health and social service delivery were elucidated.Conclusion: The results contribute new evidence toward the community domain of the CCM. Health care systems must intentionally partner with CBOs to address SDoH and improve community resources for chronic care management, and directly address structural issues to make progress.