Date of Graduation

12-2024

Document Type

Dissertation

Degree Name

Doctor of Philosophy in Health, Sport and Exercise Science (PhD)

Degree Level

Graduate

Department

Health, Human Performance and Recreation

Advisor/Mentor

Dobbs, Page D.

Committee Member

Niño, Michael D.

Second Committee Member

Bhochhibhoya, Shristi

Third Committee Member

Hammig, Bart J.

Keywords

exploratory factor analysis; Future Families and Child Wellbeing; healthcare accessibility; place-based health; social determinants of health; socioecological model

Abstract

Objective. The social determinants of health (SDH) are various non-medical factors that influence health behaviors and health outcomes, and they are measured in variety of different ways. The purpose of this dissertation is to explore the relationship SDH items that may group to form a new domain and may be associated with outcomes of health care accessibility. This dissertation seeks to explain a novel understanding of social determinants of health and healthcare accessibility through the lens of the socioecological model and place-based SDH items.
Methodology. This retrospective study design utilized data from the baseline survey and year-22 wave of the Future Families and Child Wellbeing Study (FFCWS). First, an exploratory factor analysis and confirmatory factor analysis were used to identify if social determinant items grouped together to form a place-based domain. In the next study, along with demographics place based items were analyzed using a logistic regression to identify if any items were associated with healthcare accessibility at the individual interpersonal community and institutional levels.
Results. The social place domain of SDH was found to have four items that load together, including neighborhood safety, walkability, perception of neighbor’s willingness to help others, and poverty level classification. None of the place based neighborhood items identified in study 1 were associated with healthcare accessibility in study 2. However, poverty level, along with other demographics such as gender, race, ethnicity, spoken language, and insurance status were found to be associated with healthcare access at all four levels of the socioecological model.
Conclusion. While place based SDH items group together, the neighborhood level items are not associated with healthcare accessibility outcomes when using the FFCWS. Traditional SDH continue to increase the odds of experiencing barriers to care, like financial resources and discrimination’s association to gender, race, and ethnicity. Public health researchers should continue to explore place based SDH and health programming should continue to acknowledge the influence of SDH and healthcare access.

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