Date of Submission
4-2024
Document Type
Thesis
Degree Name
Doctor of Health Science
Department
Health Sciences
First Advisor
Karl Minges, Ph.D., MPH
Second Advisor
Maggie Holland, Ph.D., MPH
Third Advisor
Michael Urban, OTD, MBA, M.S.
MeSH
Economics, Medical, Veterans Health
LCSH
Medical economics, Health--Social aspects, Veterans--Medical care
Abstract
Adverse social determinants of health (SDOH) can contribute to poor health outcomes, highlighting the importance of understanding veterans' unmet social needs. The purpose of this study was to conduct a quantitative analysis of health-related social needs (HRSNs) among veterans screened for SDOH to better understand the unique needs of this population. Minimal information on veterans' self-reported social needs is available in the current literature, and little is known about whether veterans want to receive help for their social needs. Therefore, this study aimed to close the knowledge gap by analyzing the self-reported HRSNs among veterans screened for nine SDOH domains, with the added novelty of assessing whether they would like assistance for their identified needs.
Data were collected from veterans who completed the Clinical Assessment of Social and Health Equity Worksheet (CASHEW). The study included a convenience sample of veterans presenting for primary care at the Toledo VA Clinic in Toledo, Ohio, from February 27, 2023, to September 30, 2023. Primary outcomes included the prevalence of social needs related to housing, food, utilities, transportation, legal, social isolation, employment, education, and technology and subcategories based on the level of need. The CASHEW screener response options were also analyzed to determine which SDOH domains veterans selected wanting or declining assistance for their unmet social needs. Additional statistical methods were used to analyze the data through multiple logistic regressions to determine how socio-demographic variables were associated with indicating any social needs.
Over one in four veterans (28.2%) screened indicated a need on the CASHEW screener, with 48.8% of those veterans indicating one need, 21.5% indicating two needs, and 29.7% indicating three or more needs. The most reported needs were social isolation or loneliness, education, and utilities. Among the nine SDOH domains, the most prevalent reported need where veterans declined assistance was social isolation or loneliness. Education was the most reported need where veterans wanted to discuss available assistance. Based on the findings from the multivariate logistic regression analyses, Hispanic or Latino veterans and divorced veterans were associated with increased odds of indicating any needs, while the odds of indicating any needs decreased for every one-year increase in age. Lastly, socio-demographic characteristics were associated with housing, food, utilities, legal, social isolation or loneliness, employment, and education needs. However, there were no statistically significant socio-demographic predictors for indicating transportation or technology needs on the CASHEW screener.
The findings indicate the necessity to utilize self-reported patient-level data to identify veterans with unmet needs and tailor interventions to improve health outcomes, as certain sociodemographics are associated with increased odds of indicating social needs.
Recommended Citation
Yates, Melissa, "Health-Related Social Needs and Demographic Correlates Among Veterans Screened for Social Determinants of Health" (2024). Health Science Doctoral Thesis. 13.
https://digitalcommons.newhaven.edu/healthscidocthesis/13