SDOH Can Both Support and Hinder Recovery From COVID-19

In a phenomenological trial, investigators sought to identify themes characterizing patient perspectives on the influence of social determinants of health (SDOH) during recovery from COVID-19. Participants in the trial identified domains that both positively and negatively influenced their recovery from illness, suggesting that longitudinal data on SDOH is required to better address obstacles and identify resources for patients during recovery from acute illnesses.¹

Social determinants of health can impact a patient's recovery from acute diseases such as COVID-19. | Image Credit: © nabeel | stock.adobe.com

Phenomenological research is a form of qualitative research methodology that focuses on the study of an individual’s lived experiences. In research addressing SDOH, a phenomenological approach can be a useful tool to help health care professionals learn from the lived experiences of their patients.²

Although SDOH have always played a role in impacting health outcomes, the study authors recount how rates and severity of COVID-19 illness in many communities during the COVID-19 pandemic were complicated by dynamic social conditions, such as access to health care, familial support, and population density, which were especially burdensome in marginalized populations.¹

Since the beginning of the pandemic, awareness about how SDOH can affect patient health outcomes has risen, leading pharmacists to consider SDOH when treating patients. In an interview, Jacinda Abdul-Mutakabbir, PharmD, MPH, AAHIVP, discussed how lack of education and agency in health care can often be overlooked barriers to care, and that SDOH are major contributors to a lack of access to timely treatment for COVID-19.³

Gaining a more thorough understanding of how SDOH interact to exacerbate COVID-19 illness is critical to not only better inform pharmacists and treatment providers but also provide better management of acute illnesses for patients. In the current study, the investigators used COVID-19 as a model to understand how SDOH can support or hinder patient recovery from an acute illness. Qualitative methods were used to allow an in-depth exploration of the ways SDOH may interconnect, in patients' own words.¹

A total of 24 interviews were conducted: 10 were with patient-caregiver dyads, 13 with patients alone, and 1 with 2 patients who served as each other’s caregiver. Importantly, 15 patients (60%) were from lower-disadvantage neighborhoods, while 10 (40%) were from higher-disadvantage neighborhoods. Regarding their initial COVID-19 illness, 21 patients (84%) were hospitalized, and all 25 had at least 1 post-acute sequela of a SARS-CoV-2 symptom.¹

Several facilitators and barriers to recovery were highlighted within each domain of SDOH. Examples of factors that were helpful during patients’ recovery were having disability accommodations at home or in public, community support, flexible work arrangements, and grocery or food delivery by members of their social network. Contrastingly, unsafe neighborhoods, disruption of social services, unforeseen health-related expenses, and conflicting public health information all were reported to have hindered recovery.¹

Three cross-cutting themes were identified that encompassed multiple SDOH domains: innovative mobilization of resources, navigating the destabilization and change introduced by illness, and mistrust of previously established institutions. Regarding the first theme, innovation was described as policies that contributed to the maintenance and replenishment of financial resources used for COVID-19 management. These included sick and medical leave and paid time off. Innovations surrounding telemedicine services and food and grocery delivery were also useful to respondents.¹

The second theme of navigating destabilization included 3 subthemes: fear of human connection, uncertain health state, and disruption of social networks. Patients reported that COVID-19 made social interactions difficult, and led to them to avoid interactions with others. Anxiety was documented regarding patients’ future health, and the disruption of social networks because of deaths of family and friends was also reported.¹

Lastly, the final theme encompassed issues of unreliable protection and recommendations, dissolution of social contracts, and dismissal by clinicians. Mixed messaging surrounding COVID-19 prevention strategies led participants to not rely on official public health communication. Many patients also had negative experiences with clinicians, as they reported how their concerns and symptoms were dismissed and led to distrust in the health system at large.¹

Overall, these findings speak to the major impact of SDOH on illness recovery, building on research that up until now has mainly focused on critical illness or mental illness. Efforts to incorporate these SDOH in clinical decision-making should demonstrate trustworthiness by working with community-based organizations and diversifying health system workforces. The investigators note that establishing health structures that can rapidly innovate to a changing environment is optimal for integrating social and medical care.^1,4

“These data can be used to identify patients at greatest risk for adverse outcomes as well as determine opportunities for system- and policy-level interventions that can mitigate the outcomes of long-standing structural inequities that impact health,” the study authors concluded.¹

REFERENCES

1. Navuluri N, Bhavsar NA, Chen V, et al. Role of social determinants of health in COVID-19 recovery. JAMA Netw Open. 2025;8(1):e2453261. doi:10.1001/jamanetworkopen.2024.53261

2. Neubauer BE, Witkop CT, Varpio L. How phenomenology can help us learn from the experiences of others. Perspect Med Educ. 2019 Apr;8(2):90-97. doi:10.1007/s40037-019-0509-2

3. Hunter E. Social determinants of health are being highlighted more in pharmacy practice. Pharmacy Times. Published March 26, 2023. Accessed January 21, 2025. https://www.pharmacytimes.com/view/social-determinants-of-health-are-being-highlighted-more-in-pharmacy-practice

4. Jain S, Hauschildt K, Scheunemann LP, et al. Social determinants of recovery. Current Opinion in Critical Care. 2022;28(5):557-565. doi:10.1097/MCC.0000000000000982