Public health nursing interventions for social determinants of health

Background: The social determinants of health (SDOH) such as poverty and racism are well documented; however PHN interventions related to SDOH have not been standardized and described. The objective of this study was to explore the extent of PHN practice and influence regarding the SDOH at individual, community, and system levels.

Methods: A descriptive and correlational study of self-reported public health nursing (PHN) interventions. PHNs from 100 tribal- and local-health departments in 16 states responded e- professional list servs invitations to complete an internet survey of 53 SDOH interventions. The survey was developed by a Midwestern Public Health Nurse Council using clinical expert consensus and the Omaha System. Survey data were analyzed using descriptive and correlational methods. Publicly available staffing and financial data were then added to the survey response database.

Results: All 53 SDOH interventions were reported by PHNs, with responses varying by population and level: individual level for maternal-child health (85.4%), adults (85.1%) and families (84.6%); community level (49.4%), and system level (36.4%). An additional 34 interventions were reported in free text. Analysis of financial and staffing data showed that the number of PHNs was more strongly associated with the total number of SDOH interventions (r=.38) than either the organization's total budget (r=.11) or the total number of LPNs, RNs, and PHNs (r=.30).

Conclusions: PHNs address SDOH among diverse populations at individual, community, and system levels. Agencies employing a higher ratio of PHNs may have greater focus on addressing SDOH. The Omaha System supports documentation of SDOH interventions.