1. Write a paragraph describing the extent to which an socioecological framework incorporating issues related to social determinants has been applied to your area of research. Are there opportunities for improving our understanding of or approach to disparities in your area with a greater emphasis on a socioecological framework? Consider drawing a DAG or a socioecological model (like the one shown in class for obesity) to illustrate your point (you can take a picture to post on the forum).
In the research area of radiology technology assessment, there have been relatively few studies in which a socioecological framework has been applied incorporating issues related to social determinants. For example, there is evidence that there are disparities in the rates of mammography-based breast cancer detection which are associated with race, socioeconomic status, and health insurance type. Similarly, there is evidence that there are disparities in the use of newer screening technologies such as screening breast MRI. Beyond the subspecialty of breast imaging, there has been other limited work regarding disparities in the use of head imaging in the emergency setting and missed care opportunities in outpatient imaging centers. But otherwise, potential disparities throughout the field of diagnostic and interventional radiology are incredibly poorly understood. As the use of imaging continues to grow, with a constant stream of new imaging techniques in the pipeline, the potential for associated worsening of health care disparities is alarming. The rise of artificial intelligence-based data processing techniques within the field may further amplify such disparities as a function of past trends. Thus, there are significant opportunities for using a socioecological framework to improve our understanding of radiology-related health disparities throughout the field of medical imaging.
2. In the WHO reading, the authors describe structural stratifiers (e.g. income, education, etc) and intermediary determinants such as material and psychosocial circumstances. Pick 3 of these factors (at least one structural and one intermediary). Explain why you chose the factors (might use Braveman article to provide justification) and describe how each could be an important determinant of a health outcome of your choosing. The association could be reported in published research or it could be your hypothesized relationship. Consider whether how these factors might function over the lifecourse and/or intergenerationally.
One of my health outcomes of interest is timely follow-up imaging examinations for equivocal findings on radiological studies. There are many effective interactions required for execution of radiologist follow-up recommendations which may be affected by structural or intermediary determinants. In order for a successful follow-up event, the radiologist must accurately first identify the finding and communicate the finding in the report. The finding may be communicated simply in the text of the report, through an electronic message, or through a phone call. The person to whom the result is communicated may be any of a number of individuals within the health care team with differential experience in managing the recommendation for follow-up imaging. Once the need for follow-up is communicated to the patient, a number of patient specific factors may contribute to a timely follow-up event. Almost all of these sequential interactions are sensitive to structural stratifiers and intermediary determinants.
Race is one structural determinant which could be an important contributor to timely radiology follow-up examinations. As mentioned above, there is compelling evidence that there are disparities in breast cancer screening driven by race. Structural, interpersonal, and internalized racism may in part mediate these types of effects within the context of the above-described interactions. Health care system distrust related to both historical and ongoing inequitable treatment of minority communities may play a significant role, as evidenced by a recent article suggesting black men seeing black male doctors were much more likely to agree to certain preventive measures. Occupation is a second structural determinant which may significantly contribute to timely radiology follow-ups. On the one hand, occupation is strongly related to income and social standing which may influence follow-up rates, but additionally, occupation reflects social networks and autonomy, affecting the rates at which patients are able to adhere to follow-up recommendations, through psychosocial processes. In addition to these structural stratifiers, a number of intermediary determinants may be important contributors to disparities with regard to this outcome, for example, neighborhood socioeconomic status may affect access to high quality health clinics and imaging facilities, opportunities for education about health significance more broadly, as well as the social support needed to make time to schedule and complete follow-up appointments.