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).
I am involved with researching the disparities in accessibility to colorectal cancer (CRC) screenings amongst the South Asian populations in the Bay Area through the UC Berkeley School of Public Health. CRC is the third leading cause of deaths in the United States and the second amongst the targeted population. Despite these significant rates, the preventive measures such as FIT tests and colonoscopies are heavily underutilized in the older South Asian population due to lack of awareness and education surrounding the CRC narrative. Our focus groups and key informant interviews have demonstrated that this population is particularly prone to high rates of late stage CRC diagnosis because many older aged South Asians are recent immigrants/dependent on their adult children, who have difficulty in navigating through their healthcare system. Many individuals have cited that language barriers with their physicians have caused issues in understanding the protocol for the CRC screenings. Despite the effectiveness of community outreach events and informational presentations and brochures in the local languages, follow up before/after screenings is difficult to measure. Timely action following screenings is required for early diagnosis and treatment for this population. The multi-step screening process can be time intensive and these steps are a cultural stigma for many individuals of the targeted population. Improvements in the screening process and follow up after obtaining results is necessary to reduce the rates of late stage diagnosis for the older-aged South Asians in the Bay Area.
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.
Race/ethnicity (structural variable): Based on the extensive literature reviews and publications I have read for my CRC research project, there is overwhelming evidence which suggests that race and ethnicity is a primary variable in the disparities of CRC screenings. Our entire project was formed based on the notion that South Asians in particular have lower rates of screenings and higher rates of late stage diagnosis. Our hypothesis was that the cultural stigma against discussing CRC amongst family members and the intensive screening process was causing the poor screening rates. However, after conducting key informant interviews, we actually discovered that the language barriers and lack of accessible physicians who speak the native South Asian languages fluently was impacting the lower screening rates and the health literacy for the population. The new immigrants were unaware of which facilities and medical screenings were available to them and at what cost.
Material circumstances (intermediary variable): Public Health publications on CRC disparities suggest that material circumstances such as housing conditions, accessible transportation/means to get to clinics, financial means to afford clinical treatments, etc are responsible for the way an individual takes care of themself and interacts with their healthcare system. Utilization of preventive medicine techniques such as CRC screenings and interventions such as outreach events is contingent upon various factors, including the material circumstances.
Behavioral and Biological Factors (intermediary variable): While poor health behaviors and biological factors contribute to the low CRC screening rates amongst this population, the behavioral factors are directly contingent upon health literacy and awareness of the individual regarding the public health concern. As researchers we may think this is a difficult variable to control, and it certainly is, but with health outreach events and educational campaigns, we can at least attempt to bridge the gap between education and the population.