SDOH (Pastakia) Flashcards
Cognitive Dissonance
mental discomfort that results from holding two conflicting beliefs, values, or attitudes
Signs of Cognitive Dissonance
- feeling uncomfortable before making decision
- justify or rationalize decision
- embarrassed or ashamed of something you have done
- experiencing guilt or regret about something in the past
- doing things because of social pressure or fear of missing out
Causes of Cognitive Dissonance
Forced compliance
New Information
Decisions
Dealing with Cognitive Dissonance
adding more beliefs to outweigh dissonant beliefs
reducing importance of conflicting belief
changing beliefs
Specific Example of Cognitive Dissonance in Class
Andrew Natsios, former USAID administrator, stating that Africans cannot tell time and that AIDS medications would be hard to use for them as they are taken multiple times each day
What agreement did President Bush sign to help AIDs
PEPFAR
Adherence to ART in Africa
the adherence rates in African compared to the US are very similar and actually statistically significant more in some aspects of Africa
Equity vs Equality
Equity: each person has different circumstances and allocates the exact resources needed to receive equal outcome
Equality: each person is given the same resources
Importance of Non Clinical Factors
40%: Socioeconomic Factors
30%: Choices + Behaviors
20%: Healthcare
10%: Physical environment
Example: In Marion county, IU Health Medical is present however the life expectancy is still very low (70)
Poverty Levels in Kenya
79% of population is in poverty (< 2 $/day) in Western Kenya
Life Expectancy of 10 yr old for Type 1 Diabetes
Africa has the lowest life expectancy of < 25
Diabetes Care Cascade
only 11% would get the diabetes medications they need
Guidance for HIV in African before Medications
Nutrition
- fruits, vegetables
Garlic
Shower after intercourse
Outcomes based on Income Status
High-Income:
- greatest chance for success
- greatest protection from risk
Low-Income:
- minimum chance for success
- highest chance for risk
Attempts to Provide Equity in Society
Unconditional Cash Transfers
Food Stamps
Unemployment benefits
Medicare & ACA
SDOH Activities and Effects on A1c
when providing REFERRALS to resources/services for SDOH, each clinic showed significant drops in A1c
A1c Changes by SDOH Needs
- those who have SDOH needs identified had a higher baseline A1c
- people with SDOH needs had less of a reduction in A1c than those without need
Why did people without SDOH need have a better reduction in A1c after 60-119 days
- if you do not correct the SDOH need, you will not correct the A1c
- the study is limited in only assessing individuals over 60-119 days –> SDOH changes take much longer such as > 1 year to see impacts in health
Standard Questionairre
Prapare tool
Unconditional Cash Transfer
direct provisions of cash without any strings attached
Did a lump sum or stable salary each month for UCT
lump sum as there is a deficit hole in money allowing the patients to dig themselves out of the hole
