Social Determinants of Health Assessed Among Nurses: A KAP-Oriented Systematic Review Using the Dahlgren-Whitehead Rainbow Model

TL;DR

This study maps which social factors most influence nurses' knowledge, attitudes, and practices, highlighting areas needing more focus to improve health equity.

Contribution

The paper systematically reviews and categorizes social determinants of health (SDoH) relevant to nurses using the Dahlgren-Whitehead Rainbow Model.

Findings

Poverty, social justice, and discrimination are frequently studied SDoH in nursing KAP.

Age, sex, and constitutional factors are underrepresented in SDoH research related to nursing.

Nursing education and interprofessional collaboration are suggested to address health inequities.

Abstract

What are the main findings?
The SDoH that are most frequently explored in relation to nurses’ and students’ knowledge, attitudes and practices are poverty, social justice, social gradient, social inclusion and exclusion, discrimination, diversity, equity and inequality, food insecurity and access to nutritious food, employment status, geographical isolation, healthcare services, housing difficulties, transportation, social support, individual lifestyle factors, and health literacy.The SDoH needing further focus are those linked to stable individual conditions, like age, sex, and constitutional factors, as these did not arise in connection with nurses’ or students’ knowledge, attitude and practice.

The SDoH that are most frequently explored in relation to nurses’ and students’ knowledge, attitudes and practices are poverty, social justice, social gradient, social inclusion and exclusion, discrimination, diversity, equity and inequality, food insecurity and access to nutritious food, employment status, geographical isolation, healthcare services, housing difficulties, transportation, social support, individual lifestyle factors, and health literacy.

The SDoH needing further focus are those linked to stable individual conditions, like age, sex, and constitutional factors, as these did not arise in connection with nurses’ or students’ knowledge, attitude and practice.

What are the implications of the main findings?
Mapping the most and least frequently assessed SDoH in relation to knowledge, attitudes and practices can inform the development of nursing education and training.Promoting health and health equity requires addressing SDoH through collaborative action across sectors. Nurses can be agents of change in this process.

Mapping the most and least frequently assessed SDoH in relation to knowledge, attitudes and practices can inform the development of nursing education and training.

Promoting health and health equity requires addressing SDoH through collaborative action across sectors. Nurses can be agents of change in this process.

Background and Objectives: Social Determinants of Health (SDoH) are factors that can contribute to health inequities. Improving the conditions in which people are born, grow, and live requires collaboration between professionals from different health sectors. Given their health and well-being-focused care, nurses are crucial to promoting health equity in the care they provide. Thus, their knowledge, attitudes, and actions—i.e., practice—(KAP) regarding SDoH could serve as a helpful starting point for promoting care that also focuses on non-medical factors. This study aims to map the SDoH assessed in the literature in relation to nurses’ and nursing students’ KAPs, using the Dahlgren–Whitehead Rainbow Model as a logical framework. Methods: Following PRISMA guidelines, a systematic literature review was conducted using PubMed, Scopus, Web of Science, CINAHL, and PsycINFO. Records published until June 2024 were selected from primary studies involving nurses and nursing students, with no time limits. The assessed determinants were adapted and categorised according to the Rainbow Model Levels. Results: 22 results were eligible. The SDoH (in general), poverty, social justice, social gradient, social inclusion and exclusion, discrimination, diversity, equity and inequality, food insecurity and access to nutritious food, employment status, geographical isolation, healthcare services, housing difficulties, transportation, social support, individual lifestyle factors, and health literacy were assessed on KAPs. Conversely, health equity has been assessed just for knowledge and attitudes. Considering the latter level of the Rainbow Model and the relative categorisation of the results, age, sex, and constitutional factors were not examined in the studies included in this review. Conclusions: This review maps the most and least frequently assessed SDoH in relation to KAP. As nurses are essential to providing care that considers SDoH, improving health outcomes, and addressing health inequities, and advocating for community health, it would be valuable to enhance nursing education from baccalaureate through postgraduate courses. Moreover, a strong relationship with different healthcare professionals is needed.