HJAR Jul/Aug 2025

HEALTHCARE JOURNAL OF ARKANSAS I  JUL / AUG 2025 71 Tanya Hawkins, BSN, RN UAMS South Central-Pine Bluff developed when patients believe that you are genuinely concerned about their health and well-being. Once this relationship is established, patients are more inclined to disclose the non-medical barriers that af- fect their access to healthcare. Hjelm et al. explain that these trusting relationships are based on vulnerabilities and the expec- tation that any actions will provide a bene- fit and no harm. 6 Patient engagement strategies for vulnerable populations Healthy patient engagement is required to address SDOH and ensure vulnerable populations actively participate in their healthcare. 7 Engagement strategies aim to improve the health literacy of patients, foster patients’ trust in healthcare pro- viders, and promote self-management of health conditions. Research stresses the need to consider cultural aspects through culturally sensi- tive engagement approaches and the ex- periences and needs of patients’ unique backgrounds. 7 Consequently, health liter- acy issues can comprise significant barri- ers to patient involvement in community settings. Many patients have difficulty un- derstanding medical instructions, navigat- ing the health system, and making sound health decisions. One technological solu- tion for overcoming this health barrier is the Diagnostics Literacy Advocacy Model. This framework has been proposed to as- sist vulnerable populations in improving health literacy with appropriate educa- tional materials that are also culturally acceptable. 8 Barriers to addressing SDOH and potential solutions Social determinants of health can be addressed through case management and telehealth; however, rural commu- nities continue to experience a multitude of challenges. 9 Some of these barriers include funding constraints, workforce shortages, and systematic healthcare in- equities. Many healthcare organizations cannot access the resources to establish comprehensive SDOH interventions and thus cannot provide holistic care. 3 Fur- thermore, the workforce shortages in rural healthcare settings exacerbate an already overburdened system in which providers have neither the time nor the capacity to address their patients’social needs as thor- oughly as required. To address this issue, healthcare initia- tives need to intervene at the policy lev- el and include strategies that incentivize healthcare professionals to work in un- derserved areas and expand training for case managers. 3 Community partnerships are the primary contributors to overcom- ing community healthcare barriers. These partnerships can also foster collaborations between health systems, social service agencies, and local governments to devel- op integrated patient support networks that offer them access to nutritional ser- vices and housing. 10 Conclusion Addressing SDOH through a case man- agement approach is essential to improv- ing patient engagement and reducing healthcare disparities in rural communi- ties.1 Addressing social determinants of health is a very important task for nurse case managers, as it fosters a more com- prehensive understanding of patient needs and health barriers.1 By incorporating SDOH into their practice, nurse case man- agers can help to improve health outcomes and promote health equity among diverse populations. n REFERENCES 1 Campagna, V.; Mitchell, E.; Krsnak, J. “Addressing Social Determinants of Health: A Care Coordination Approach for Professional Case Managers.” Professional Case Management, vol. 27, no. 6 (November/December 2022): 263-270. https://doi.org/10.1097/ NCM.0000000000000590 2 Cleveland Clinic. “Social Determinants of Health.” Last reviewed May 8, 2024. https:// my.clevelandclinic.org/health/articles/social- determinants-of-health 3 Dauner, K. N.; Loomer, L. “A qualitative assessment of barriers and facilitators associated with addressing social determinants of health among members of a health collaborative in the rural Midwest.” BMC Health Services Research, vol. 21 (Aug. 24, 2021): 867. https://doi.org/10.1186/ s12913-021-06859-6 4 Sieck, C.J.; Nicks, S.E.; Salem, J.; et al. “Addressing Equity and Social Needs: The New Frontier of Patient Engagement Research.” Advances in Health Care Management, vol. 21 (Dec. 12, 2022): 151-165. https://doi.org/10.1108/ S1474-823120220000021008 5 Wolfe, M.K.; McDonald, N.C.; Holmes, G.M. “Transportation Barriers to Health Care in the United States: Findings from the National Health Interview Survey, 1997-2017.” American Journal of Public Health, vol. 110, no. 6 (June 2020): 815-822. https://doi.org/10.2105/AJPH.2020.305579 6 Hjelm, M.; Andersson, A.; Ujkani, V.; Andersson, E.K. “Registered nurse case managers’ work experiences with a person-centered collaborative healthcare model: an interview study.” BMC Health Services Research, vol. 24 (Sept. 23, 2024): 1108. https://doi.org/10.1186/s12913-024- 11500-3 7 Kothawala, S.; Wang, Y.; Sandeep, K.G. “Impact of Patient Engagement and Social Determinants of Health on Care of Eosinophilic Gastrointestinal Disorders Patients.” Journal of Pediatric Gastroenterology and Nutrition, vol. 74, issue 2 (February 2022): 272–276. https://doi. org/10.1097/mpg.0000000000003318 8 Mashamba-Thompson, T.P. “Diagnostics Literacy Advocacy Model for Vulnerable Populations.” Diagnostics, vol. 12, no. 3 (March 15, 2022): 716. https://doi.org/10.3390/diagnostics12030716 9 Zahnd, W.E.; Murphy, C.; Knoll, M.; et al. “The Intersection of Rural Residence and Minority Race/Ethnicity in Cancer Disparities in the United States.” International Journal of Environmental Research and Public Health, vol. 18, no. 4 (Feb. 3, 2021): 1384. https://doi.org/10.3390/ ijerph18041384 10 Agonafer, E.P.; Carson, S.L.; Nunez, V.; et al. “Community-based organizations’ perspectives on improving health and social service integration.” BMC Public Health, vol. 21 (March 6, 2021): 452. https://doi.org/10.1186/s12889-021- 10449-w Tanya Hawkins is an RN casemanager with 14 years of experience. She works at University of Arkansas for Medical Sciences (UAMS) in Pine Bluff as part of a collaborative teamdelivering holistic, patient-cen- tered care.She earned a Bachelor of Science in nurs- ing fromUniversity of Phoenix and recently earned a Master of Science in nursing at University of Arkan- sas at Monticello. She is Surveyor Minimum Quali- fications Test certified by Centers for Medicare and Medicaid Services.