Athletic Trainers' Observations of Social Determinants of Health in the Secondary School Setting: A Card Study

Context: Athletic trainers (ATs) are in a unique position to mitigate the negative impact of social determinants of health (SDH) in their patients. In the secondary school setting, understanding common SDH may inform strategies that reduce these impacts. However, little is known about the types of SDH that ATs observe in patients in this setting.

Objective: To investigate SDH observed by ATs at the point-of-care in the secondary school setting.

Design: Descriptive, observational card study.

Setting: Secondary schools.

Participants: Twenty-seven ATs (mean [SD] age = 29.9 (5.6) years, 23 [85.2%] female).

Main outcome measure: Athletic trainers recorded SDH on a standardized observation card during patient interactions. Cards provided instructions for completion and had a 4-column table with a list of 19 predetermined SDH, a checkbox for observed SDH, a checkbox for perceived negative impact of observed SDH on patient health, and an open box to write in actions taken to address the observed SDH.

Results: Overall, 676 cards with 748 observed SDH were collected from 27 secondary schools. Of those, 46.9% (351/748) were perceived to have a negative impact on patient health. The top 3 observed SDH were academic stressors (14.2%, 106/748), access to social media (12.6%, 94/748), and lack of health literacy (11.4%, 85/748). The ATs reported acting on 37.7% of negatively perceived SDH 24 through counseling and education (48.6%, 137/282), additional resources (20.6%, 58/282), referral to others (17.4%, 49/282), and communication with others (13.5%, 38/282).

Conclusions: Our results indicated ATs in the secondary school setting were observing and acting to mitigate the negative impact of SDH. However, these ATs should be prepared to provide resources for patients negatively impacted by academic stressors, social media, and lack of health literacy. Resources, referrals, and additional education for patients may support a healthier community and positively impact athlete health and well-being.