Date of Award


Degree Name

PhD Leadership Studies

Dissertation Committee

Lea A. Hubbard, PhD Laura J. Deitrick, PhD John C. Kuek, PhD


Vulnerable Populations, Social Determinants of Health, Integrated Model, Health and Well-being, Cultural Alignment, Social Capital



There is an urgent need to reform the health care delivery system in the United States, as recognized through current bipartisan efforts. Society’s vulnerable populations especially need health care reform as health care outcomes are the poorest among disadvantaged populations. Moreover, vulnerable populations are twice as likely to develop chronic diseases than the general population and they remain ill due to other contextual, societal factors affecting their ability to achieve health and well-being. This population is subjected to adverse life events that suggest a more comprehensive approach to health and well-being is called for.

The Circle of Care is a multisectoral health care model provided at La Maestra’s health care facility, a federally qualified health center designed to attend to the multiple needs of vulnerable individuals. The medical services are integrated with other social determinants of health: economic development, housing, youth development, legal, immigration, food pantry, community garden, eligibility, and other social services.

The goal of this qualitative study was to identify, through the perspective of patients, the overlapping prior adverse life events that brought patients to the Center and their experiences accessing the Circle of Care services. Data was disaggregated by gender, ethnicity, and age to gain an understanding of how these factors influenced access, engagement with the integrated model and its influence on their health and well-being.

Results from 20 in-depth interviews with La Maestra patients over the course of one year indicate that participants found value in the instrumental resources of comprehensive, integrated social determinants services. The transactional exchange of social capital facilitated by the Circle of Care professionals empowered patients, increased social connectivity and promoted access to additional social capital resources. La Maestra’s network facilitated cultural alignment and trust and provided resources that proved intrinsically valuable to participants in advancing their health status.

The findings provide insights useful to the fields of health care and social work in the development of best practices. Layering services to address the adverse social determinants through an integrated community-based strategy creates opportunity, empowerment and well- being for our most vulnerable populations.

Keywords: vulnerable populations, social determinants of health, social capital

Document Type

Dissertation: Open Access


Leadership Studies