Date of Award


Degree Name

PhD Nursing

Dissertation Committee

Cynthia D. Connelly, PhD, RN, FAAN, Chairperson Caroline Etland, PhD, RN, CNS, ACHPN, Committee Member Razel Milo, PhD, DNP, MSN, FNP-C, RN, Committee Member


Social Determinants of Health, Health Confidence


Purpose/Aims: The purpose of this study was to investigate the relationship among social determinants of health (SDOH), select sociodemographics, and health confidence level in adults receiving care at an urgent care center.

Background/Rationale: To improve overall health and reduce health inequities during a global pandemic and unprecedented rates of inflation, the relevancy and urgency of identifying how patient-level SDOH impact health confidence level are even greater. Extant research indicates a relationship between the number of unmet social needs and low health confidence. Low health confidence predicts poor involvement in self-care and is associated with an increased use of costly health care services

Conceptual Basis: The social ecological model postulates health is determined by multiple interrelated factors occurring at various levels.

Methods: A descriptive cross-sectional prospective cohort design. A convenience sample of adults (N = 240) receiving services at a Southern California urgent care center were enrolled. Measurements included the PRAPARE screening instrument, Health Confidence Measure, and sociodemographic questionnaire.

Data Analysis: Descriptive and inferential statistics, including logistic regression were used to address study aims. All data were analyzed using the Statistical Product and Service Solutions (SPSS) 29.0 software.

Findings: Significant association were found between participants’ health confidence and material security, health confidence and social integration, and health confidence and stress. Among patients with unmet needs, 61% had low health confidence; among those spending time with family/friends 1-2 times per week, 75% had low health confidence; and among those with very much stress, 64% had low health confidence. Logistic regression explained 24.5% variance in participants’ health confidence. The odds of reporting low health confidence were higher for patients with fewer social interactions, when compared with those with more frequent social interactions; and quite a bit of stress, when compared to those who reported no stress.

Implications for Research: This study highlights the insidious prevalence of SDOH and impact of social isolation and stress on health confidence and provides the basis for implementing standardized SDOH screening in the urgent care setting. Future research is recommended.

Document Type

Dissertation: Open Access



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