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Addressing Social Determinants of Health for Marginalized Populations: The Affordances of Digital Interventions
Asli Kalayci, Bengisu Tulu, Lindsay Smith, Nick Richardson, Steven Jenkins, Faye Taxman
The World Health Organization describes the Social Determinants of Health (SDOH) as non-medical factors that influence the health outcomes of individuals such as the economic, social and physical environments. Marginalized communities face complex SDOH that limit an individual’s ability to cope with disorders due to recurring problems including poverty, limited access to affordable health services, substance use disorder (SUD) and material deprivation. In the context of marginalized populations, our study focused on Justice-Involved People (JIPs) who are under probation. Post incarceration, individuals experience challenges including high rates of homelessness and poor access to coordinated healthcare or other SDOH services. Although post-release models exist, these models are scarce and stigmatization toward JIPs and limited service availability are commonly observed in healthcare settings. In the criminal justice system, JIPs can be encouraged through non-clinical support from Digital Health Interventions to attend appointments, continue SUD treatment and access SDOH services. The smooth transition of JIPs back to their communities, facilitated by digital interventions, could address social isolation.
The Probation/Parole and Reentry Coach App (PARCA) platform facilitates communication, between probation officers (POs) and JIPs, through a Justice Team Portal for POs and a mobile application for JIPs. JIPs can set and achieve personal goals related to employment, housing, substance use treatment, and healthcare. The dual functionality of the platform allows POs to monitor the progress and schedule appointments. The pilot implementation of PARCA was completed in two research sites in Texas, United States. We collected data from two cohorts of POs and JIPs. First, we conducted baseline interviews shortly after onboarding procedures. Second, we conducted follow-up interviews two weeks after the usage periods, focusing on PARCA features and feedback. Data analysis is ongoing, in accordance with technology affordance, which refers to what is offered or provided to the user by an object (Gibson 1986). Qualitative data revealed that JIPs need to make sense of the technology in relation to their personal goals and environment. However, when technology artifacts are irrelevant to their needs, it challenges JIPs’ sensemaking and limits the range of the affordances and utilization of the technology.
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