Social and behavioral science and health brief notes
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Social and Behavioral Science & Health — Brief Notes
1. What Are Social & Behavioral Sciences in Health?
Social and behavioral sciences examine how individual behavior, social environment, culture, and structural forces shape health outcomes. They underpin public health, preventive medicine, clinical communication, and health policy.
2. Social Determinants of Health (SDOH)
The WHO defines SDOH as "the conditions in which people are born, grow, live, work, and age" — shaped by the distribution of money, power, and resources.
Clinical care accounts for only ~20% of health outcomes. Social determinants account for far more. — Goldman-Cecil Medicine
Five Core Domains (Healthy People Framework)
| Domain | Key Factors |
|---|---|
| Economic Stability | Poverty, employment, food security, housing |
| Education Access & Quality | Literacy, early childhood education, higher education |
| Health Care Access & Quality | Primary care access, health insurance, health literacy |
| Neighborhood & Built Environment | Housing quality, food deserts, clean water, transportation, safety |
| Social & Community Context | Social support, isolation, discrimination, civic participation |
Mechanism
- Upstream (structural) determinants → govern political, economic, and social conditions
- Downstream (proximal) determinants → influence individual behaviors and exposures
Miller's Anesthesia, 10e; Fuster and Hurst's The Heart, 15e
3. Key Concepts
Health Equity vs. Health Disparities
- Health disparity: A difference in health outcomes linked to social, economic, or environmental disadvantage
- Health equity: The attainment of the highest level of health for all people — requires removing avoidable inequalities
Socioeconomic Status (SES)
Low SES → higher rates of smoking, obesity, diabetes, hypertension, cardiovascular disease, and overall mortality. Low SES also predicts poor health literacy and engagement with preventive care.
Health Literacy
The ability to read, understand, and act on health information. Poor health literacy → medication errors, missed appointments, poor chronic disease management.
Social Capital
The degree of social connectedness (networks, trust, norms) within a community. Higher social capital → better mental health, faster recovery from illness, lower mortality.
Social Isolation & Loneliness
Independent risk factor for depression, cognitive decline, cardiovascular disease, and premature death. Equivalent risk to smoking 15 cigarettes/day (some studies).
4. Health Behavior Models
A. Health Belief Model (HBM)
People are most likely to change behavior if they perceive:
- Susceptibility — they are at risk
- Severity — the condition is serious
- Benefits — the behavior change helps
- Barriers — barriers to change are manageable
- Cues to action — reminders/triggers exist
B. Transtheoretical Model (Stages of Change)
Developed by Prochaska & DiClemente. Five stages:
| Stage | Description |
|---|---|
| Precontemplation | Not considering change |
| Contemplation | Aware of problem, thinking about it |
| Preparation | Intending to act, making small steps |
| Action | Actively modifying behavior |
| Maintenance | Sustaining the change; preventing relapse |
Clinicians tailor interventions to the patient's current stage. Relapse is normal — patients cycle through stages. — Textbook of Family Medicine, 9e
C. Social Cognitive Theory (Bandura)
- Self-efficacy (confidence in one's ability to change) is the central driver of behavior
- Behavior is shaped by the interaction of person, behavior, and environment (reciprocal determinism)
D. Theory of Planned Behavior
Behavior is predicted by intention, which is shaped by:
- Attitude toward behavior
- Subjective norms (social pressure)
- Perceived behavioral control (= self-efficacy)
5. Motivational Interviewing (MI)
A patient-centered, collaborative counseling method to elicit intrinsic motivation for behavior change. Developed by Miller (1983), originally for alcohol use.
Four principles — mnemonic RULE:
- Resist the "righting reflex" — don't give unsolicited advice
- Understand the patient's motivations — goals must come from the patient
- Listen empathically — active, reflective listening
- Empower the patient — reinforce their capacity to change
Core techniques:
- Open-ended questions
- Affirmations
- Reflective listening
- Summarizing (OARS)
Evidence: Brief MI in clinical settings is more effective than no treatment and generally equivalent to longer, costlier interventions. — Textbook of Family Medicine, 9e
6. Stress & Health
Biopsychosocial Model
Health and illness result from interaction of biological (genetics, physiology), psychological (behavior, cognition, emotion), and social (SES, environment, culture) factors.
Allostatic Load
Cumulative physiological burden from chronic stress and adversity — measured by dysregulation in neuroendocrine, cardiovascular, and metabolic systems. Elevated allostatic load → accelerated aging, CVD, metabolic disease.
Adverse Childhood Experiences (ACEs)
- Childhood abuse, neglect, household dysfunction
- Dose-response relationship: more ACEs → higher risk of cardiovascular disease, cancer, mental illness, substance use, premature death
7. Cultural Competence & Health
Culture shapes beliefs about illness causation, acceptable treatments, communication styles, and help-seeking. Culturally incompetent care → miscommunication, non-adherence, health disparities.
Key principles:
- Cultural humility: Ongoing self-reflection and openness rather than assuming cultural expertise
- Cross-cultural communication: Use qualified interpreters (not family members) for language barriers
- Explanatory models (Kleinman): Ask patients what they believe causes their illness, its effects, and desired treatment
8. Health Communication & Behavior Change
| Strategy | Application |
|---|---|
| Brief counseling (5 A's) | Ask, Advise, Assess, Assist, Arrange — used for smoking, obesity, alcohol |
| Shared decision-making | Patient and clinician jointly decide among options |
| Teach-back | Confirm understanding by asking patients to repeat instructions |
| Social media/technology | Apps, telehealth, patient portals for behavior support |
9. Population Health
Definition: Health outcomes of a defined group, including the distribution of outcomes and their determinants.
Key elements:
- Epidemiology & surveillance
- Risk stratification
- Chronic disease management
- Prevention programs (primary, secondary, tertiary)
Addressing social needs in clinical practice (5 intervention types):
- Awareness — clinicians understand SDOH
- Assistance — direct help (food vouchers, transportation)
- Adjustment — modify clinical care (telehealth, simplified regimens)
- Alignment — partner with community organizations
- Advocacy — policy-level change
Goldman-Cecil Medicine, 26e
10. Health Disparities by Key Dimensions
| Dimension | Health Impact |
|---|---|
| Race/Ethnicity | Structural racism → higher CVD, maternal mortality, infant mortality in Black populations |
| Gender | Women: higher depression, autoimmune disease; Men: higher injury, suicide, CVD at younger ages |
| Geography | Rural populations: higher CVD mortality, worse access to specialty care |
| Age | Elderly: polypharmacy, functional decline; Children: vulnerability to ACEs, poverty |
| Sexual orientation/Gender identity | Higher mental health burden, discrimination in health care |
11. Physician-Patient Relationship & Ethics
- Autonomy: Respect patients' right to make informed decisions
- Non-maleficence / Beneficence: Balance doing good with avoiding harm
- Justice: Fair distribution of health resources; address inequity
- Informed consent: Voluntariness, disclosure, capacity, comprehension
12. Quick Summary Table
| Topic | Core Concept |
|---|---|
| SDOH | 5 domains; shape 80%+ of health outcomes |
| Health Belief Model | Perceived susceptibility, severity, benefits, barriers |
| Stages of Change | Precontemplation → Contemplation → Preparation → Action → Maintenance |
| Motivational Interviewing | RULE; elicit intrinsic motivation |
| Social Cognitive Theory | Self-efficacy is key |
| Biopsychosocial Model | Biological × Psychological × Social |
| Allostatic Load | Cumulative stress burden |
| Health Literacy | Prerequisite for effective self-care |
| Cultural Humility | Ongoing learning > static "competence" |
| Population Health | Clinical care + SDOH + policy |
Sources: Miller's Anesthesia, 10e · Fuster and Hurst's The Heart, 15e · Goldman-Cecil Medicine, 26e · Textbook of Family Medicine, 9e
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