Social Determinants of Health and the Use of Community-Based Rehabilitation Following Stroke: Methodologic Considerations

Social determinants are nonmedical factors frequently used to study disparities in health outcomes but have not been widely explored in regard to rehabilitation service utilization. In our National Institutes of Child Health and Human Development-funded study, Access to and Effectiveness of Community-Based Rehabilitation After Stroke, we reviewed several conceptual models and frameworks for the study of social determinants to inform our work. The overall objective of this special communication is to describe our approach to identifying, selecting, and using area-level measures of social determinants to explore the relationship between social determinants and rehabilitation use. We present our methods for developing a conceptual model and a methodologic framework for the selection of social determinant measures relevant to rehabilitation use, as well as an overview of publicly available data on social determinants. We then discuss the methodologic challenges encountered and future directions for this work.