A new five-part video education series, “Curbside Manner: Health Beyond the Hospital,” has been created by RWJBarnabas Health. Addressing issues pertaining to equity, culture, and diversity, the series aims to train healthcare providers to integrate social care into clinical settings and to address key social and behavioral issues, including racism in healthcare; the causes and consequences of poor nutrition; the connection between housing on health outcomes; and issues related to substance use, mental health, and violence.

Mikesell said it is already known that up to 80% of health concerns stem from the social contexts in which people live — and that patient outcomes improve when providers are trained and educated to address social determinants of health (SDOH).

The series extends healthcare education for all levels of healthcare providers, “from physicians to intake workers, social workers, to community outreach workers, and everyone in between” beyond classroom learning to “achieve robust communities of practice that span disciplines, geographies, and cultures, thus truly moving healthcare beyond the hospital.”

Associate Professor of Communication Lisa Mikesell, a contributor to the series, said she became involved in its creation when RWJBH contacted SC&I searching for experts in communication, particularly patient-clinician communication. “They were directed to me since much of my work examines what constitutes patient-centered and family-centered communication in a number of health and mental health settings and how to foster trusting patient-clinician relationships.”

Her role as a contributor to the series, she said, was “primarily to offer state of the art information about the importance of incorporating social determinants of health in conversations with patients and also how to do that with sensitivity and compassion, and in both linguistically and culturally appropriate ways. Clinic interviews tend to be primarily structured by the chief medical complaint. This is in many ways understandable, but we know that so much impacts one’s health and the decisions one makes – are able to make – to address health and wellbeing: housing, food insecurity, substance use, which is precisely what this series addresses.”

Mikesell said it is already known that up to 80% of health concerns stem from the social contexts in which people live — and that patient outcomes improve when providers are trained and educated to address social determinants of health (SDOH).

“Negative communication in clinic encounters can be the reason that some patients do not return or follow-up with care, which is extraordinarily unfortunate,” Mikesell said, “So this education series felt like a very timely, well-organized, and motivated initiative that includes some tremendous experts in medicine and public health that I really admire, so I was honored to be part of it.” 

Mikesell said the issues addressed in the series include “life circumstances that are difficult for a patient to talk about and for a provider to address.” For example, according to the module on nutrition, “Over 37 million individuals in America go to bed hungry and, overwhelmingly, 138 million Americans are obese. Both of these issues lead directly back to an inability to access good, nutritious foods and result in chronic diseases such as diabetes, heart disease, depression, and many others.”

When thinking about what to include in the nutrition module, Mikesell said, “Our cultural background influences one of the most fundamental aspects of human daily life – what we eat. Many food practices are culturally defined and are consciously or unconsciously sustained to affirm ethnic and social group identity. Foods that are tied to our culture and family have meaning related to preserving or passing along family traditions, providing a sense of familiarity, and often enable expressions of caring and respect. Patients are often provided dietary recommendations as if these are easy and straightforward, but asking someone to change those customs -- those everyday habits -- is not only a matter of will (though that may certainly be a factor). We have to remember that when we ask people to change eating habits, we may be asking them to reframe who they are and how they connect to their families and communities. That is not a small thing to ask.”  

“Something we hear from all kinds of patients pretty frequently is that they don’t ‘feel heard,’ Mikesell said, “which for many means that they also don’t feel safe, and so they are less willing to share information that could be vital to their healthcare."

Safe and affordable housing is also connected closely to health outcomes, Mikesell said. The module addressing housing explains healthcare providers “must understand the right questions to ask and the resources that are available to ensure that their patients’ homes are warm in the winter and cool in the summer; equipped with the safety features that they need; free from toxins such as lead, mold, pest infestation and animal dander; and that they are receiving other benefits and supports for which they are eligible to help defray the cost of housing. Concurrently, health is affected by the stressors associated by the financial burdens of owning a home and the neighborhood in which your home is located. For all of these reasons, housing is too important to health, social and economic outcomes to be ignored.”

Some of the most challenging conversations providers and patients need to have, Mikesell said, concern substance abuse, mental health, and domestic violence, topics that are often taboo, but they affect populations across the socioeconomic spectrum.

“Something we hear from all kinds of patients pretty frequently is that they don’t ‘feel heard,’ Mikesell said, “which for many means that they also don’t feel safe, and so they are less willing to share information that could be vital to their healthcare. I think it can help to remember that healthcare encounters, for patients, often feel like a very institutionalized interaction. For practitioners on the other end of those interactions, healthcare encounters are, of course, very task-oriented and focused on usually very clear clinical objectives. But patients also come with fears, concerns, lived experiences and situations that they may or may not realize are impacting their ability to care for their own health and possibly the health of others. And these fears and concerns aren’t often automatically afforded space during encounters when healthcare needs must be addressed and addressed quickly. So my contribution to this series was to provide some strategies for how we might start to do this better.” 

“Curbside Manner” fulfills Continuing Medical Education (CME) credits authorized by the American Medical Association and will be offered through 2022 (and possibly indefinitely) through RWJBarnabus Health. More information on the series is available here.

Learn more about the Communication Department at the Rutgers School of Communication and Information on the website.