Date of Conferral

10-20-2026

Date of Award

October 2026

Degree

Doctor of Public Health (DrPH)

School

Health Sciences

Advisor

Twanda Wadlington

Abstract

Little is known about whether patient-reported social determinants of health (SDoH) are associated with cesarean complications, a gap limiting equitable prevention. The purpose of this quantitative cross-sectional study, guided by the World Health Organization’s Conceptual Framework for Action on SDoH and the socioecological model, was to examine associations between six SDoH screening domains and surgical site infection (SSI), hemorrhage requiring clinical escalation, and length of stay (LOS) after covariate adjustment. Secondary data were comprised of N = 10,157 cesarean deliveries among adults in a multistate hospital system in 2025. Analyses used Bonferroni-corrected logistic and linear regression. Education and literacy concern was associated with SSI (OR = 17.01, 95% CI [3.03, 95.33], p = .001), suggesting literacy barriers to wound care. Transportation concern (OR = 6.57, 95% CI [1.95, 22.12], p = .002) and screening nonparticipation (OR = 2.41, 95% CI [1.35, 4.31], p = .003) were associated with hemorrhage, suggesting unmet social needs signal risk. Nonparticipation (B = 0.19, 95% CI [0.15, 0.22], p < .001) and utility difficulties concern (B = 0.34, 95% CI [0.19, 0.48], p < .001) were associated with 20.7% and 39.8% longer LOS, respectively. Nonparticipation, associated with two outcomes, differed by race: Black or African American patients made up 22.0% of unscreened versus 14.4% of screened patients, χ²(1, N = 10,157) = 31.29, p < .001. Monitoring screening completion by race is recommended. Positive social change may result as health systems support unscreened patients, reducing avoidable morbidity for mothers and families

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