Expanding human factors/ergonomics to address social determinants of health: A patient ergonomics approach to birth justice

Addressing the social determinants of health (SDOH) is imperative to achieving health equity. The field of human factors/ergonomics (HF/E) has started to consider SDOH in influencing patient work, but has not yet extensively encompassed SDOH in patient work system models. Using transportation access to maternal health services as a case study, this research sought to enhance the patient work system framework to include sub-factors specific to SDOH. Following a model of community-based participatory research, semi-structured interviews were conducted with 18 individuals who were pregnant within the last five years, identified as low-income, and identified as having one or more racial or ethnic minoritized identities. Thirty-three secondary themes and 28 tertiary themes were derived inductively under the deductive framework of the consolidated patient work system. Unique sub-factors of the patient work system were identified, expanding our current understanding of the dimensionalities of the patient work system. Sub-factors were mostly expanded in the domains of the physical and organizational environments. HF/E researchers and practitioners, in partnership with other disciplines and communities, should expand work system models to purposefully incorporate a range of work system factors that stem from SDOH. Extending these models produces a holistic view of systems, providing a better foundation to align design interventions with the contextual realities of marginalized populations who experience health inequities.