Expanding Human Factors/Ergonomics to Address Social Determinants of Health: A Patient Ergonomics Approach to Birth Justice

Human factors/ergonomics (HF/E) is well equipped with theories, frameworks, and methods to contribute to advancing social justice. One way to extend H/FE to improve health equity is to apply the discipline to address the Social Determinants of Health (SDOH). Using a patient ergonomics approach, this research sought to extend sub-factors of the patient work system to encompass SDOH. Employing methodologies and methods from HF/E and public health through a case study focused on transportation access to maternal health services, interviews were conducted with 20 health care and human services professionals and 18 birthing persons of color with low-income to elucidate sub-factors within the patient work system. From these interviews, systems maps were created and reviewed by participants to capture interactive relationships between and among sub-factors and outcomes. This research corroborated existing sub-factors and identified unique sub-factors of the patient work system, expanding our current understanding of the dimensionalities of the patient work system. Through systems mapping, interactions were found across all domains of the patient work system. Models of patient work should be expanded to purposefully incorporate a range of work system factors that stem from SDOH and explicate their interactions. Multi-dimensional interventions should be co-designed with communities to address the complexities of transportation access to maternal health services. This dissertation research demonstrates that HF/E researchers and practitioners can contribute to our knowledge of systems modeling in concerted efforts with other disciplines as well as use participatory approaches to produce holistic understandings of systems and generate interventions that seek to eliminate the health inequities produced by these systems.