The Social-Ecological Model applied to Chronic Kidney Disease

I’ve decided to apply the Social-Ecological Model to Chronic Kidney Disease (CKD) and examine the influences that play a role in CKD. I work in a healthcare setting which provides treatments and allied health supports to the CKD population and found that the resources which I have curated are visible and active in the patient care setting that I work in. The Social-Ecological Model (SEM) implements 4 levels of factors which influence one another in an ascending manner and explains health challenges and risks (CDC, 2022). In this case, we will apply the SEM to explain what puts a population at risk for and with CKD.

I found an article published in the Journal of the National Medical Association that explain the roles of social and environmental factors for CKD. Factors such as household income, health insurance, educational attainment, geographical residence, substance abuse, culture, diet, obesity, and stress influence CKD (Nzerue et al., 2002). This is a comprehensive list of factors and its straightforward to apply the SEM to distinguish which factors are individual, relationship, community, and societal. We can apply a simple breakdown of some these factors to the SEM.

Factors such as diet, stress, substance abuse, and educational attainment are individual influences for CKD and interventional approaches can be implemented for a person at risk of or with CKD. The migration of population to inner city areas where there are higher poverty levels and substance abuse can lead to health consequences when interacting with such physical and economic deteriorations. Geographical placement is a community factor in the SEM in which the environment can influence the risk and management of CKD. I work in a community hospital near the downtown core of Toronto and the community factors are prevalent when trying to help patients manage their CKD. Some populations have cultural expectations which play a role in influencing the risk of and management of CKD and I have seen some patients who are hesitant and refuse medical interventions for their disease. Cultural norms are recognized as a societal level factor and require education and promotion of kidney disease interventions.

The idea that each factor level in the SEM is dependent on the former is also visible when looking at how spherical influences on CKD create a snowball effect. For example, CKD patients who have issues with substance abuse (Individual factor level) are typically associating with groups involved in substance abuse (relationship factor level) and reside in challenging housing situations where access to substances is common (community factor level).

Golden, S. D., McLeroy, K. R., Green, L. W., Earp, J. A. L., & Lieberman, L. D. (2015). Upending the social ecological model to guide health promotion efforts toward policy and environmental change. Health Education & Behavior, 42(1_suppl), 8S-14S.

Nzerue, C. M., Demissochew, H., & Tucker, J. K. (2002). Race and kidney disease: role of social and environmental factors. Journal of the National Medical Association, 94(8 Suppl), 28S.

Patzer, R. E., & McClellan, W. M. (2012). Influence of race, ethnicity and socioeconomic status on kidney disease. Nature Reviews Nephrology, 8(9), 533-541.