Identifying salient behavioral health access and social determinant of health factors among a Latino population with uncontrolled diabetes living on the U.S.-Mexico border.

BACKGROUND: Valid measures of behavioral health access and social determinants of health (SDOH) can inform health promotion, programming, and strategies to address identified gaps. Existing SDOH screening tools and domains were not developed using data from low-income Latino populations or community-based interventions, which may limit their relevance for these purposes. AIM/OBJECTIVES: This study sought to identify salient constructs of behavioral health and SDOH based on factor analysis among a low-income, underinsured Latino population with type 2 diabetes. METHODOLOGY: We gathered data from 6,735 Latino participants from two Texas-Mexico border counties enrolled in a multi-year diabetes management intervention to evaluate associations between observed behavioral health access and SDOH variables. We characterized common themes using factor analysis. RESULTS: We found one independent summary factor related to behavioral health access and four factors related to SDOH: 1. Insurance and health care barriers; 2. Major stress from lack of medical provider and resources; 3. Urgent financial or social hardship; and 4. Transportation barriers. CONCLUSION: The results inform a set of measures across multiple domains unburdened with multicollinearity and aligned with previous research on SDOH. The findings provide deep insight for strategies to address SDOH gaps using measures tailored to specific populations in clinical and community settings. Use of these measures could help better identify and intervene on the unmet needs that negatively impact health outcomes.