Linking Electronic Health Records and In-depth Interviews to Uncover Barriers to Social Mobility and Health in a Declining Coal Mining Community

Awarded Scholars:
Jennifer Silva, Indiana University
Elizabeth Durden, Bucknell University
Annemarie Hirsch, Geisinger Health Systems
Project Date:
Jan 2020
Award Amount:
Project Programs:
Social, Political, and Economic Inequality

Poor health is a barrier to social mobility, and disadvantaged populations are more likely to experience poor health and poor medical care. But the relationship between economic disadvantage and health is complex and the mechanisms that underly health attitudes and behaviors in poor communities are poorly understood. Research designed to explore the mechanisms through which class, race, and gender inequalities shape health experiences and behaviors, and how these are related to poverty and social mobility would further our understanding of the social determinants of health. Many social science studies document health care challenges from the individual’s perspective, whereas in studies of medical care, the voice of the patient is typically missing, leaving much unknown about the pathways through which inequality and health experiences interact.

Sociologist Jennifer Silva and her colleagues propose a mixed-methods project that would link electronic health record (EHR) data with patients’ narrative accounts of their experiences, worldviews, struggles, and obstacles to social, physical, emotional, and economic well-being. The investigators will address four questions. First, what are the mechanisms by which economic disadvantage and racial identity impact physical and emotional well-being? Second, what kinds of discrepancies exist between formal medical records and patient narratives? Next, how do experiences within the healthcare system shape women’s everyday approaches to their health and well-being? Fourth, do the EHRs reveal patterns in medical care (e.g., diagnoses, prescribing of medications, treatment plans) that might promote or hinder participants’ ability to achieve economic and social well-being? Exploring these questions with a focus on differences by race and ethnicity is a key aspect of the project.

Data collection takes place in two rural counties in the anthracite coal region of northeastern Pennsylvania where mining jobs have been replaced by low-wage service jobs in education, healthcare, and retail that are largely non-union and offer few benefits. 


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