Determinantes psicosociales de salud en procesos de exclusión e inclusión social

Aquesta tesi doctoral pretén investigar la forma en què diferents factors de risc disruptivos així com el benestar psicològic, benestar social i uns certs estils d'afrontament, influeixen en la salut autopercibida en persones en situació d'inclusió i exclusió social. La finalitat última és identificar factors psicosocials que poden convertir-se en moduladors de salut en trajectòries d'inclusió i exclusió social, per a orientar polítiques anticipatòria, reactives o estratègiques per a reduir les inequidades en salut. Amb aquest propòsit es van administrar diferents qüestionaris per a avaluar la salut autopercibida, el benestar psicològic i benestar social i conèixer el maneig de diferents estils d'afrontament en una mostra de 210 persones: 107 en situacions d'inclusió social i 103 en situació d'exclusió social. Amb els resultats obtinguts es va evidenciar quines dimensions de benestar psicològic, benestar social i estils d'afrontament podrien convertir-se en moduladors saludables per a millorar els estats de salut i per tant la qualitat de vida. Es proposen dos models; model de determinants psicosocials de salut en procesos d'inclusó social i el model de determinants psicosocials de salut en procesos d'exclusió social.Esta tesis doctoral pretende investigar la forma en que diferentes factores de riesgo disruptivos así como el bienestar psicológico, bienestar social y ciertos estilos de afrontamiento influyen en la salud autopercibida en personas en situación de inclusión y exclusión social. La finalidad última es identificar factores psicosociales que pueden convertirse en moduladores de salud en trayectorias de inclusión y exclusión social, para orientar políticas anticipatoria, reactivas o estratégicas para reducir las inequidades en salud. Con este propósito se administraron diferentes cuestionarios para evaluar la salud autopercibida, el bienestar psicológico y bienestar social y conocer el manejo de diferentes estilos de afrontamiento en una muestra de 210 personas: 107 en situaciones de inclusión social y 103 en situación de exclusión social. Con los resultados obtenidos, se evidenció qué dimensiones de bienestar psicológico, bienestar social y estilos de afrontamiento podrían convertirse en moduladores saludables para mejorar los estados de salud y por ende la calidad de vida. Se proponen dos modelos; modelo de determinantes psicosociales de salud en procesos de inclusión social y el modelo de determinantes psicosociales de salud en procesos de exclusión social.This doctoral thesis aims to investigate how different disruptive risk factors as well as psychological well-being, social well-being and certain coping styles influence self-perceived health in people in a situation of social inclusion and exclusion. The ultimate aim is to identify psychosocial factors that can become health modulators in trajectories of social inclusion and exclusion, in order to guide proactive, reactive or strategic policies to reduce health inequalities. For this purpose, different questionnaires were administered to assess self-perceived health, psychological-social well-being and the management of different coping styles in a sample of 210 people: 107 in situations of social inclusion and 103 in situations of social exclusion. The results obtained will show which dimensions of psychological and social well-being and coping styles could become healthy modulators to improve health states and therefore quality of life, both in processes of social inclusion and social exclusion and two models are proposed: the model of social determinants of health in social inclusion processes and the model of psychosocial determinants of health in social exclusion processes

Model of psychosocial determinants of health in processes of social exclusion

The substantial increase in the number of families facing social exclusion in Europe and its direct relationship with health inequities is a challenge for studies approaching the social determinants of health and policies dealing with welfare and social inclusion. We start from the premise that reducing inequality (SDG10), has a value and contributes on other goals such as improving health and well-being (SDG3), ensuring quality education (SDG4), promoting gender equality (SDG5) and decent work (SDG8). In this study, we identify disruptive risk factors and psychological and social well-being factors that influence self-perceived health in trajectories of social exclusion. The research materials used a checklist of exclusion patterns, life cycles and disruptive risk factors, Goldberg’s General Health Questionnaire (GHQ-12), Ryff’s Psychological Well-being (PWB) Scale and Keyes’ Social Well-being Scale. The sample consists of 210 people (aged between 16 and 64  years): 107 people in a situation of social inclusion and 103 people in a situation of social exclusion. The data treatment involved statistical analysis, including correlation study and multiple regression analysis, aimed at developing a model of psychosocial factors that may act as health modulators, considering social factors as predictors in the regression model. The results showed that individuals in the sample, in a situation of social exclusion, have a greater accumulation of disruptive risk factors, and these are related to having fewer psychosocial and cognitive resources to cope with stressful situations: less self-acceptance, less mastery of the environment, less purpose in life, less level of social integration and social acceptance. Finally, analysis showed that in the absence of social integration and purpose in life, self-perceived health statuses decline. This work allows us to use the model obtained as a basis for confirming that there are dimensions of psychological and social well-being that should be considered stress-buffering factors in trajectories of social exclusion. These findings can help design psychoeducational programs for prevention and intervention with the aim of improving psychological adjustment and health states, as well as to promote proactive and reactive policies to reduce health inequalities