The ‘Why’ Behind Athletic Trainers: Experiences with the Social Determinants of Health at In-Crisis Secondary Schools

Context: Athletic Trainers (ATs) are primary healthcare providers at secondary school athletic events and are often the only access some student-athletes have to healthcare. Understanding the social determinants of health (SDoH) is crucial for providing high-quality healthcare for athletes. Objective: To gain insight into the experiences of ATs working at secondary schools considered “in-crisis” by the U.S. Census Bureau’s Small Area Income and Poverty Estimates (SAIPE) Program levels of low income. Setting: Secondary School Design: Qualitative Study Data Collection and Analysis: We recruited 13 ATs who provided athletic training services at schools that were considered “in-crisis” via email utilizing the Athletic Training Locations and Services database. We completed online interviews until we achieved data saturation. We used a phenomenology approach to analyze the transcripts from the interviews. To secure trustworthiness, we used multi-analyst triangulation, peer review, and analytic memoing. Results: ATs were motivated by the ability to provide a consistent trusted presence in patients’ lives that supported their overall well-being. Participants felt the SDoH did alter their clinical decision-making, but did not reduce the quality of care provided. ATs acted as fierce advocates for their patients to ensure their basic needs were met (food, clothes, toiletries, transportation, insurance, etc). Participants felt called to serve in their workplaces because of their unique positions to influence the lives of their patients and received high-quality care. ATs also felt supported by the communities they served to create a positive community health impact. Although participants felt well supported by school administrations, they felt time constraints due to high patient loads. Conclusions: ATs working at “in-crisis” secondary schools are vital to communities due to their ability to navigate the impacts of the SDoH, establishing accessible equitable healthcare. Efforts should prioritize preparing ATs and students to provide care for similar populations, and continuing to support incentives for employing ATs at in-crisis secondary schools.