社会决定因素与手术结果的差异有关，但这种关联的机制仍存在知识空白。通过探索多种社会生态层面的视角，有助于阐明这些联系的机制。我们的研究旨在确定影响结肠直肠手术利用的社会决定因素，包括障碍和促进因素，以全面代表结肠直肠手术的利益相关者。我们招募代表5个社会生态层面的参与者：患者（个体）、看护者/外科医生（个人）、领导（医院组织）、社区和政府（政策）。患者参加了焦点小组，其余参与者则进行了个别访谈。使用半结构化访谈指南在每个社会生态层面探究手术护理的障碍和促进因素。 三个编码员采用归纳主题分析和内容分析分析了记录，评分者间一致性达到93%。共进行了6个患者焦点小组（18人）和12个关键利益相关者的访谈。患者平均年龄为54.7岁，其中66%为黑人，61%为女性。最常见的疾病是结直肠癌（28%）、炎症性肠病（28%）和憩室炎（22%）。关键的社会决定因素对手术护理影响在每个层面上均有体现，包括个体（清晰的沟通、精神压力）、个人（医务人员的沟通和信任，与COVID有关的探视限制）、组织（多种联系方式、优质教育材料、排班系统、歧视）、社区（社区和家庭支持和交通）和政策（慈善护理、患者倡导组织、保险覆盖）。关键社会决定因素-影响结肠直肠手术患者护理-在每个社会生态层面上均有体现，这可能提供了减少手术差异的干预方向。Copyright © 2023 Elsevier Inc. All rights reserved.

Although specific social determinants of health have been associated with disparities in surgical outcomes, there exists a gap in knowledge regarding the mechanisms of these associations. Gaining perspectives from multiple socioecological levels can help elucidate these mechanisms. Our study aims to identify social determinants of health that act as barriers or facilitators to surgical care among colorectal surgery stakeholders.We recruited participants representing 5 socioecological levels: patients (individual); caregivers/surgeons (interpersonal); and leaders in hospitals (organizational), communities (community), and government (policy). Patients participated in focus groups, and the remaining participants underwent individual interviews. Semistructured interview guides were used to explore barriers and facilitators to surgical care at each socioecological level. Transcripts were analyzed by 3 coders in an inductive thematic approach with content analyses. The intercoder agreement was 93%.Six patient focus groups (total n = 18) and 12 key stakeholder interviews were conducted. The mean age of patients was 54.7 years, 66% were Black, and 61% were female. The most common diseases were colorectal cancer (28%), inflammatory bowel disease (28%), and diverticulitis (22%). Key social determinants of health impacting surgical care emerged at each level: individual (clear communication, mental stress), interpersonal (provider communication and trust, COVID-related visitation restrictions), organizational (multiple forms of contact, quality educational materials, scheduling systems, discrimination), community (community and family support and transportation), and policy (charity care, patient advocacy organizations, insurance coverage).Key social determinants of health-impacting care among colorectal surgery patients emerged at each socioecological level and may provide targets for interventions to reduce surgical disparities.Copyright © 2023 Elsevier Inc. All rights reserved.