{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T04:07:00Z","timestamp":1770005220060,"version":"3.49.0"},"reference-count":43,"publisher":"Public Library of Science (PLoS)","issue":"2","license":[{"start":{"date-parts":[[2021,2,11]],"date-time":"2021-02-11T00:00:00Z","timestamp":1613001600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"funder":[{"name":"U.S. Department of Veterans Affairs, Veterans Health Administration, Health Services Research and Development Service","award":["CDA 14-156"],"award-info":[{"award-number":["CDA 14-156"]}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Patients\u2019 life contexts are increasingly recognized as important, as evidenced by growing attention to the Social Determinants of Health (SDoH). This attention may be particularly valuable for patients with complex needs, like those with HIV, who are more likely to experience age-related comorbidities, mental health or substance use issues. Understanding patient perceptions of their life context can advance SDoH approaches.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Objectives<\/jats:title>\n<jats:p>We sought to understand how aging patients with HIV think about their life context and explored if and how their reported context was documented in their electronic medical records (EMRs).<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Design<\/jats:title>\n<jats:p>We combined life story interviews and EMR data to understand the health-related daily life experiences of patients with HIV. Patients over 50 were recruited from two US Department of Veterans Affairs HIV clinics. Narrative analysis was used to organize data by life events and health-related metrics.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Key results<\/jats:title>\n<jats:p>EMRs of 15 participants documented an average of 19 diagnoses and 10 medications but generally failed to include social contexts salient to patients. In interviews, HIV was discussed primarily in response to direct interviewer questions. Instead, participants raised past trauma, current social engagement, and concern about future health with varying salience. This led us to organize the narratives temporally according to past-, present-, or future-orientation. \u201cPast-focused\u201d narratives dwelled on unresolved experiences with social institutions like the school system, military or marriage. \u201cPresent-focused\u201d narratives emphasized daily life challenges, like social isolation. \u201cFuture-focused\u201d narratives were dominated by concerns that aging would limit activities.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec005\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>A temporally informed understanding of patients\u2019 life circumstances that are the foundation of their individualized SDoH could better focus care plans by addressing contextual concerns salient to patients. Trust-building may be a critical first step in caring for past-focused patients. Present-focused patients may benefit from support groups. Future-focused patients may desire discussing long term care options.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0246534","type":"journal-article","created":{"date-parts":[[2021,2,11]],"date-time":"2021-02-11T23:07:32Z","timestamp":1613084852000},"page":"e0246534","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":7,"title":["The temporal nature of social context: Insights from the daily lives of patients with HIV"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6055-4177","authenticated-orcid":true,"given":"Gemmae M.","family":"Fix","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eileen M.","family":"Dryden","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacqueline","family":"Boudreau","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nancy R.","family":"Kressin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allen L.","family":"Gifford","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Barbara G.","family":"Bokhour","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"340","published-online":{"date-parts":[[2021,2,11]]},"reference":[{"issue":"9846","key":"pone.0246534.ref001","doi-asserted-by":"crossref","first-page":"1011","DOI":"10.1016\/S0140-6736(12)61228-8","article-title":"WHO European review of social determinants of health and the health divide","volume":"380","author":"M Marmot","year":"2012","journal-title":"Lancet"},{"key":"pone.0246534.ref002","article-title":"Addressing Social Determinants of Health Within Healthcare Delivery Systems: a Framework to Ground and Inform Health Outcomes","author":"D Gurewich","year":"2020","journal-title":"Journal of General Internal Medicine"},{"issue":"1","key":"pone.0246534.ref003","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1007\/s11606-016-3869-x","article-title":"The Impact of Disability and Social Determinants of Health on Condition-Specific Readmissions beyond Medicare Risk Adjustments: A Cohort Study","volume":"32","author":"J Meddings","year":"2017","journal-title":"Journal of General Internal Medicine"},{"issue":"8","key":"pone.0246534.ref004","doi-asserted-by":"crossref","first-page":"577","DOI":"10.7326\/M17-2441","article-title":"Addressing social determinants to improve patient care and promote health equity: An american college of physicians position paper","volume":"168","author":"for the H, Public Policy Committee of the American College of P","year":"2018","journal-title":"Annals of Internal Medicine"},{"key":"pone.0246534.ref005","doi-asserted-by":"crossref","unstructured":"Davidson KW, McGinn T. 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