Stepping outside the clinic walls: health professionals’ encounters with place during the COVID-19 pandemic

While existing literature has largely examined healthcare delivery within hospitals during the COVID-19 pandemic, this study extends the inquiry to the spatial dimensions of public health work in urban settings. It explores the experiences of health professionals engaged in home-based contact tracing in Türkiye, focusing on their perceptions of social determinants of health through place. Semi-structured interviews and focus group discussions were conducted with 45 health professionals from socioeconomically diverse districts in Istanbul, between July 2021 and September 2022. Data were analyzed using thematic analysis, with particular attention to the role of place. Health professionals observed a range of administrative, social, economic, cultural, and environmental challenges across households and neighborhoods they visited. Three key themes were identified: challenges in navigating the city (urban barriers and contrasting levels of urban development), perceived administrative neglect of place (time-pressured, place-ignorant planning and unregistered places), and places unsettling medical practice (socioeconomically deprived households and perceived limits of biomedicine in sociocultural contexts). These findings illustrate how place influenced health professionals’ experiences and highlight the underappreciation of place as a crucial social determinant of health. This study underscores the role of place in shaping health professionals’ perceptions of social determinants of health during COVID-19 contact tracing in Türkiye. As their awareness of health inequalities increased, health professionals experienced moral distress arising from tensions between biomedical training and complex, non-medical needs. While socioeconomic constraints were often interpreted sympathetically, sociocultural factors were more frequently moralized, pointing to gaps in cultural competence. Taken together, these findings demonstrate how place-based public health work reveals the limits of a purely biomedical approach and underscore the importance of systematically integrating health professionals’ experiential knowledge into place-sensitive, culturally competent, biosocial approaches to health policy and practice during emergencies and beyond.