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Structural disparities (eg, food insecurities, housing, and lack of transportation) at different social levels (eg, personal, family, and community) are strong determinants of health, influencing individuals' and population well-being worldwide. Research is scarce examining how clinical communication can mitigate the negative impact of social disparities obstructing the reception of quality healthcare. In this study, we explore the mediation role of patient-centered communication (PCC) between social determinants of health (SDH) and quality of care. Using a sample of 5437 adult who visited a healthcare provider in the past 12 months from the sixth Health Information National Trends Survey (HINTS 6), our key points of findings included that the models showed PCC partially mediating the connections from (a) "skipped meals" (effect = -.08, 95%CI = [-.12, -.04]), (b) "unaffordable meals" (effect = -.08, 95%CI = [-.11, -.05]), (c) "fear of eviction" (effect = -.1, 95%CI = [-.14, -.06]), and (d) "lack of transportation" (effect = -.12, 95%CI = [-.16, -.08]) to quality of care (QoC). Specifically, better communication had a positive impact on mediating the disparities; poor communication did not. Demonstrating in a nationally representative sample, our findings indicate the key role of patient-centered clinical communication in effectively alleviating the inherent challenges faced by people with low health literacy and socioeconomic status. Theoretical and practical implications are discussed., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

This study used the Medical Expenditure Panel Survey data (2010-2018) to examine associations between diabetes patients' satisfaction with their provider and ratings of healthcare received, diabetes care self-efficacy, and monitoring adherence among nonpregnant reproductive age women with diabetes. The sample included nonpregnant women of childbearing age (18-45) with diabetes mellitus (n = 767; weighted n = 1.3 million women). The results indicated that patients who reported that their usual care provider always asked/showed respect for medical, traditional, and alternative treatments that the person is happy with had 2.59 times greater odds (95% confidence interval [CI]:1.32-5.10) of giving high ratings of healthcare (8-10) compared to those whose provider did not show respect for treatments. Results also showed that patients who reported they were asked to decide between a choice of treatments had 1.76 greater odds (95% CI:1.03-3.01) of diabetes care monitoring adherence. Findings demonstrate the importance of patient-centered communication experiences in relation to diabetes care monitoring adherence. Implications of the findings for clinical encounters are discussed., Competing Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2024.)

Introduction: This study examined associations between patient-provider race/ethnicity concordance and gender concordance on overall healthcare ratings, self-efficacy, and diabetes care monitoring in non-pregnant women of childbearing age with diabetes mellitus before and after adjusting for sociodemographic factors., Methods: We analyzed longitudinal data from the 2010-2019 Medical Expenditure Panel Survey. The sample was limited to non-pregnant women of childbearing age (18-45 years) diagnosed with diabetes (unweighted n = 327; weighted n = 566,504). Bivariate analysis, logistic regression, and latent variable modeling were performed., Results: Few racially minoritized women reported racial/ethnic and gender concordance with their healthcare provider. Only 2.9% of Hispanic women reported having a Hispanic provider and 12.1% of non-Hispanic Black women reported seeing a non-Hispanic Black provider compared to 81.1% of non-Hispanic White women who reported seeing a non-Hispanic White provider (p < .0001). Among Hispanic women, 15.3% reported seeing a female provider compared to 25.2% of non-Hispanic Black and 53.5% of non-Hispanic White women. Patient-provider race/ethnicity and gender concordance were not statistically significantly associated with overall healthcare ratings, self-efficacy, or diabetes care monitoring., Conclusions: This study revealed a large disparity in race/ethnicity and gender concordance among minority women of reproductive age with diabetes compared to their non-Hispanic White counterparts. There is a need for larger, more robust studies to examine the influence of provider and other healthcare characteristics on diabetes-related outcomes in this understudied population., Competing Interests: Declarations Ethics Approval Not applicable. Consent to Participate Not applicable. Consent for Publication Not applicable. Competing Interests The authors declare no competing interests. Disclaimer This information or content and conclusions are those of the author(s) and should not be construed as the official position or policy of nor should any endorsements be inferred by HRSA, HHS, or the US Government., (© 2023. W. Montague Cobb-NMA Health Institute.)

COVID-19 related health disparities are prevalent among higher risk populations like the Hispanic community. Vaccination is one readily available public health tool, yet vaccine uptake is lower among minority populations and hesitations and concerns are high. In the present study, interpersonal and media sources of information about COVID-19 were discussed in a series of six focus groups with Spanish-language dominant and bilingual English-Spanish respondents in a large metropolitan area in Texas. Participants reported using legacy media as a main source of information about COVID-19 vaccines and encountered conspiracy theories and misinformation on social media. Using the Health Belief Model as the theoretical lens, we found individuals' and family members' perceived susceptibility to COVID-19 played a part in participants wanting to find and get the vaccine. Provider recommendations may have served as cues to action. Ease of receiving the vaccines at church and pharmacies may have served to boost participants self-efficacy. Perceived barriers include vaccine specific reasons such as the fast pace of initial authorization, side effects, and long-term effects along with conspiracy theories. Prevailing information gaps regarding the COVID-19 vaccines and the resulting uncertainty are discussed. Understanding information sources and the trust Hispanic communities place in these sources is important in designing effective health messages.

Objectives: COVID-19 exacerbated pre-existing social inequalities. Using three theories linking clinical and media contexts to patients' health outcomes, our study investigated (1) potential factors of cancer patients' trust in healthcare providers and social media; (2) how such trust may influence healthy lifestyles during COVID-19., Methods: Using structural equation modeling, we investigated effects of key patient-provider communication variables and media factors on healthy behaviors among cancer survivors (N = 1130) using a nationally representative dataset (HINTS-SEER restricted use files, January-July 2021)., Results: More healthy behaviors since COVID-19 began were associated with more trust in healthcare providers, lower trust in social media about COVID-19, and more use of social media for health purposes. More trust in social media about COVID-19 was associated with more use of social media for health purposes (p < .01). More trust in healthcare providers about COVID-19 was associated with increased perceptions of patient-provider communication (p < .01)., Conclusions: Findings can inform interventions to connect at-risk cancer patients (e.g., those younger and with lower educational background) with providers in trust-enhancing conversations during situations like COVID-19., Practice Implications: Partnership building between providers and patients can be supplemented with scientific videos on popular social media sites like YouTube during public health crises and emergencies., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

One of the most detrimental side effects of the COVID-19 pandemic is the needed but not received care. Forgone health care affects the general public, but particularly children with special care needs. Previous research focused on non-modifiable factors, such as demographic background and insurance coverage. Based on Politi and Street's model of collaborative decision-making, we explored how two modifiable communication factors contributed to the prevention of forgone pediatric care during the COVID-19 pandemic. Using a nationally representative sample ( n  = 10845) from the 2020 National Survey of Children's Health (NSCH) survey, we found that health-care providers' family-centered communication and shared decision-making may reduce the possibility of forgone care through improved satisfaction with providers' communication. For children with mental health needs, providers' family-centered communication may also stimulate family's capacity to openly communicate, leading to better involvement in care and timely health care seeking. This helps to address COVID-related uncertainty, prevent higher health-care expenditures, and reduce negative health outcomes.

Objective: Telehealth usage for healthcare encounters has increased dramatically due to the coronavirus disease (COVID-19) precautions. As the pandemic health threat subsides, it is important to understand how telehealth encounters are perceived by users. In this study, we explore how patient-centered communication (PCC), and media and organizational factors, influence patients' intentions to use telehealth in the future., Methods: An online survey was conducted among 326 adult patients who reported visiting a healthcare provider using telehealth within the past 12 months. Structural equation modeling explored how contextual factors influenced patients' adoption of telehealth., Results: PCC and ease of use indirectly predicted telehealth adoption through enhanced patient satisfaction and sense of care continuity. Sense of security indirectly predicted telehealth adoption via its association with enhanced rating of care quality., Conclusion: The functionality of telehealth technology does not solely determine patients' telehealth adoption. Instead, positive healthcare experiences, facilitated by organizational support, quality media designs, as well as patient-centered communication, are associated with telehealth adoption., Practice Implications: Healthcare providers should strategically improve telehealth-related communication processes that can lead to better patient health outcomes., Competing Interests: Declaration of Competing Interest The authors have no relevant financial or non-financial interests to disclose., (Copyright © 2023 Elsevier B.V. All rights reserved.)

Mental health counselors regularly use active listening skills to be present with each client; however, active listening may cause burnout due to high emotional labor, inadequate staffing, excessive workload, and many other issues, each of which contributes to career exits. COVID-19 exacerbated all of these factors, and-adding to already stressful conditions-most mental health professionals were forced to conduct therapy sessions via telehealth. For this study, twenty licensed mental health counselors at various stages of their careers were interviewed during the height of the pandemic to understand their experiences with the technology and other factors related to their workload during that time. Thematic qualitative analysis was used to explore effects of active listening-including requisite adjustments made for virtual therapy sessions-on counselors' emotional exhaustion and burnout levels. Results show how back-to-back, daily therapy sessions increased listening exhaustion levels and that counselors experienced both long-term and short-term listening exhaustion when utilizing telehealth due to lack of nonverbal cues and other related factors pertaining to online delivery. Implications for counselors, social workers, and other mental health professionals are discussed., Competing Interests: Conflict of interest: The authors declare no potential conflict of interest, and all authors confirm accuracy., (©Copyright: the Author(s).)

Objective: To determine associations between patient-centered communication (PCC) and overall healthcare ratings, self-efficacy, and management adherence among reproductive-age women with diabetes within the framework of Epstein and Street's conceptual model., Methods: We analyzed longitudinal data from the 2012-2018 Medical Expenditure Panel Survey. The sample included 493 non-pregnant women of childbearing age (18-45 years) with diabetes. Independent variables were domains of PCC (listening, explaining, respecting, spending time, giving instructions, among others). Dependent variables were overall healthcare ratings, self-efficacy, and management adherence. Crude and adjusted associations were evaluated., Results: Non-pregnant women of childbearing age who reported that their provider always listened to them, explained things, showed respect, and spent enough time with them had greater odds of reporting high overall healthcare ratings. Those who reported their provider always listened to them and spent enough time with them had greater odds of reporting better diabetes care adherence than those whose health care providers did not., Conclusion: Findings demonstrate that non-pregnant women of childbearing age who report having optimal PCC are more likely to adhere to their diabetes care regimen., Innovation: This is the first known study using a nationally representative sample of non-pregnant women of childbearing age to examine multiple layers of PCC., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Kyrah K. Brown reports financial support was provided by 10.13039/100000102Health Resources and Services Administration., (© 2023 The Authors.)

Sexually transmitted infections (STIs) affect millions of people annually, costing $16 billion in direct costs each year. Young adults often avoid communicating with their romantic partners about STIs for fear of stigma, thereby limiting their own and their partners' ability to make informed and accurate health decisions. Using Communication Privacy Management theory as the theoretical framework, this study investigates how young adults in romantic relationships communicate about STIs with their partner. Findings show that participants report having conversations about STIs, but do not engage in regular STI testing, thereby limiting their ability to provide accurate information. They also discuss STIs in general rather than the communicating about their own history with STIs, being tested for STIs, or discussing STI test results with their partners. Practical and theoretical implications are discussed.

Objectives: The study objective was to investigate differences in patient experiences with health care providers among non-pregnant women of childbearing age with diabetes mellitus (DM) by race/ethnicity., Design: This study used cross-sectional data from the 2012-2018 Medical Expenditure Panel Survey. The sample was limited to women of childbearing age (18-45 years) who have ever been told they had diabetes ( n  = 763; weighted n  = 903,670). The key independent variable was race/ethnicity. The variables of interest included patient experiences with health care in the past 12 months: patient-provider communication (PPC); patient-provider racial/ethnic concordance; patient-provider gender concordance; and satisfaction., Results: After adjusting for age, marital status, education, poverty level, health insurance, and perceived health status, non-Hispanic (NH) Black women had lower odds (adjusted odds ratio [aOR] = 0.04; 95% confidence interval [CI] = 0.01-0.11) of receiving care from a health care provider of the same race compared with NH white women. Similar results were found among Hispanic and NH women of other or multiple races. Hispanic women had lower odds (aOR = 0.18; 95% CI = 0.06-0.50) of seeing a health care provider of the same race/ethnicity compared with NH white women in adjusted models. There were no statistically significant differences in PPC, patient-provider gender concordance, and satisfaction with their health care provider among Hispanic, NH Black, or NH women of other or multiple races in comparison to NH White women., Conclusion: There is a need to improve PPC quality and satisfaction in this patient population. Patient-provider racial/ethnic discordance among women of color with DM is concerning given the existing diabetes-related disparities. More research on women with DM is needed to inform and improve patient experience and health outcomes., Competing Interests: No competing financial interests exist., (© Kyrah K. Brown et al., 2023; Published by Mary Ann Liebert, Inc.)

Objective: COVID-19 has exacerbated pre-existing rates of overweight and obesity in the United States. mHealth technologies are gaining in popularity for its potential to reduce obesity, if facilitated by patient-centered communication. This study explores predictors of overweight and obese individuals' exercise levels during COVID-19., Methods: 2191 respondents who visited a doctor in the past year and self-reported being overweight were selected from the 2020 Health Information National Trends Survey (HINTS). Respondents reported their physical activity, beliefs about obesity, health tracking behaviors, and communication with providers during the pandemic. Structural equation modeling was used to explore connections among the variables., Results: Patient-provider (e-)communication was significantly associated with changes in people's obesity-related beliefs and mHealth tracking usage, predicting moderate exercise during the pandemic., Conclusion: The findings illustrate the need for patient-centered communication encounters to include discussions on mHealth technologies and accessible methods of engaging in physical activity.Innovation: This study examined secondary data provided by overweight and obese individuals from the early days of the COVID-19 pandemic; this population may benefit from targeted health interventions using mHealth technologies. Our findings suggest that healthcare providers should engage patients through mHealth technology and seek to improve digital health literacy to progress physical activity nationwide., Competing Interests: The authors declare that they have no conflicting or competing interests to report., (© 2022 The Authors.)

Our study aimed to estimate how a pediatric patient's health condition status influences parents' perceptions of patient- and family-centered care (PFCC). We analyzed five years (2013-2017) of Medical Expenditure Panel Survey data in efforts to expand understanding of the family influence in pediatric health encounters, using family systems theory as our theoretical lens. The sample included 36,675 parents of children with developmental or chronic health conditions who reported visiting a health-care provider within the past 12 months. The independent variable was a combined measure of any developmental or chronic health conditions previously diagnosed in the child being assessed. Dependent variables included parent reports of communication variables related to how often providers: listened; showed respect; spent enough time; and explained things well. Multivariable logistic regression was used to evaluate the odds of receiving PFCC using a dichotomous measure of PFCC quality and separate domains. Results found that 1) the dichotomous variable of PFCC showed that parents of children with health conditions were less likely to report their provider always performed all elements of PFCC compared to parents whose children did not have any health conditions; 2) parents of children with developmental or chronic health conditions were less likely to report their provider always explained things well compared to parents whose children did not have any health conditions. Efforts to improve PFCC should focus on training providers to demonstrate high-quality practices to improve health outcomes for pediatric patients with developmental or chronic conditions.

Objective: Patient perceptions of healthcare ratings, diabetes self-efficacy, and diabetes management play a role in diabetes-related outcomes, particularly among women of childbearing age. Guided by a modified Interaction Model of Client Health Behavior framework, the objective was to compare differences in perceptions of health care ratings, diabetes self-efficacy, and diabetes management among non-Hispanic Black, Hispanic, and non-Hispanic White women of childbearing age., Methods: The sample comprised 7 years (2012-2018) of Medical Expenditure Panel Survey data. The sample was limited to women of childbearing age (18-45 years) who have ever been told they had diabetes (n = 691; weighted n = 932,426). Dependent variables were health care rating, diabetes self-efficacy, and diabetes care management. The key independent variable was race/ethnicity (non-Hispanic Black, Hispanic, non-Hispanic White). We adjusted for sociodemographic characteristics and perceived health status using multiple linear and multivariable logistic regressions., Results: Non-Hispanic Black women (41.6%) self-reported their health status as fair or poor (44.9%) compared to non-Hispanic White (33.3%) and Hispanic (37.6%). In adjusted models, non-Hispanic Black women had 46% lower odds (95% CI = 0.31, 0.94) of reporting high health care ratings compared to non-Hispanic White women. Non-Hispanic Black women had 43% lower odds (95% CI = 0.35, 0.95) and Hispanic women had 47% lower odds (95% CI = 0.34, 0.80) of reporting higher levels of diabetes care management than non-Hispanic White women., Conclusions: This study provides important information regarding diabetes health care ratings, self-efficacy, and self-management behaviors. Because of the increasing prevalence of diabetes among women of childbearing age, it is important to improve health care particularly for racial/ethnic minority women with diabetes., (© 2021. W. Montague Cobb-NMA Health Institute.)

The objective of this study was to estimate and compare the prevalence of patient- and family-centered cae (PFCC) received by children in the United States (US) with chronic and developmental health conditions and determine associations between the presence of the conditions and parents' perceptions of PFCC after controlling for covariates. Linked data from the 2012-2016 National Health Interview Survey (NHIS) and 2013-2017 Medical Expenditure Panel Survey (MEPS) (n = 7,835) were tested using crude and adjusted logistic regression procedures. Parents of children with developmental delays had 32% lower odds (95% CI = 0.51-0.90) of reporting their healthcare provider always exhibited all PFCC qualities. Parents of children with allergies and developmental delays had 26% (95% CI = 0.58-0.95) and 42% (95% CI = 0.42-0.80) lower odds of reporting their provider always listened carefully compared to parents whose children did not. Findings demonstrate the importance of continuous training for providers to tailor communication for families who have children with health conditions., Competing Interests: Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article., (© The Author(s) 2022.)

Purpose: The COVID-19 pandemic is correlated with decreased physical activity (PA). Transitioning to remote work may impact people's acceptability and preferences for remotely delivered behavioral interventions, including PA. The objective was to examine perceptions of COVID-19 impacts on PA engagement and motivation, and perspectives related to remotely delivered PA interventions., Design: Cross-sectional small-group interview., Setting: Harris County, Texas. Participants: Insufficiently active, overweight/obese adults (16 healthy adults [aged 25-52 years], and 7 cancer survivors [aged 50-74 years])., Method: Group discussion was guided by semi-structured questions. Audio-transcribed data (278 pages) was analyzed using Braun and Clarke's process centering identification, analysis, organization, description, and reports., Results: Overall, participants expressed a decreased level of PA due to the pandemic. Difficulties (e.g., care-taking activities, working from home, and safety concerns) negatively affected motivation. Participants indicated high acceptability of remotely delivered PA interventions, with advantages of virtual technology features (e.g., did not have to maintain a gym membership) and even accountability in maintaining a PA routine (e.g., using virtual groups to engage in community support)., Conclusion: Participants described COVID-19 negatively affects access to PA opportunities yet also expressed willingness to engage in remotely delivered PA interventions instead of in-person programs because of their COVID-19 experiences. Remote interventions can greatly increase accessibility and offer opportunities to provide personalized motivation and accountability that people need to be more physically active.

Objective: Mobile and wearable sensor technology is increasingly common and accessible. The aim of this study was to explore individuals' perceptions and acceptability of mobile and wearable sensors, as well as concerns., Methods: Purposive sampling was used to recruit non-patient adults ( n = 22) and cancer survivors ( n = 17) for face-to-face and virtual small-group interviews. Reflexive thematic analysis of the data focused on privacy concerns., Results: Participants reported that privacy was generally not a concern for sensor adoptions for physical activity health interventions except for health insurer access., Conclusion: The patient perspectives as reported in the findings illustrate the need for transparency between potential adopters and users of mobile and wearable devices and health care practitioners, as well as secure privacy policies for health insurers., Innovation: Older adults often are perceived as unwilling to adopt mHealth technologies for many reasons, including privacy concerns. This study examined an important patient population, cancer survivors, who are often overlooked yet may benefit from targeted health interventions using mHealth technologies, and compared their responses with a non-patient population for prevention purposes. Our findings suggest that one's lived health experiences (cancer survivorship) are more influential than one's age in adopting mHealth technologies., Competing Interests: The authors declare that they have no conflicting or competing interests to report.

Even before COVID-19, women around the world performed more unpaid domestic labor, specifically unpaid care labor, than men. COVID-19 has only exacerbated the gender gap in this domestic labor. For Western women, especially mothers in the United States of America, the normative discourse of intensive motherhood and the gendered pressure inherent in the unrealistic standards set by the discourse have only increased the amount of unpaid domestic and care labor required of mothers. Using qualitative, in-depth interviews with 18 mothers during May-June 2020, this study examines privileged mothers' perceptions of what they did well in parenting both before and during the early part of the COVID-19 pandemic. The mothers' pragmatic adaptations during the pandemic posed challenges to the norms of intensive motherhood, as did emergent ideas about integrative mothering articulated before the pandemic's onset. We find that while COVID-19 has increased expectations on mothers, it has also provided a turning point wherein expectations can be changed, as the participants suggested. Implications for intensive motherhood scholars, mothers, and communication researchers are discussed, along with future research., Competing Interests: Conflict of interestThe authors declare no conflicts of interest for this manuscript. No funding was received for conducting this study., (© This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply 2022.)

Alcohol usage among young adults remains a prominent public health concern. Communicating with family members about alcohol can positively influence young adults' perceptions of social norms, yet the stigmatized nature of alcohol-related conversations in the family create a barrier to occurrence of these conversations. This study examines how young adults' familial communication patterns relate to their descriptive and injunctive social norms about limiting alcohol, using Communication Privacy Management Theory as the theoretical framework. Specifically, this study seeks to understand how conversation orientation, conformity orientation, warm conformity orientation, and cold conformity orientation associates with two sets of social norms (descriptive and injunctive), and to investigate how implicit privacy rules mediates each of these relationships. The current study examines 444 college students' responses to several quantitative measures. Implicit privacy rules did fully mediate the relationships between conversation orientation and injunctive social norms about limiting alcohol as well as warm conformity orientation and injunctive social norms about limiting alcohol.

Sexually transmitted infections (STIs) are among the most common infectious diseases in the United States with nearly 20 million new cases diagnosed each year in young adults (age 15-24). Communicating with romantic partners about STIs can positively influence health outcomes, as treatment can then be sought, yet the discussions themselves can pose several face risks to both the person requesting STI information from a partner and the receiver of that request. This study examines how young adults enact and manage facework strategies in STI-related conversations with romantic partners, using Politeness Theory and Communication Privacy Management Theory as theoretical frameworks. Specifically, this study seeks to understand how self-efficacy in conversations about STIs, intentions to talk about STIs and willingness to communicate about health in general predicts four face response strategies (avoid, communicate with partner/talk, defend self, consider other), and to investigate how boundary permeability moderates each of these relationships. We found that boundary permeability affected the relationships between intentions regarding STIs and the communicate with partner and consider other face management responses in conversations about STIs.

Objective: The main objective of this study was to utilize eye-tracking technology and self-report measures to test the effectiveness of varying strengths of fear appeals when educating about the seriousness of depression and motivate depressed individuals to engage in health-information-seeking., Methods: We analyzed data from 117 university employees affected by a range of depression symptoms who were randomly assigned to a low-threat, moderate threat, and high-threat message condition in a lab-based experimental setting. Attention patterns were captured while participants viewed the health message. A particular emphasis was placed on understanding the role of valence and arousal in determining attention patterns., Results: Attentional processes induced emotions (valence) and intensity (arousal) and differed by strength of fear appeal, but were not influenced by symptoms of depression in this study. Arousal mediated the effects of strong fear appeals on attitudes toward information-seeking, whereas negative emotions did not., Conclusion and Practice Implications: Until further research suggests otherwise, caution is warranted when utilizing fear appeals that are highly arousing for health education and promotion., (Copyright © 2019 Elsevier B.V. All rights reserved.)