1. Racial Disparities in Patient Activation: The Role of Economic Diversity.
- Author
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Holt, Jeana M., Winn, Aaron, Cusatis, Rachel, Talsma, AkkeNeel, and Crotty, Bradley H.
- Subjects
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RACISM , *STATISTICS , *CONFIDENCE , *CONFIDENCE intervals , *PATIENT participation , *SELF-management (Psychology) , *BLACK people , *MATHEMATICAL models , *FISHER exact test , *RACE , *HEALTH literacy , *SOCIOECONOMIC factors , *T-test (Statistics) , *INCOME , *REPEATED measures design , *THEORY , *DESCRIPTIVE statistics , *AT-risk people , *FACTOR analysis , *RESEARCH funding , *WHITE people , *EDUCATIONAL attainment - Abstract
The Patient Activation Measure (PAM) assesses a person's level of knowledge, skills, and confidence to self-manage their day-to-day health. We conducted a mediation analysis to examine potential direct effects of race on significantly lower baseline PAM scores in Black than in White participants (p<0.001) who were a subset of 184 adults who participated in a randomized controlled trial. In the mediation analysis, using natural indirect effects, the continuous outcome was the PAM score. The mediators were income, education, ability to pay bills, and health literacy; race (Black or White) was the "exposure." The results indicate that income (p=0.025) and difficulty paying monthly bills (p=0.04) mediated the relationship between race and baseline PAM score, whereas health literacy (p=0.301) and education (p=0.436) did not. Researchers must further investigate the role of economic diversity as an underlying mechanism of patient activation and differences in outcomes. Clinical Trial Registration: Avoiding Health Disparities When Collecting Patient Contextual Data for Clinical Care and Pragmatic Research: NCT03766841 https://clinicaltrials.gov/ct2/show/NCT03766841?term=crotty&draw=2&rank=1 [ABSTRACT FROM AUTHOR]
- Published
- 2021
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