Provider and patient influences on the formation of socioeconomic health behavior disparities among pregnant women

Abstract

Socially advantaged individuals are better positioned to benefit from advances in biomedicine, which frequently results in the emergence of social inequalities in health. I use survey and in-depth interviews with pregnant women and their health care providers from four Midwestern clinics in the United States, conducted in 2009 and 2010. I compare socioeconomic differences in intake of two new prenatal supplements: Vitamin D and omega-3 fatty acid. Although socioeconomic differences in omega-3 fatty acid supplementation emerged, there were no differences in the use of vitamin D. I argue that providers may have contributed to the prevention of a health disparity in vitamin D supplementation by implementing an aggressive uniform protocol. These results suggest that providers not only serve as a conduit for the dissemination of new biomedical information, the strength and uniformity of their recommendations have the potential to prevent or exacerbate socioeconomic differences in health behaviors.

Social networks and the emergence of health inequalities following a medical advance: Examining prenatal H1N1 vaccination decisions

“…In this light, using multiple methods, particularly ones that incorporate a qualitative approach that allows researchers to inquire directly about health decisions, provides a valuable perspective to understand how networks contribute to the ways social inequalities are generated and maintained. Triangulating interviews would further strengthen researchers' capacity to understand network processes -for example, interviews with a partner (Moen and Hernandez, 2009) or health-care providers (Hernandez, 2013). Second, future research on the role of network mechanisms in socioeconomic inequalities in health need to account for the fact that people do not weigh influence from others equally.…”

“…Understanding the persistence of socioeconomic inequalities in health requires that we examine the specific processes that generate them (Link and Phelan, 1995;Lutfey and Freese, 2005;Glied and Lleras-Muney, 2008;Chang and Lauderdale, 2009;Hernandez, 2013). These socioeconomic inequalities in health persist, in part, because people in socioeconomically advantageous positions possess the resources necessary to avoid newly identified health risks when medical research advances (Link et al, 1998).…”

Unequal interactions: Examining the role of patient-centered care in reducing inequitable diffusion of a medical innovation, the human papillomavirus (HPV) vaccine

“…One’s ability to adopt new practices is a function of flexible resources e knowledge, money, power, prestige, and beneficial social connections e that typically vary by race/ethnicity and SES (Link and Phelan, 1995). Consequently, many studies use fundamental cause theory to explain why more advantaged groups are first to adopt new health behaviors or medical procedures (Hernandez, 2013; Korda et al, 2011; Link, 2008) and why SES and racial/ethnic health disparities grow after drug and other treatment advances (Chang and Lauderdale, 2009; Glied and Lleras-muney, 2008).…”

“…Thus, studies of inequities in diffusion of new medical technologies have paid less attention to other actors’ agency, for instance, the role of healthcare professionals and their interactions with patients. For exceptions, see Freese and Lutfey’s (2011) discussion of fundamental causes’ effects at an institutional level and Hernandez’s (2013) study of how routine provider recommendations were associated with reduced SES disparities in use of prenatal supplements. Additionally, it is difficult to measure when individuals’ resources are leveraged, so researchers rely on racial/ethnic and SES disparities (and their trends) as evidence that fundamental causes are at play, which obscures potential causal pathways (Mackenbach, 2012; Miech et al, 2011).…”

Towards a sociology of risk work: A narrative review and synthesis

“…Translating risk is a fundamentally social process, and different methods of implementing interventions may have unintended consequences for who those access them. For instance, Hernandez () compared uniform and tailored application of recommendations for supplements in pregnancy, finding that the former resulted in fewer social disparities in uptake.…”