Racial Disparities in Patient Activation: The Role of Economic Diversity

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

Status and factors associated with patient activation and its relationship with HIV clinic outcomes among Yi minority people living with HIV in Liangshan, China: a cross-sectional study

“…We found that lower personal monthly income, self-rated method of ART effect based on self-perception and higher illness perception score were associated with a lower PAM score. It is not surprising that lower personal monthly income is a risk factor for a low PAM score, which is consistent with the findings reported in previous studies that the income levels of participants are related to patient activation (29)(30)(31). Participants with a lower income might spend less money and exert less effort on health maintenance (31), resulting in a low PAM score; they may also adopt more passive behavior toward the management of their health.…”

A codesigned integrated kidney and diabetes model of care improves patient activation among patients from culturally and linguistically diverse backgrounds

“…A previous study among elderly minority patients 39 reported that the relationship between African American race and lower patient activation was fully mediated by health literacy. Another study among patients who attended primary care clinics reported lower activation scores among Black participants but suggested that the relationship between race and activation could be mediated by income 40 . Unfortunately, in our study, we did not collect health literacy and income data to confirm this finding.…”

“…Another study among patients who attended primary care clinics reported lower activation scores among Black participants but suggested that the relationship between race and activation could be mediated by income. 40 Unfortunately, in our study, we did not collect health literacy and income data to confirm this finding. Second, when interpreting our results, it is important to consider that even though the PAM has been used across multiple racial, ethnic and language groups, 41 it is unknown if the contextual components of PAM are race or culturally specific.…”

“…Another study among patients who attended primary care clinics reported lower activation scores among Black participants but suggested that the relationship between race and activation could be mediated by income. 40 Unfortunately, in our study, we did not collect health literacy and income data to confirm this finding.…”

Factors associated with patient activation among individuals with depression within racial/ethnic groups in the United States

“…Patients with higher activation are more likely to have a usual source of care, more likely to get preventive care, less likely to delay getting care ( Hibbard & Cunningham, 2008 ), and have better health outcomes ( Greene & Hibbard, 2012 ). Several studies have found lower patient activation in Black/African American individuals than in White individuals ( Eliacin et al, 2018 , Gwynn et al, 2016 , Hibbard et al, 2008 , Holt et al, 2021 ), leading to consideration of whether targeting improvements in patient activation among racial minorities could lead to reducing disparities in health outcomes.…”