Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, WI 53792, USA.
Patient Educ Couns. 2012 Jun;87(3):319-26. doi: 10.1016/j.pec.2011.09.012. Epub 2011 Nov 8.
To understand the association of race/ethnicity with engagement in pediatric primary care and examine how any racial/ethnic disparities are influenced by socioeconomic status.
Visit videos and parent surveys were obtained for 405 children who visited for respiratory infections. Family and physician engagement in key visit tasks (relationship building, information exchange, and decision making) were coded. Two parallel regression models adjusting for covariates and clustering by physician were constructed: (1) race/ethnicity only and (2) race/ethnicity with SES (education and income).
With and without adjustment for SES, physicians seeing Asian families spoke 24% fewer relationship building utterances, compared to physicians seeing White, non-Latino families (p<0.05). Latino families gathered 24% less information than White, non-Latino families (p<0.05), but accounting for SES mitigates this association. Similarly, African American families were significantly less likely to be actively engaged in decision making (OR=0.32; p<0.05), compared to White, non-Latino families, but adjusting for SES mitigated this association.
While engagement during pediatric visits differed by the family's race/ethnicity, many of these differences were eliminated by accounting for socioeconomic status.
Effective targeting and evaluation of interventions to reduce health disparities through improving engagement must extend beyond race/ethnicity to consider socioeconomic status more broadly.
了解种族/民族与参与儿科初级保健的关系，并研究社会经济地位如何影响任何种族/民族差异。
获取了 405 名因呼吸道感染就诊的儿童的就诊视频和家长调查。对家庭和医生在关键就诊任务（建立关系、信息交流和决策制定）中的参与情况进行了编码。构建了两个平行回归模型，分别调整了协变量和按医生聚类：（1）仅种族/民族和（2）种族/民族与 SES（教育和收入）。
无论是否调整 SES，与看到白人非拉丁裔家庭的医生相比，看到亚裔家庭的医生在建立关系方面的话语减少了 24%（p<0.05）。与白人非拉丁裔家庭相比，拉丁裔家庭收集的信息量减少了 24%（p<0.05），但考虑到 SES 可以减轻这种关联。同样，与白人非拉丁裔家庭相比，非裔美国家庭在决策制定方面的参与度显著降低（OR=0.32；p<0.05），但调整 SES 后这种关联有所减弱。
尽管儿科就诊期间的参与情况因家庭的种族/民族而异，但通过提高参与度来减少健康差异的干预措施的有效目标和评估必须超越种族/民族，更广泛地考虑社会经济地位。
要通过改善参与度来有效针对和评估减少健康差异的干预措施，必须超越种族/民族，更广泛地考虑社会经济地位。
