Wu Qiwei Luna, Kindratt Tiffany B, Brannon Grace Ellen
Department of Communication Studies, Texas Tech University, Lubbock, TX, USA.
Public Health Programs, Department of Kinesiology, University of Texas Arlington, Arlington, TX, USA.
J Patient Exp. 2024 Dec 26;11:23743735241310094. doi: 10.1177/23743735241310094. eCollection 2024.
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.
不同社会层面(如个人、家庭和社区)的结构性差异(如粮食不安全、住房和交通不便)是健康的重要决定因素,影响着全球个人和人群的福祉。关于临床沟通如何减轻社会差异对获得优质医疗保健的负面影响的研究很少。在本研究中,我们探讨了以患者为中心的沟通(PCC)在健康的社会决定因素(SDH)和医疗质量之间的中介作用。我们使用了来自第六次全国健康信息趋势调查(HINTS 6)的5437名在过去12个月内就诊过医疗服务提供者的成年人样本,我们的主要研究结果包括,模型显示PCC部分中介了从(a)“不吃饭”(效应=-0.08,95%置信区间=[-0.12,-0.04])、(b)“买不起饭菜”(效应=-0.08,95%置信区间=[-0.11,-0.05])、(c)“担心被驱逐”(效应=-0.1,95%置信区间=[-0.14,-0.06])和(d)“交通不便”(效应=-0.12,95%置信区间=[-0.16,-0.08])到医疗质量(QoC)的联系。具体而言,更好的沟通对调解差异有积极影响;沟通不畅则没有。在全国代表性样本中的研究结果表明,以患者为中心的临床沟通在有效缓解健康素养低和社会经济地位低的人群所面临的固有挑战方面发挥着关键作用。我们还讨论了理论和实践意义。