Kendrick B Gwynn1, Michael R Winter2, Howard J Cabral3, Michael S Wolf4, Amresh D Hanchate5, Lori Henault5, Katherine Waite5, Timothy W Bickmore6, Michael K Paasche-Orlow5. 1. Section of General Internal Medicine, Boston University School of Medicine, Boston, MA; Boston Medical Center, Boston, MA, USA. Electronic address: kgwynn@bu.edu. 2. Data Coordinating Center, Boston University School of Public Health, Boston, MA, USA. 3. Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA. 4. Center for Health Care Studies, Institute for Public Health and Medicine, Northwestern University, Chicago, IL, USA. 5. Section of General Internal Medicine, Boston University School of Medicine, Boston, MA; Boston Medical Center, Boston, MA, USA. 6. College of Computer and Information Science, Northeastern University, Boston, MA, USA.
Abstract
OBJECTIVE: The aim of this study was to use path analysis methods to determine if health literacy mediates the relationship between race and patient activation. METHODS: We performed a secondary analysis of data from a randomized controlled trial in elderly, urban, minority patients using path analysis. Path analysis was used to evaluate the mediation of race on patient activation through different variables. Several models were tested for best fit for their effects on patient activation. RESULTS: Across all models, significant mediation paths were identified from race to lower patient activation through health literacy. This relationship remained significant throughout alternative model testing for covariate combinations. The best-fit model included an indirect effect of sex on patient activation through health literacy indicating that the mediation effect of health literacy on patient activation was most profound for African American males. Health literacy had a bigger influence on patient activation for participants with a greater comorbidity than for those with fewer conditions. No significant direct effect was shown between race and patient activation in any of the models. CONCLUSION: Racial disparities in patient activation were fully mediated by health literacy skills. PRACTICE IMPLICATIONS: Future interventions to improve racial disparities in patient activation need to be targeted at improving health literacy.
RCT Entities:
OBJECTIVE: The aim of this study was to use path analysis methods to determine if health literacy mediates the relationship between race and patient activation. METHODS: We performed a secondary analysis of data from a randomized controlled trial in elderly, urban, minority patients using path analysis. Path analysis was used to evaluate the mediation of race on patient activation through different variables. Several models were tested for best fit for their effects on patient activation. RESULTS: Across all models, significant mediation paths were identified from race to lower patient activation through health literacy. This relationship remained significant throughout alternative model testing for covariate combinations. The best-fit model included an indirect effect of sex on patient activation through health literacy indicating that the mediation effect of health literacy on patient activation was most profound for African American males. Health literacy had a bigger influence on patient activation for participants with a greater comorbidity than for those with fewer conditions. No significant direct effect was shown between race and patient activation in any of the models. CONCLUSION: Racial disparities in patient activation were fully mediated by health literacy skills. PRACTICE IMPLICATIONS: Future interventions to improve racial disparities in patient activation need to be targeted at improving health literacy.
Authors: Katie Kiser; Daniel Jonas; Zachary Warner; Kelli Scanlon; Betsy Bryant Shilliday; Darren A DeWalt Journal: J Gen Intern Med Date: 2011-09-21 Impact factor: 5.128
Authors: Chandra Y Osborn; Kerri Cavanaugh; Kenneth A Wallston; Sunil Kripalani; Tom A Elasy; Russell L Rothman; Richard O White Journal: J Health Commun Date: 2011
Authors: Drenna Waldrop-Valverde; Chandra Y Osborn; Allan Rodriguez; Russell L Rothman; Mahendra Kumar; Deborah L Jones Journal: AIDS Behav Date: 2009-08-08
Authors: Namratha R Kandula; Phyllis A Nsiah-Kumi; Gregory Makoul; Josh Sager; Charles P Zei; Sara Glass; Quinn Stephens; David W Baker Journal: Patient Educ Couns Date: 2009-04-22
Authors: Sarah S Nouri; Laura J Damschroder; Maren K Olsen; Jennifer M Gierisch; Angela Fagerlin; Linda L Sanders; Felicia McCant; Eugene Z Oddone Journal: J Gen Intern Med Date: 2019-02-12 Impact factor: 5.128
Authors: Edward L Barnes; Millie D Long; Michael D Kappelman; Christopher F Martin; Robert S Sandler Journal: Inflamm Bowel Dis Date: 2019-06-18 Impact factor: 5.325
Authors: Phaedra Yamson; John Tetteh; Daniel DeGraft-Amoah; Henry Quansah; George Mensah; Richard Biritwum; Alfred Edwin Yawson Journal: Inquiry Date: 2021 Jan-Dec Impact factor: 1.730
Authors: Eunjeong Ko; Veronica Cardenas; María Luisa Zúñiga; Susan I Woodruff; Viviane Rodriguez; Helen Palomino Journal: Int J Environ Res Public Health Date: 2021-06-30 Impact factor: 3.390