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Racial Disparities in Patient Activation: The Role of Economic Diversity. West J Nurs Res 2021 06;43(6):517-529



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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

Author List

Holt JM, Winn A, Cusatis R, Talsma A, Crotty BH


Bradley H. Crotty MD Associate Professor in the Medicine department at Medical College of Wisconsin
Rachel N. Cusatis PhD Assistant Professor in the Medicine department at Medical College of Wisconsin
Aaron Winn PhD Assistant Professor in the School of Pharmacy Administration department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Educational Status
Health Literacy
Patient Participation