Disenfranchising Talk Mediates the Relationship Between Social Determinants of Health and Wellbeing Outcomes for Women of Color Patients with Autoimmune Disease

Abstract

Autoimmune disease disproportionately afflicts women of color (i.e., Black/African American, Hispanic/Latina, Multiethnic-racial) of childbearing age. Social determinants of health (SDOH) and dismissive healthcare provider (HCP) interactions exacerbate these disparities in health outcomes for women of color with autoimmune disease. Guided by the theory of communicative (dis)enfranchisement, this study assesses whether disenfranchising talk (DT) mediates the relationship between SDOH (i.e., race/ethnicity, insurance status, income, employment, education, and sexual orientation) and health outcomes including patient satisfaction, overall well-being, and tangible social support for women of color with autoimmune disease. Findings affirmed the mediating role of DT, such that Multiethnic-racial patients and those with less insurance coverage and lower household income reported less tangible social support, poorer overall well-being, and lower patient satisfaction when they experienced HCP DT. We offer theoretical and practical implications.