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Patient Educ Couns. 2013 Mar;90(3):392-8. doi: 10.1016/j.pec.2011.07.019. Epub 2011 Aug 19.

Patient reported interpersonal processes of care and perceived social position: the Diabetes Study of Northern California (DISTANCE).

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  • 1San Francisco General Hospital Division of General Internal Medicine, University of California, San Francisco, USA.



A patient's sense of his/her standing in the social hierarchy may impact interpersonal processes of care (IPC) within the patient-provider encounter. We investigated the association of perceived social position with patient-reported IPC.


We used survey data from the Diabetes Study of Northern California (DISTANCE), studying 11,105 insured patients with diabetes cared for in an integrated healthcare delivery system. Perceived social position was based on the MacArthur subjective social status ladder. Patient-reported IPC was based on a combined scale adapted from the Consumer Assessment of Health Plans Study provider communication subscale and the Trust in Physicians scale.


Lower perceived social position was associated with poorer reported IPC (p<0.001). The relationship remained statistically significant after controlling for age, sex, race/ethnicity, depressive symptoms, physical functioning, income and education.


Beyond objective measures of SES, patients' sense of where they fall in the social hierarchy may represent a pathway between social position and patient satisfaction with the quality of patient-provider communication in chronic disease.


Interventions to address disparities in communication in primary care should incorporate notions of patients' social position.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

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