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

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.

Memorable Messages about Pregnancy and Abortion from the Perspective of College-Enrolled Emerging Adults.

Emerging adults are the age group in the U.S. most likely to become pregnant, have a child, receive abortions, and be most supportive of legal abortion. To gain insight into these seemingly contradictory facts and attitudes, this study examines emerging adults' memorable messages about abortion and pregnancy to understand the beliefs, norms, values, and expectations circulating for younger adults. Ninety-two emerging adult college students provided memorable messages about both abortion and pregnancy. Utilizing thematic co-occurrence analysis, messages about pregnancy and abortion were characterized by three themes: political ideologies of sex, healthcare experience, and life-changing. Emerging adults described the messages as making them feel knowledgeable, empowered, and scared. Two theoretical relationships were identified: (1) pregnancy is connected to the political ideologies of sex with reactions of feeling empowered and scared and (2) abortion is connected to the politics of sex and the reactions of feeling knowledgeable and scared. Theoretical implications for the theory of memorable messages and practical applications for emerging adults are discussed.

Assessing the mediating role of disenfranchising talk on the well-being of female patients with chronic overlapping pain conditions.

OBJECTIVE: Disenfranchising talk (DT) occurs when health care providers discredit, silence, and stereotype patients. Although ample research has suggested associations among negative patient-provider interactions and poorer well-being, this study is the first to investigate the mediating role of patient-provider DT in exacerbating poorer pain-related health correlates. METHODS: Female patients living with chronic overlapping pain conditions (N = 348) completed a cross-sectional survey including measures of DT, pain severity, pain catastrophizing, and pain disability, as well as demographic information. Structural equation modeling in AMOS 29 assessed whether DT mediated the relationship between age, educational attainment, and sexual orientation (demographics), and pain severity, catastrophizing, and disability (pain-related health correlates). RESULTS: Structural equation modeling revealed that DT mediated the relationship between age, educational attainment, and sexual orientation on pain-related health correlates, such that younger and LGBQA+ patients and those with less educational attainment reported heightened pain severity, catastrophizing, and disability when they also reported DT. CONCLUSION: In contrast to scholarship assessing how demographics and pain-related variables influence patient-provider communication, this study instead investigated the mediating role of DT in pain-related health correlates. PRACTICE IMPLICATIONS: Providers should avoid discrediting, silencing, or stereotyping female chronic pain patients' pain to potentially avoid exacerbating pain-related health correlates.

A (In)curable Disease? Making Meaning of Addiction from the Perspective of People in Recovery from Opioid Use Disorder.

People in recovery for opioid use must navigate their chronic illness and the corresponding stigma. Despite the prevalence of opioid use in the United States, contradictory determinations about the curability and responsibility of addiction remain. These contractions provide a complicated site from which to examine power in a health context where misinformation can be costly. In this study, we applied contrapuntal analysis, the corresponding method of relational dialectics theory, to examine the meaning of addiction from the perspective of people in recovery for opioid use disorder. Findings revealed two discourses: the Discourse of Addiction as a Disruptive Choice (DADC) and the Discourse of Addiction as Bad Luck (DABL) that interplayed through contractive practices and synchronic interplay. Findings also revealed a new contractive practice we term "mobbing."

Identity (Re)constructions in Mothers' Online Stories about Terminating Wanted Pregnancies Due to Health Complications.

Women who have an abortion experience a major disruption to their identities in addition to being at a higher risk for deleterious health outcomes such as depression, anxiety, and suicidal behavior. These identity and health implications become even more complicated when a woman terminates a wanted pregnancy due to health complications. In the present study, we took an interpretive narrative approach to explore the identity (re)constructions of 33 women who terminated a wanted pregnancy due to fetal health complications. Narrative thematic analysis revealed five distinct identities: (a) the political mother, (b) the devastated mother, (c) the grieving but hopeful mother, (d), the self-sacrificing mother, and the (e) every mother. Implications for how these identity constructions can inform both theory and practice are discussed.