Abstracts

Rationale: A number of studies provide evidence that minorities and low-income people with epilepsy receive different amounts and types of healthcare compared to non-minority, upper-income populations. The need to understand the reasons for disparities is important to advocates and policy makers seeking to eliminate inequalities in epilepsy care. The focus of the project is on two questions. 1) Are there disparities in self-management behavior and associated psycho-social factors between patient populations of different socio-economic status (SES)? 2) Does the relationship between psychosocial factors and self-management vary by SES? Answers to such questions are needed to help inform program administrators, clinicians, and policy makers of the nature of disparities that exist among people living with epilepsy and the potential impact of strategies to reduce or eliminate them. Methods: We systematically recruited patients from a public hospital clinic in Houston, Texas that serves a predominantly low-income, minority, uninsured population, and a private free-standing clinic that serves a more balanced racial/ethnic and higher socioeconomic status population that is mostly insured. The patients at each site completed a questionnaire on self-management behavior and a number of related psycho-social factors including self-efficacy, knowledge, depression, social support, satisfaction, stigma, desire for control, and outcome expectations. Bivariate statistics were derived comparing differences by site in self-management and psycho-social characteristics of patients. Multivariate models were estimated to examine the relative importance of SES in the relationship between self-management and the psycho-social factors adjusted for demographic and clinical characteristics. Results: The average scores on overall self-management and the self-management sub-scales of information management and safety management were higher for the low-SES group compared to the high-SES group (per item average on a 5-point scale, 3.75 vs 3.63, p<.03). There was no difference found for medication management, seizure management, and lifestyle management. The scale scores for the various psycho-social factors were all significantly different between the groups (p<.01). However, two of the factors, self-efficacy and social support, were strongly associated with self-management in both patient groups (Pearson coefficients .43 and .31 for self-efficacy, and .30 and .20 for social support). In a multivariate model, we found that these two factors remained strongly associated with self-management (p<.05) after controlling for demographic and seizure frequency characteristics of the patients. Conclusions: The self-management behavior of low-SES patients is equal to or greater than that of low-SES patients. There is a strong association between self-efficacy, social support, and self-management. The relationship was not significantly affected by SES differences between the groups suggesting that similar strategies to improve self-management may be applicable across diverse populations.