Which African American mothers disclose psychosocial issues to their pediatric providers?

Objective To determine if parents' self-efficacy in communicating with their child's pediatrician is associated with African American mothers' disclosure of psychosocial concerns during pediatric primary care visits. Methods Self-identified African American mothers (n = 231) of children 2 to 5 years were recruited from 8 urban pediatric primary care practices in the Washington, DC, metropolitan area. Visits were audiorecorded, and parents completed phone surveys within 24 hours. Maternal disclosure of psychosocial issues and self-efficacy in communicating with their child's provider were measured using the Roter Interactional Analysis System (RIAS) and the Perceived Efficacy in Patient-Physician Interactions (PEPPI), respectively. Results Thirty-two percent of mothers disclosed psychosocial issues. Mothers who disclosed were more likely to report maximum levels of self-efficacy in communicating with their child's provider compared to those who did not disclose (50% vs 35%; P =.02). During visits in which mothers disclosed psychosocial issues, providers were observed to provide more psychosocial information (mean 1.52 vs 1.08 utterances per minute, P =.002) and ask fewer medical questions (mean 1.76 vs 1.99 utterances per minute, P =.05) than during visits in which mothers did not disclose. The association between self-efficacy and disclosure was significant among low-income mothers (odds ratio 5.62, P <.01), but not higher-income mothers. Conclusions Findings suggest that efforts to increase parental self-efficacy in communicating with their child's pediatrician may increase parents' likelihood of disclosing psychosocial concerns. Such efforts may enhance rates of identifying and addressing psychosocial issues, particularly among lower-income African American patients.