{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T16:37:39Z","timestamp":1792427859247,"version":"4.5.0"},"reference-count":76,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T00:00:00Z","timestamp":1745798400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Adults from low-income backgrounds who smoke face significant health disparities related to tobacco use, often at disproportionately high rates. These individuals are more likely to endure multiple mental and physical (MP) health conditions, which can negatively influence their self-rated health (SRH). The quality and effectiveness of patient-clinician communication (PCC) can influence how patients perceive their own health. Understanding how PCC influences SRH among low-income adults who smoke and suffer from multiple MP conditions is essential for clinical care as multimorbidity is on the rise. This study examines how PCC may influence the health perceptions of low-income adults who smoke and have varying MP conditions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Low-income adults who smoke (<jats:italic>N<\/jats:italic>\u202f=\u202f58) were recruited from the San Francisco Health Network (SFHN) and were assessed for number of MP conditions, PCC, and SRH. A moderation analysis was performed to examine whether PCC moderated relations between MP conditions and SRH. Follow-up analyses were conducted to examine differences and relationships among variables. In planned exploratory analysis, all possible choices for moderator-independent-dependent-variable selections to explore the best model fit were conducted.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The results revealed that PCC moderated the association between MP conditions (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.05) and SRH. In follow-up analyses, number of MP conditions predicted poorer SRH for low-income smokers who experienced low (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.001) and average (<jats:italic>p<\/jats:italic>\u202f&amp;lt;\u202f0.01) levels of PPC but not high levels of PCC. In planned exploratory analysis, based on the Akaike Information Criterion, a quantitative basis for considering SRH as the dependent variable was established.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The intersection of tobacco-related disparities among low-income adults who smoke and manage multiple MP conditions is complex. Among this vulnerable population, poor and average PCC adversely influences how patients perceive their own health. Results highlight the importance of quality and effective communication between patients and providers. A culturally informed patient-centered approach to care may improve PCC as it encourages collaborative, individually tailored treatment that empowers patients to actively participate in their own health care.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2025.1567725","type":"journal-article","created":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T05:29:30Z","timestamp":1745818170000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["The dialogue dilemma: the role of patient-clinician communication for low-income people who smoke and manage multiple conditions"],"prefix":"10.3389","volume":"12","author":[{"given":"Monique T.","family":"Cano","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael R.","family":"Lindstrom","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo F.","family":"Mu\u00f1oz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2025,4,28]]},"reference":[{"key":"ref1","volume-title":"The health consequences of smoking\u201450 years of Progress: a report of the surgeon general [internet]","year":"2014"},{"key":"ref2","first-page":"135","volume-title":"WHO report on the global tobacco epidemic, 2017: Monitoring tobacco use and prevention policies [internet]","year":"2017"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"E107","DOI":"10.5888\/pcd17.200090","article-title":"How much Progress have we made? Trends in disparities in tobacco use","volume":"17","author":"Kingsbury","year":"2020","journal-title":"Prev Chronic Dis"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"285","DOI":"10.1093\/ntr\/ntab193","article-title":"Tobacco-related disparities viewed through the Lens of intersectionality","volume":"24","author":"Sheffer","year":"2021","journal-title":"Nicotine Tob Res"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1","DOI":"10.18332\/tid\/138241","article-title":"Factors associated with smoking in low-income persons with and without chronic illness","volume":"19","author":"Cano","year":"2021","journal-title":"Tob Induc Dis"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"53","DOI":"10.15585\/mmwr.mm6702a1","article-title":"Current cigarette smoking among adults \u2014 United States, 2016","volume":"67","author":"Jamal","year":"2018","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"1637","DOI":"10.1016\/S0140-6736(18)30941-3","article-title":"Making more of multimorbidity: an emerging priority","volume":"391","year":"2018","journal-title":"Lancet"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1038\/s41572-022-00376-4","article-title":"Multimorbidity","volume":"8","author":"Skou","year":"2022","journal-title":"Nat Rev Dis Primers"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e42","DOI":"10.1016\/S2468-2667(19)30226-9","article-title":"Social inequalities in multimorbidity, frailty, disability, and transitions to mortality: a 24-year follow-up of the Whitehall II cohort study","volume":"5","author":"Dugravot","year":"2020","journal-title":"Lancet Public Health"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"232","DOI":"10.1136\/jech-2020-214691","article-title":"Household and area-level social determinants of multimorbidity: a systematic review","volume":"75","author":"Ingram","year":"2021","journal-title":"J Epidemiol Community Health"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12916-019-1474-7","article-title":"Lifestyle factors and risk of multimorbidity of cancer and cardiometabolic diseases: a multinational cohort study","volume":"18","author":"Freisling","year":"2020","journal-title":"BMC Med"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"152","DOI":"10.1186\/s12916-017-0913-6","article-title":"The contribution of risk factors to socioeconomic inequalities in multimorbidity across the lifecourse: a longitudinal analysis of the Twenty-07 cohort","volume":"15","author":"Katikireddi","year":"2017","journal-title":"BMC Med"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"106260","DOI":"10.1016\/j.ypmed.2020.106260","article-title":"Leading determinants for multimorbidity in middle-aged Australian men and women: a nine-year follow-up cohort study","volume":"141","author":"Shang","year":"2020","journal-title":"Prev Med"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"977","DOI":"10.1093\/poq\/nfw033","article-title":"Research in and prospects for the measurement of health using self-rated health","volume":"80","author":"Garbarski","year":"2016","journal-title":"Public Opin Q"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.socscimed.2011.10.030","article-title":"Whiners and deniers \u2013 what does self-rated health measure?","volume":"75","author":"Layes","year":"2012","journal-title":"Soc Sci Med"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1234","DOI":"10.1111\/j.1475-6773.2005.00404.x","article-title":"Predicting mortality and healthcare utilization with a single question","volume":"40","author":"DeSalvo","year":"2005","journal-title":"Health Serv Res"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"21","DOI":"10.2307\/2955359","article-title":"Self-rated health and mortality: a review of twenty-seven community studies","volume":"38","author":"Idler","year":"1997","journal-title":"J Health Soc Behav"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"1515","DOI":"10.3390\/healthcare9111515","article-title":"Factors contributing to poor self-rated health in older adults with lower income","volume":"9","author":"Byun","year":"2021","journal-title":"Healthcare (Basel)"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"565","DOI":"10.1136\/jech-2016-207589","article-title":"Explaining socioeconomic inequalities in self-rated health: a systematic review of the relative contribution of material, psychosocial and behavioural factors","volume":"71","author":"Moor","year":"2017","journal-title":"J Epidemiol Community Health"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"b4471","DOI":"10.1136\/bmj.b4471","article-title":"Income inequality, mortality, and self rated health: meta-analysis of multilevel studies","volume":"339","author":"Kondo","year":"2009","journal-title":"BMJ"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1016\/S0140-6736(05)71146-6","article-title":"Social determinants of health inequalities","volume":"365","author":"Marmot","year":"2005","journal-title":"Lancet"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"96","DOI":"10.1016\/j.addbeh.2014.10.031","article-title":"Substance-use coping and self-rated health among US middle-aged and older adults","volume":"42","author":"Mauro","year":"2015","journal-title":"Addict Behav"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"106911","DOI":"10.1016\/j.ypmed.2021.106911","article-title":"Clustering of unhealthy lifestyle behaviors, self-rated health and disability","volume":"155","author":"Ortiz","year":"2022","journal-title":"Prev Med"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"e328","DOI":"10.1093\/pubmed\/fdy012","article-title":"Physical activity buffers the negative relationship between multimorbidity, self-rated health and life satisfaction","volume":"40","author":"Marques","year":"2018","journal-title":"J Public Health"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"100903","DOI":"10.1016\/j.arr.2019.04.005","article-title":"Multimorbidity and quality of life: systematic literature review and meta-analysis","volume":"53","author":"Makovski","year":"2019","journal-title":"Ageing Res Rev"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1111\/nhs.12585","article-title":"Effects of chronic diseases on health-related quality of life and self-rated health among three adult age groups","volume":"21","author":"Ge","year":"2019","journal-title":"Nurs Health Sci"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"1659","DOI":"10.1177\/13591053211001419","article-title":"Self-rated health and multimorbidity in patients with type 2 diabetes","volume":"27","author":"Umeh","year":"2022","journal-title":"J Health Psychol"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"2186","DOI":"10.1016\/j.pec.2018.08.021","article-title":"Communicating with diverse patients: how patient and clinician factors affect disparities","volume":"101","author":"P\u00e9rez-Stable","year":"2018","journal-title":"Patient Educ Couns"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"147","DOI":"10.1016\/j.socscimed.2013.07.026","article-title":"The evolving concept of \u201cpatient-centeredness\u201d in patient-physician communication research","volume":"96","author":"Ishikawa","year":"2013","journal-title":"Soc Sci Med"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"e019943","DOI":"10.1161\/JAHA.120.019943","article-title":"Association between patient-clinician relationships and adherence to antihypertensive medications among black adults: an observational study design","volume":"10","author":"Chang","year":"2021","journal-title":"J Am Heart Assoc"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1450","DOI":"10.1177\/2374373519895680","article-title":"Patient-provider relationships among vulnerable patients: the association with health literacy, continuity of care, and self-rated health","volume":"7","author":"Kamimura","year":"2020","journal-title":"J Patient Exp"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"144","DOI":"10.1016\/j.pec.2014.10.019","article-title":"Health communication, self-care, and treatment satisfaction among low-income diabetes patients in a public health setting","volume":"98","author":"White","year":"2015","journal-title":"Patient Educ Couns"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"114856","DOI":"10.1016\/j.socscimed.2022.114856","article-title":"Medicine, structural racism, and systems","volume":"298","author":"Aaron","year":"2022","journal-title":"Soc Sci Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"350","DOI":"10.1177\/00221465211032947","article-title":"Structural intersectionality as a new direction for health disparities research","volume":"62","author":"Homan","year":"2021","journal-title":"J Health Soc Behav"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"291","DOI":"10.1016\/j.pec.2011.11.013","article-title":"Factors affecting frequency of communication about family health history with family members and doctors in a medically underserved population","volume":"88","author":"Kaphingst","year":"2012","journal-title":"Patient Educ Couns"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"364","DOI":"10.3390\/healthcare12030364","article-title":"The impact of limited English proficiency on healthcare access and outcomes in the U.S.: a scoping review","volume":"12","author":"Twersky","year":"2024","journal-title":"Healthcare (Basel)"},{"key":"ref37","doi-asserted-by":"publisher","first-page":"e0267782","DOI":"10.1371\/journal.pone.0267782","article-title":"Challenges and solutions in communication with patients with low health literacy: perspectives of healthcare providers","volume":"17","author":"Murugesu","year":"2022","journal-title":"PLoS One"},{"key":"ref38","doi-asserted-by":"publisher","first-page":"e194","DOI":"10.3928\/24748307-20210529-01","article-title":"Health literacy, primary care health care providers, and communication","volume":"5","author":"Mor-Anavy","year":"2021","journal-title":"Health Lit Res Pract"},{"key":"ref39","first-page":"101","article-title":"Health literacy and physician-patient communication: a review of the literature","volume":"10","author":"Sim","year":"2016","journal-title":"Int J Commun Health"},{"key":"ref40","doi-asserted-by":"publisher","first-page":"1635","DOI":"10.2147\/PPA.S145942","article-title":"Healthcare provider relational quality is associated with better self-management and less treatment burden in people with multiple chronic conditions","volume":"11","author":"Eton","year":"2017","journal-title":"Patient Prefer Adherence"},{"key":"ref41","doi-asserted-by":"publisher","first-page":"4189","DOI":"10.1007\/s11606-022-07533-1","article-title":"My goals are not their goals: barriers and facilitators to delivery of patient-centered Care for Patients with multimorbidity","volume":"37","author":"Schuttner","year":"2022","journal-title":"J Gen Intern Med"},{"key":"ref42","doi-asserted-by":"publisher","first-page":"741","DOI":"10.1007\/s10900-015-0148-4","article-title":"Healthcare communication barriers and self-rated health in older Chinese American immigrants","volume":"41","author":"Tsoh","year":"2016","journal-title":"J Community Health"},{"key":"ref43","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1016\/j.pec.2013.02.008","article-title":"Effect of information seeking and avoidance behavior on self-rated health status among cancer survivors","volume":"92","author":"Jung","year":"2013","journal-title":"Patient Educ Couns"},{"key":"ref44","doi-asserted-by":"publisher","first-page":"1360","DOI":"10.1016\/j.pec.2015.06.011","article-title":"Disclosure of complementary health approaches among low income and racially diverse safety net patients with diabetes","volume":"98","author":"Chao","year":"2015","journal-title":"Patient Educ Couns"},{"key":"ref45","doi-asserted-by":"publisher","first-page":"1947","DOI":"10.1016\/j.pec.2016.06.025","article-title":"Does physician communication style impact patient report of decision quality for breast cancer treatment?","volume":"99","author":"Martinez","year":"2016","journal-title":"Patient Educ Couns"},{"key":"ref46","doi-asserted-by":"publisher","first-page":"2093","DOI":"10.1007\/s00520-015-3014-0","article-title":"Association between patient-provider communication and lung Cancer stigma","volume":"24","author":"Shen","year":"2016","journal-title":"Support Care Cancer"},{"key":"ref47","volume-title":"Who is low income and very low income in the Bay Area? (an updated look)","author":"Fukumori","year":"2023"},{"key":"ref48","doi-asserted-by":"publisher","first-page":"1092","DOI":"10.1001\/archinte.166.10.1092","article-title":"A brief measure for assessing generalized anxiety disorder: the GAD-7","volume":"166","author":"Spitzer","year":"2006","journal-title":"Arch Intern Med"},{"key":"ref49","doi-asserted-by":"publisher","first-page":"606","DOI":"10.1046\/j.1525-1497.2001.016009606.x","article-title":"The PHQ-9","volume":"16","author":"Kroenke","year":"2001","journal-title":"J Gen Intern Med"},{"key":"ref50","doi-asserted-by":"publisher","first-page":"47","DOI":"10.1192\/bjp.bp.116.189027","article-title":"Impact of long-term medical conditions on the outcomes of psychological therapy for depression and anxiety","volume":"210","author":"Delgadillo","year":"2017","journal-title":"Br J Psychiatry"},{"key":"ref51","doi-asserted-by":"publisher","first-page":"1119","DOI":"10.1111\/j.1360-0443.1991.tb01879.x","article-title":"The Fagerstrom test for nicotine dependence: a revision of the Fagerstrom tolerance questionnaire","volume":"86","author":"Heatherton","year":"1991","journal-title":"Addiction"},{"key":"ref52","doi-asserted-by":"publisher","first-page":"214","DOI":"10.1186\/s12888-016-0929-z","article-title":"Associations between lifetime potentially traumatic events and chronic physical conditions in the south African stress and health survey: a cross-sectional study","volume":"16","author":"Atwoli","year":"2016","journal-title":"BMC Psychiatry"},{"key":"ref53","doi-asserted-by":"publisher","first-page":"1246","DOI":"10.1111\/j.1532-5415.2011.03483.x","article-title":"Vulnerability of older Latino and Asian immigrants with limited English proficiency","volume":"59","author":"Kim","year":"2011","journal-title":"J Am Geriatr Soc"},{"key":"ref54","doi-asserted-by":"crossref","DOI":"10.4135\/9781452232966","volume-title":"Outcome measures for health education and other health care interventions","author":"Lorig","year":"1996"},{"key":"ref55","doi-asserted-by":"publisher","first-page":"1149","DOI":"10.3758\/BRM.41.4.1149","article-title":"Statistical power analyses using G*power 3.1: tests for correlation and regression analyses","volume":"41","author":"Faul","year":"2009","journal-title":"Behav Res Methods"},{"key":"ref56","volume-title":"Introduction to mediation, moderation, and conditional process analysis: A regression-based approach","author":"Hayes","year":"2017"},{"key":"ref57","doi-asserted-by":"publisher","first-page":"e49","DOI":"10.1017\/SJP.2021.46","article-title":"Mediation, moderation, and conditional process analysis: concepts, computations, and some common confusions","volume":"24","author":"Igartua","year":"2021","journal-title":"Span J Psychol"},{"key":"ref58","doi-asserted-by":"publisher","first-page":"111","DOI":"10.1016\/j.idm.2019.12.010","article-title":"A primer on model selection using the Akaike information criterion","volume":"5","author":"Portet","year":"2020","journal-title":"Infect Dis Model"},{"key":"ref59","doi-asserted-by":"publisher","first-page":"357","DOI":"10.1038\/s41586-020-2649-2","article-title":"Array programming with NumPy","volume":"585","author":"Harris","year":"2020","journal-title":"Nature"},{"key":"ref60","doi-asserted-by":"publisher","first-page":"261","DOI":"10.1038\/s41592-019-0686-2","article-title":"SciPy 1.0: fundamental algorithms for scientific computing in Python","volume":"17","author":"Virtanen","year":"2020","journal-title":"Nat Methods"},{"key":"ref61","doi-asserted-by":"publisher","first-page":"e94207","DOI":"10.1371\/journal.pone.0094207","article-title":"The influence of the patient-clinician relationship on healthcare outcomes: a systematic review and Meta-analysis of randomized controlled trials","volume":"9","author":"Kelley","year":"2014","journal-title":"PLoS One"},{"key":"ref62","doi-asserted-by":"publisher","first-page":"60","DOI":"10.1186\/s12913-020-4901-8","article-title":"Communication skills training for physicians improves health literacy and medical outcomes among patients with hypertension: a randomized controlled trial","volume":"20","author":"Tavakoly Sany","year":"2020","journal-title":"BMC Health Serv Res"},{"key":"ref63","doi-asserted-by":"publisher","first-page":"628","DOI":"10.1378\/chest.09-2328","article-title":"Patient-clinician communication","volume":"138","author":"Slatore","year":"2010","journal-title":"Chest"},{"key":"ref64","doi-asserted-by":"publisher","first-page":"1678","DOI":"10.1111\/jan.16492","article-title":"The influence of patient\u2013provider communication on self-management among patients with chronic illness: a systematic mixed studies review","volume":"81","author":"Iroegbu","year":"2025","journal-title":"J Adv Nurs"},{"key":"ref65","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1016\/j.pec.2004.02.011","article-title":"Socio-economic status of the patient and doctor-patient communication: does it make a difference?","volume":"56","author":"Willems","year":"2005","journal-title":"Patient Educ Couns"},{"key":"ref66","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1177\/0001699316670715","article-title":"The educational gradient in self-rated health in Europe: does the doctor\u2013patient relationship make a difference?","volume":"60","author":"Pr\u00e4g","year":"2017","journal-title":"Acta Sociol"},{"key":"ref67","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1111\/hex.12640","article-title":"How to practice person-centred care: a conceptual framework","volume":"21","author":"Santana","year":"2018","journal-title":"Health Expect"},{"key":"ref68","doi-asserted-by":"publisher","first-page":"193","DOI":"10.1097\/ACM.0b013e31802d94b2","article-title":"Can patient-centered attitudes reduce racial and ethnic disparities in care?","volume":"82","author":"Beach","year":"2007","journal-title":"Acad Med"},{"key":"ref69","doi-asserted-by":"publisher","first-page":"548","DOI":"10.1111\/j.1365-2753.2007.00914.x","article-title":"Patient-centredness, self-rated health, and patient empowerment: should providers spend more time communicating with their patients?","volume":"14","author":"Rohrer","year":"2008","journal-title":"J Eval Clin Pract"},{"key":"ref70","doi-asserted-by":"publisher","first-page":"1247","DOI":"10.1016\/j.pec.2017.02.016","article-title":"Promoting patient participation in healthcare interactions through communication skills training: a systematic review","volume":"100","author":"D\u2019Agostino","year":"2017","journal-title":"Patient Educ Couns"},{"key":"ref71","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1200\/JCO.2012.44.2699","article-title":"Consultations between patients with breast cancer and surgeons: a pathway from patient-centered communication to reduced hopelessness","volume":"31","author":"Robinson","year":"2013","journal-title":"J Clin Oncol"},{"key":"ref72","doi-asserted-by":"publisher","first-page":"1296","DOI":"10.1176\/ps.62.11.pss6211_1296","article-title":"A web-based program to empower patients who have schizophrenia to discuss quality of care with mental health providers","volume":"62","author":"Steinwachs","year":"2011","journal-title":"Psychiatr Serv"},{"key":"ref73","doi-asserted-by":"publisher","first-page":"19","DOI":"10.1080\/10410236.2014.943633","article-title":"Breast-cancer patients\u2019 participation behavior and coping during presurgical consultations: a pilot study","volume":"30","author":"Venetis","year":"2015","journal-title":"Health Commun"},{"key":"ref74","doi-asserted-by":"publisher","first-page":"510","DOI":"10.1007\/s11606-017-4265-x","article-title":"The effectiveness of self-management interventions for individuals with low health literacy and\/or low income: a descriptive systematic review","volume":"33","author":"Schaffler","year":"2018","journal-title":"J Gen Intern Med"},{"key":"ref75","doi-asserted-by":"publisher","first-page":"30","DOI":"10.1002\/nop2.382","article-title":"Promoting self-efficacy in patients with chronic disease beyond traditional education: a literature review","volume":"7","author":"Farley","year":"2020","journal-title":"Nurs Open"},{"key":"ref76","volume-title":"Motivational interviewing: helping people change and grow [internet]","author":"Miller","year":"2023"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1567725\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,4,28]],"date-time":"2025-04-28T05:29:34Z","timestamp":1745818174000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2025.1567725\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,4,28]]},"references-count":76,"alternative-id":["10.3389\/fmed.2025.1567725"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2025.1567725","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,4,28]]},"article-number":"1567725"}}