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Health Expectations : An International Journal of Public Participation in Health Care and Health Policy logoLink to Health Expectations : An International Journal of Public Participation in Health Care and Health Policy
. 2019 Aug 9;22(5):1173–1184. doi: 10.1111/hex.12956

Socio‐economic differences in patient participation behaviours in doctor–patient interactions—A systematic mapping review of the literature

Sarah Allen 1,✉, Simon N Rogers 2,3, Rebecca V Harris 1
PMCID: PMC6803421  PMID: 31398772

Abstract

Background

The degree to which patients participate in their care can have a positive impact on health outcomes. This review aimed to map the current literature on patient participation behaviours in interactions with physicians and the extent to which differences in these behaviours can be explained by socio‐economic status (SES).

Search strategy

Four electronic databases were searched from 1980 onwards using key words related to socio‐economic status and patient participation behaviours.

Study selection

Titles, abstracts and full texts were screened by two reviewers, with the second reviewer screening 20% of all entries.

Data extraction

Data on year of publication, country, patient population, setting, patient participation behaviour studied, and SES measure used were extracted.

Main results

Forty‐nine studies were included in the review. Most studies were conducted in the United States, and the most commonly studied patient participation behaviour was involvement in decision making. Most studies measured SES using education as an indicator, with very few studies using occupation as a measure. Many studies did not report on participants’ medical condition or study setting. Patient participation in their health‐care appointment increased with increasing SES in 24 studies, although in 27 studies no significant association was found.

Discussion and conclusions

Current literature was found to be mainly US‐centric. Many studies did not specify participants’ medical condition or in what setting the study was undertaken. More studies are needed on less commonly studied patient participation behaviours. It would be helpful for further studies to also include a wider range of SES indicators.

Keywords: communication, Doctor–patient relationship, inequalities, patient participation, socio‐economic status

1. INTRODUCTION

Patient‐centred care has been associated with beneficial outcomes such as a greater adherence to treatment, satisfaction and improved quality of life.1, 2, 3, 4 The Institute of Medicine defines patient‐centred care as providing care that is respectful of and responsive to individual patient preferences, needs and values, ensuring that patient values guide all clinical decisions.5 Thus, the extent to which patients participate in discussions during their hospital or clinic visits is seen as an important barometer of patient‐centred care. Although there is no universally applied definition on what type of behaviours constitutes patient participation in clinical visits,6 most studies focusing on patient participation behaviours involve a range of behaviours such as question asking, raising concerns, and expressing opinions, preferences and emotions.7

Often ‘patient participation behaviours’ are described as a general group of behaviours that characterize doctor–patient communication, rather than describing in detail the different ways patient participation can be measured or other component parts of doctor–patient communication behaviour which are classified in a different way. For example, an important previous systematic review by Verlinde et al8 focused more globally on doctor–patient communication behaviours, with the electronic search terms based on ‘doctor–patient communication’ and ‘physician–patient relations’. The review reported evidence showing that a social gradient in doctor–patient communication exists and classified this according to the following classification: verbal behaviour including instrumental and affective behaviour, non‐verbal behaviour and patient‐centred behaviour. Although the review found that patients with low socio‐economic status (SES) tended to participate less actively in their care, the study and its search strategy were insufficiently sensitive to allow identification as to whether certain patient participation behaviours were more researched or more important than others, since the focus of the study was doctor–patient communication in general.

The Verlinde et al8 review also limited identification of literature exploring the social gradient in doctor–patient communication and social gradient, to studies reporting the ‘social class related concepts of’ educational level, income or occupation. Confusingly, three of the studies included in this review measured SES using ‘social class’, although the authors did not specify exactly how this was defined. However, there are several other indicators of SES which may also be associated with patient participation behaviours such as the patients’ health insurance status or receipt of benefits, and also area‐level measures of deprivation related to the patients’ home address (Indices of Multiple Deprivation), which may not have been captured previously, and may still be relevant.9 Bearing in mind the potential importance of this area and its likely relationship to beneficial health outcomes, we undertook a systematic mapping review to identify what research had been done which specifically examined how patient participation behaviours in doctor–patient interactions are related to differences in a wide range of possible measures of socio‐economic status.

We chose to conduct a systematic mapping review, as such reviews are useful for detecting patterns in a large body of literature in order to identify areas for future research. As such, details of the included studies are summarized without quality assessment or presenting statistical analyses.10, 11

2. PURPOSE

Our research question was as follows: How and why does tendency to and desire for patient participation behaviours in health‐care consultations with physicians vary according to SES and what measures of SES have been explored? For the purpose of this review, we defined patient participation behaviours as consisting of question asking, raising concerns, involvement in decision making, rapport building, and expression of opinions, preferences and emotions.

3. DATA SOURCES

An electronic search was undertaken of the following databases: Medline, CINAHL, PsychINFO and Web of Science. Literature was searched from 1980 to 2018; since prior to 1980, there was much less electronic indexing. A pilot search was conducted to identify potentially eligible papers, assess the amount of relevant literature in the field and identify suitable search terms. At this stage, we found that including screening appointments and emergency admissions made the scope of the review far too broad and unmanageable; therefore, we decided to introduce limits in the electronic search terms regarding ongoing doctor–patient relationships. The electronic search contained free text and subject headings including patient‐centred care, question asking, raising concerns, involvement in decision making, building rapport, expression of preferences, emotions or opinions, educational status, income, occupational status, employment, social class and socio‐economic factors. This was modified as necessary for each database and can be found in Appendix S1.

Inclusion criteria for the review were as follows:

  • Studies involving patient perspectives on actual and desired question asking, raising concerns, involvement in decision making, rapport building, or expression of opinions, preferences and emotions.

  • SES gradient measured in the form of education, income, occupation or ‘other measures’ which included patients’ health insurance status, income indicators of state benefits and area‐based measures relating to the patients’ home address.

  • Published in 1980 onwards.

  • Studies involving adult patients.

  • Only studies which focused on doctor–patient interactions.

  • Written in English language only.

Studies were excluded if:

  • They included only health‐care professional perspectives on patient participation.

  • Patients under 18 or parents of patients only were recruited.

  • Adult patient perspectives of childhood experiences were collected.

  • The study was conducted in a country on the OECDs Development Assistance Committee list of Official Development Assistance recipients.12 This was in order to limit literature to higher income countries where the health‐care systems were likely to be similar.

  • The appointment involved emergency attendances or screening.

  • The interactions were with health‐care professionals who were not medical doctors.

  • They were opinion articles.

  • They were systematic reviews.

4. STUDY SELECTION

One reviewer (SA) screened all titles and abstracts identified through electronic searches, and 20% of the entries were double screened by a second reviewer (DH). All full‐text articles were then screened by one reviewer (SA), and 20% of the full texts were double screened by a second reviewer (DH). If the two reviewers disagreed on any papers, this was resolved by discussion with two other independent reviewers (RH and SR).

5. DATA EXTRACTION

Data extraction was independently conducted by both reviewers and the following information was obtained: year published, country the study was conducted in, study method and design, population recruited, study setting, sample size, how SES is measured, what patient participation behaviours are reported and key results.

6. RESULTS

The title and abstracts of 4718 articles were imported into Endnote, and 368 duplicates were removed. This left 4350 entries, of which 3989 articles were excluded leaving 361 entries. After screening all 361 full‐text articles, the two reviewers disagreed on 11 papers. Following discussion, seven papers were excluded. After screening, 49 studies were included in the review. The PRISMA diagram can be found in Figure 1.

Figure 1.

Figure 1

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PRISMA diagram

Details of the characteristics of the 49 included studies can be found in Table 1. Overall, 39 (79.6%) of the included studies were published in the last 10 years, with only 10 being published before 2008. Most of the studies were conducted in the United States (46.9%), with the Netherlands being the second most common (10.2%). There were only three studies conducted in Australia, and only three conducted in the UK. ‘Other’ countries included Spain, Estonia, Germany, Norway and Finland (Figure 2).

Table 1.

Characteristics of included studies and reported direction of association between socio‐economic status and patient participation behaviours

Author Country   Study population Methods Number of participants Socio‐economic status (SES) measure Patient participation behaviours measured Direction of association
1. Aasen et al (2012)34 Norway   End‐stage renal disease patients Qualitative interviews 11 Education Involvement in decision making, question asking, and expression of opinions No statistical analyses performed
2. Ackermans et al (2018)35 The Netherlands   Patients with osteoarthritis of the hip or knee Questionnaire 142 Education and employment Involvement in decision making, and expression of opinions, preferences and emotions No associations
3. Adams et al (2001)26 Australia   Asthma patients Questionnaire 128 Income, education, employment, receipt of benefits, and housing situation Involvement in decision making Positive association with education only
4. AlHaqwi et al (2015)36 Saudi Arabia   Adult family practice patients Questionnaire 236 Education Involvement in decision making Positive association
5. Aro et al (2012)37 Estonia   Adult ICU patients Questionnaire 166 Education Involvement in decision making Negative association
6. Arora et al (2000)38 USA   Hypertension, diabetes, congestive heart failure, myocardial infarction and clinical depression patients Questionnaire 2197 Education, income and employment Involvement in decision making Positive association with education only
7. Attanasio et al (2015)39 USA   Women aged 18‐45 who gave birth in US hospitals Questionnaire 2400 Education and insurance Question asking Positive association for education
Negative association for insurance type
8. Beauchamp et al (2015)40 Australia   Patients attending chronic disease services Questionnaire 813 Insurance and education Involvement in decision making No associations
9. Bell et al (2001)15 USA   Patients reporting a new or worsening problem, or worries about serious illness Questionnaire 909 Education, employment, income and insurance Raising concerns No association for education and income only, other SES variables not analysed
10. Bozec et al (2016)23 France   Head and neck squamous cell carcinoma patients Questionnaire 200 Education and occupation Expression of preferences No associations
11. Chung et al (2012)41 USA   Patients admitted to a general internal medicine service Questionnaire 8308 Education Involvement in decision making and expression of preferences Positive association for involvement in decision making only
12. Cohen et al (2013)22 USA   Patients admitted to hospital for hematopoietic stem cell transplantation Longitudinal qualitative interviews 60 Education and occupation Involvement in decision making No statistical analyses performed
13. Dang et al (2017)21 USA   New patients attending a HIV clinic Longitudinal qualitative interviews 21 Occupation Question asking and involvement in decision making No statistical analyses performed
14. De las Cuevas et al (2014)42 Spain   Outpatient psychiatric patients Questionnaire 846 Education Involvement in decision making No associations
15. Deen et al (2011)13 USA   Community health centre patients Intervention‐ pilot study 252 Education Involvement in decision making No associations
16. Durand et al (2016)43 UK   Chronic kidney disease patients Questionnaire 492 Education Involvement in decision making No associations
17. Ellington et al (2006)44 USA   General population (some had cancer) Focus groups 55 Education and employment Involvement in decision making and expression of preferences No statistical analyses performed
18. Friis et al (2016) 16 Denmark   Patients with diabetes, cardiovascular disease, COPD, musculoskeletal disorders, cancer, or mental disorders Questionnaire 29,473 Education Question asking, raising concerns, and expression of opinions, preferences and emotions Positive associations
19. Garfield et al (2007)27 UK   Patients with type 2 diabetes or rheumatoid arthritis Questionnaire 516 Social class (composite measure) Involvement in decision making Positive associations
20. Gleason et al (2016)28 USA   Older adults with hypertension, arthritis, cholesterol, diabetes, cancer, heart disease or depression Questionnaire 277 Education, financial strain, and finances at the end of the month Involvement in decision making No significant associations
21. Henselmans et al (2015)45 The Netherlands   Patients diagnosed with a somatic chronic disease Questionnaire 1314 Education Involvement in decision making, question asking, and expression of opinions, preferences and emotions No significant associations
22. Jacobs‐Lawson et al (2009)46 USA   Lung cancer patients Questionnaire 100 Income and education Involvement in decision making and expression of preferences No significant associations for education only, income not entered into analysis
23. Janz et al (2004)17 USA   Breast cancer patients Questionnaire 101 Education, employment and income Involvement in decision making, question asking, raising concerns, and expression of opinions, preferences and emotions Positive association between education and involvement in decision making only
No significant associations for income and employment, and other participation behaviours not entered into analysis
24. Jonsdottir et al (2016) 47 Iceland   Patients who reported and consulted for chronic pain Questionnaire 754 Education and income Involvement in decision making No significant associations
25. Lu et al (2011)14 USA   Underserved women newly diagnosed with breast cancer Intervention‐ pilot study 231 Education Involvement in decision making, question asking, and raising concerns Positive association for question asking only
No significant associations for other variables
26. Lubetkin et al (2010)48 USA   Patients attending urban health centres Questionnaire 454 Education Involvement in decision making Positive association
27. Magnezi et al (2015)19 Israel   General population Questionnaire 508 Education and income Involvement in decision making, rapport building, and expression of preferences Negative associations for rapport building and expression of preferences only
Involvement in decision making not entered into analysis
28. Maly et al (2008)18 USA   Breast cancer patients Questionnaire 257 Education and income Question asking, raising concerns, involvement in decision making, and expression of opinions, preferences and emotions Positive associations
29. Manderbacka (2005)20 Finland   Coronary heart disease patients Qualitative interviews 30 Occupation and employment Involvement in decision making No statistical analyses performed
30. Mercer et al (2016)24 UK (Scotland)   Patients attending a GP practice Questionnaire 659 Scottish Indices of Multiple Deprivation Involvement in decision making Positive association
31. Moise et al (2017)49 USA   Patients with uncontrolled hypertension Questionnaire 195 Education and insurance Involvement in decision making Positive association for education only
32. Moret et al (2017)25 France   Gynaecology, orthopaedic, internal medicine, and emergency medicine hospital inpatients Questionnaire 255 Deprivation (EPICES score and perceived social status), education, and employment Involvement in decision making Positive association for deprivation only
Other variables not entered into analysis
33. Morishige et al (2017)50 Japan   Inflammatory bowel disease patients Questionnaire 1035 Income, education and employment Involvement in decision making No associations
34. Morrison et al (2003) 51 Australia   General population Questionnaire 1297 Education and income Involvement in decision making, and expression of preferences Negative associations
35. Murray et al (2007)52 USA   General population Questionnaire 3177 Education, income and insurance Involvement in decision making Positive associations for education and income only
36. Nijman et al (2014)53 The Netherlands   General population Questionnaire 1432 Education and income Involvement in decision making Positive associations
37. Olson et al (2010)54 USA   Hospital inpatients Questionnaire 89 Education and insurance Involvement in decision making No associations
38. Overgaard et al (2012)55 Denmark   Low risk women receiving midwifery unit or obstetric unit care Questionnaire 375 Education and employment Involvement in decision making No associations
39. Phipps et al (2008) 56 USA   African American cancer patients who received chemotherapy Questionnaire 26 Income and education Involvement in decision making No associations
40. Rademakers et al (2012)57 The Netherlands   Patients with rheumatoid arthritis, spinal disc herniation, or malignant or benign breast abnormalities Questionnaire 1019 Education Involvement in decision making and question asking Positive associations
41. Skolasky et al (2011)58 USA   Community dwelling multimorbid adults Questionnaire 855 Education and income Involvement in decision making Positive association for education only
42. Smith et al (2016)59 USA   General population Questionnaire 3400 Income and education Involvement in decision making Positive associations
43. Spies et al (2006)60 Germany   Patients attending a chronic pain clinic Questionnaire 341 Income, employment and education Involvement in decision making and question asking Positive associations for education only
44. Stepleman et al (2010)61 USA   Multiple sclerosis patients Questionnaire 199 Education and employment Involvement in decision making Positive associations
45. Tariman et al (2014)62 USA   Symptomatic myeloma patients Questionnaire 20 Employment, education, and income Involvement in decision making No associations
46. Tsimtsiou et al (2014)63 Greece   Hospitalized patients Questionnaire 454 Education and income Involvement in decision making and question asking Positive associations for education only Income not entered into analysis
47. van den Brink‐Muinen et al (2011)64 The Netherlands   Patients diagnosed with a somatic chronic disease Questionnaire 2423 Education Involvement in decision making No association
48. Yek et al (2017)65 Singapore   Patients attending a pre‐operative evaluation clinic for elective surgical procedures Questionnaire 364 Education, employment, insurance and income Involvement in decision making and question asking Positive associations for education, employment, and insurance only
Income not entered into analysis
49. Yeo (2016) 66 USA   General population Questionnaire 2297 Education, employment, income and insurance Involvement in decision making and question asking Negative associations for education and income only
Positive associations for insurance Employment not entered into analysis
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Figure 2.

Figure 2

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Countries the included studies were conducted in

The majority of studies used questionnaires to collect data (75.5%), with only five studies using qualitative techniques such as interviews or focus groups, and only two studies 13, 14 were interventions. Both interventions were pilot studies with no control group. The most commonly studied condition was cancer (20.4%), with four studies recruiting arthritis patients, and four studies with diabetes patients. Most studies did not specify what condition (if any) their participants had (36.7%). ‘Other’ conditions included asthma, chronic pain, HIV, multiple sclerosis and inflammatory bowel disease (Figure 3). None of the three UK studies recruited cancer patients.

Figure 3.

Figure 3

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Diagnoses of recruited participants

The most common setting for studies involved secondary or tertiary care (44.9%), with primary care being the setting in only 11 studies. Unfortunately, 16 studies did not specify which setting their research referred to when collecting data from participants. The most commonly studied patient participation behaviour was involvement in decision making (46 studies), whereas five studies examined raising concerns,14, 15, 16, 17, 18 and only one study looked at rapport building.19 Question asking and expression of opinions, preferences or emotions was more commonly studied, featuring in 13 and 12 studies, respectively. The rapport building study recruited participants from the general population and so there was a lack of studies which focused on rapport building which involved participants in a health setting. Three of the raising concerns studies were with breast cancer patients (Table 2).

Table 2.

Summary of SES variables and patient participation behaviours used in included studies

  Patient participation behaviours
Involvement in decision making Question asking Raising concerns Rapport building Expression of opinions, preferences or emotions
SES measure
Education 1, 2, 3, 4, 5, 6, 8, 11, 12, 14, 15, 16, 17, 20, 21, 22, 23, 24, 25, 26, 27, 28, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49 1, 7, 18, 21, 23, 25, 28, 40, 43, 46, 48, 49 9, 18, 23, 25, 28 27 1, 2, 10, 11, 17, 18, 21, 22, 23, 27, 28, 34
Employment 2, 3, 6, 17, 23, 29, 32, 33, 38, 43, 44, 45, 48, 49 23, 43, 48, 49 9, 23   2, 17, 23
Income 3, 6, 22, 23, 24, 27, 28, 33, 34, 35, 36, 39, 41, 42, 43, 45, 46, 48, 49 23, 28, 43, 46, 48, 49 9, 23, 28 27 22, 23, 27, 28, 34
Occupation 12, 13, 29 13     10
Insurance 8, 31, 35, 37, 48, 49 7, 48, 49 9    
Deprivation 30, 32        
Receipt of benefits 3        
Housing situation 3        
Social class 19        
Financial strain 20        
Finances at end of month 20        
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Each study in Table 1 was assigned a number, which corresponds with the numbers in this tab.

The most commonly used measure to explore relationships between patient participation behaviours and SES was educational level (45 studies). Only four studies used occupation as an indicator of SES,20, 21, 22, 23 and only two studies used a composite measure of deprivation.24, 25 One study measured housing situation and receipt of benefits,26 one used a composite measure of social class,27 and one looked at financial strain and finances at the end of the month.28 It is also important to note that many studies examined more than one type of patient participation behaviour or used more than one measure of SES. Most studies (33) used more than one measure of SES, whereas only 18 studies examined more than one type of patient participation behaviour (Table 2).

Table 1 shows the direction of associations reported in the included studies. Of the 49 included studies, 5 did not perform statistical analyses as they had employed qualitative methodologies. Positive associations between SES and patient participation behaviours (PPBs) were reported by 24 studies, while 5 studies reported negative associations. Twenty‐seven studies reported no association between at least some of their variables. Eleven studies reported associations of differing directions for different measures of SES or different PPBs within their study. Since the studies were so mixed in terms of design, participants’ condition, outcomes and setting, it was not appropriate to undertake any meta‐analyses.

Of the 23 studies conducted in the United States, 13 reported a positive association between SES and PPB, 2 reported a negative association, and 14 reported no association between at least some of their variables. Three studies did not perform statistical analyses, and 9 studies reported associations of differing directions for different measures of SES and PPB.

Of the 10 studies conducted with cancer patients, 4 reported a positive association between SES and PPB, 7 reported no association between at least some of their variables, and 2 reported associations of differing directions for different measures of SES and PPB. One study did not perform statistical analyses.

7. DISCUSSION

Although the goal of systematic review searches is to identify all relevant studies on a topic, it is necessary to balance comprehensively covering a topic (or sensitivity of a search) with how manageable it is within resources available.11 On the other hand, a wider search may reduce precision (identifying non‐relevant articles), which while more comprehensive, may be more difficult to summarize because types of studies may vary quite widely. Systematic mapping reviews help by a method to overview a larger area so that gaps to inform future research can be identified.10, 11

Our study shows that while an earlier systematic review exploring literature on the social gradient in doctor–patient communication had a relatively broad search strategy, this included only 20 papers,8 whereas our study focusing purely on patient participation behaviours and SES differences identified 49 studies. Although this may indicate an expanding area of research, this may also be because our study used a wider set of SES indicators than had been used previously. Our research is particularly informative because it focused in detail on the patient‐side of the clinical interactions, whereas other reviews have had a main focus on behaviours in the consultation.8, 29

We found that the most commonly used measure of SES in studies of this type was educational level, while measures of participants’ occupation have been much less frequently used. Income and employment status were not as commonly measured as educational level, although they were still used in some studies. Occupation is a key indicator of SES and likely to have an important influence on the doctor–patient relationship,30 and so it is surprising to find so few previous studies using this measure.

We found that the most frequently studied patient participation behaviour was involvement in decision making, whereas raising concerns and building rapport were comparatively relatively neglected. In contrast, Verlinde et al 8 found fewer studies on joint decision making and a larger number of studies involving other types of patient participation behaviours. Perhaps patient‐orientated communication studies have had more focus on decision‐making aspects of communication, whereas doctor‐orientated communication studies focus on other aspects of the relationship—or our more specific electronic search terms which included ‘decision making’, meant that we could better reflect the amount of research which has been undertaken in this field.

Although previous studies have found that rapport building in the doctor–patient relationship can have a number of positive outcomes, including treatment satisfaction, understanding health information, coping and adherence to treatment,1, 3, 31 only one study was identified which looked at how this behaviour was related to SES difference, and so further research in this area is particularly needed.

Most studies used more than one measure of SES which in some cases allowed a comparison of the effects of each different measure, although in some of these, not all the SES variables were entered into the analysis but were simply used to describe the sample. The objective of our study was to map the literature in this area rather than to produce a synthesis across several types of studies; however, we extracted data from included studies on whether a statistically significant association between SES and PPB had been reported. This indicated that although PPB was found to be related to SES in about half of the studies, in about half, they were not. Summarizing results are made more difficult by the heterogeneity which exists between studies in this area, and the range of different measures of SES and indicators of PPB which had been used. For example, although several studies showed an association with education and patient participation behaviours, as many as 17 studies found no statistically significant association between the two variables; and so the relationship is likely to be complex. On the other hand, few studies seem to have found a significant association between patient participation behaviours and employment or income. Larger and more sophisticated studies are needed, using a range of SES indicators and a more in‐depth description of patient participation behaviours, and the setting involved.

While the most common condition studied was cancer and the most common setting was secondary or tertiary care, 36.7% of studies did not specify what condition (if any) their participants were diagnosed with or what health‐care setting their questions regarding patient participation referred to. This is potentially important information which is missing from these studies, as setting and condition which the patient is consulting for can influence a patient's preferred and experienced level of participation in a consultation.7, 32, 33

Most studies included in the review were conducted in the United States, making the current research in this area very US‐centric. This may limit the generalizability of the results of these studies, as other countries have differently structured health‐care systems which might influence patient participation behaviours. There is a need for more studies on patient participation behaviours outside of the United States.

8. CONCLUSION

In conclusion, our findings suggest that most patient participation research relies on education as an indicator of SES and mainly explores involvement in decision making as the patient participation behaviour of interest. Most previous studies have been undertaken in the United States, but many lack important information on the setting or the patients’ condition. More studies on specific patient participation behaviours such as rapport building and raising concerns are needed, and other studies undertaken outside the United States. Use of a wider range of SES measures such as occupation, housing situation, receipt of benefits and household finances would be useful additional data.

CONFLICTS OF INTEREST

None.

Supporting information

 

Click here for additional data file. (14.9KB, docx)

ACKNOWLEDGEMENTS

The authors would like to acknowledge the work of Danielle Hewitt as second reviewer on this mapping review.

Allen S, Rogers SN, Harris RV. Socio‐economic differences in patient participation behaviours in doctor–patient interactions—A systematic mapping review of the literature. Health Expect. 2019;22:1173–1184. 10.1111/hex.12956

Funding information

This work was supported by The National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care North West Coast (NIHR CLAHRC NWC). Sarah Allen is a PhD student at the NIHR CLAHRC NWC. The views expressed are those of the author(s) and not necessarily those of the NHS, the NIHR or the Department of Health.

Data Availability Statement: Data sharing is not applicable to this article as no new data were created or analysed in this study.

DATA AVAILABILITY STATEMENT

Data sharing is not applicable to this article as no new data were created or analysed in this study.

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