The Role of Cognition and Sociodemographics on Health Brokering Performance in a Diverse Adult Sample

Background: Health brokering is a phenomenon through which individuals assist their loved ones (usually older and/or with lower literacy levels) in understanding health-related subjects, or engaging with healthcare services, by acting as intermediaries and interpreters of information on their behalf. Health brokering may be associated with key demographic and clinical factors closely known to drive disparities in health care, serving as a mechanism for underserved communities to leverage shared knowledge and advocate for efficient health services. However, little is known about the predictors of successful health brokering; understanding the factors that enhance or limit health brokering performance may be key to contextualizing the health care experiences of diverse patients, particularly those at higher risk for chronic conditions. Objectives: The purpose of the study was to determine the relationship between health brokering performance (see Appendix A) and the following outcomes of interest: sociodemographic and cultural measures, health literacy, cognitive and physical functioning, and mental health. In addition, this study expanded the existing literature on health brokering by relying on a novel, performance-based health brokering measure in addition to existing self-report tools. Method: A total sample of 96 undergraduate students from the University of Houston and 48 community community-dwelling adults were recruited to participate in this study. Undergraduate students and community participants all completed a two-stage study consisting of an online survey and an in-person assessment. Correlation matrices were used to address Aim 1, while linear regression analyses were used to address the goals described in Aims 2 through 4. Results: Sociodemographic and cultural factors—such as socioeconomic status, family relationship quality, and alignment between individual and familial cultural identity—were modestly associated with performance on a novel health brokering task. Among health literacy measures, only eHealth literacy significantly predicted brokering performance, highlighting the relevance of digital navigation skills. Cognitive performance emerged as a robust predictor, particularly among younger participants, while physical and emotional health had limited explanatory power. In a hierarchical model, executive functioning accounted for the greatest proportion of variance in brokering performance, after controlling for demographic and psychosocial factors. Discussion: Findings suggest that health brokering is shaped by a combination of social positioning and individual cognitive abilities. The predictive value of eHealth literacy emphasizes the growing role of digital competencies in health navigation. Results highlighting cognition as a key predictor of brokering performance are consistent with the notion that brokering involves high-level processing and decision-making. Notably, differences across participant groups further suggest that life experience may moderate how these skills are deployed. Conclusion: Health brokering competence appears to stem from a complex interplay of cognitive, cultural, and relational factors. Digital and executive functioning skills, in particular, play a central role in effective brokering, while demographic and relational contexts shape the sociocultural experience of undertaking health brokering roles. These insights point to the value of supporting health brokers through institutional practices in order to meet the real-world demands of diverse patient populations.

Name thesis:degree_name

Doctor of Philosophy

Discipline thesis:degree_discipline

Clinical Psychology

Grantor

University of Houston

Year dc:date.issued

2025

Author dc:creator

• Ochoa Lopez, Andrea Pilar

Advisor dc:contributor.advisor

• Medina, Luis D.

Committee members dc:contributor.committeemember

• Woods, Steven P
• Torres, Isabel
• Neighbors, Clayton

• Psychology

Language dc:language.iso

English

Handle dc:identifier.uri

https://hdl.handle.net/10657/20760

OAI identifier oai:identifier

oai:uh-ir.tdl.org:10657/20760