Motivating providers to reduce racial disparities in their own practice

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DESCRIPTION (provided by applicant): Anticipated Impacts on Veterans Healthcare. Our long-term goal is to eliminate the provider contribution to racial disparities in access to and quality of care. The work proposed in this stud is an essential step in pursuit of that goal, as it is expected to result in knowledge about how to increase provider readiness to engage in actions to reduce healthcare disparities. Project deliverables are aimed at motivating providers to participate in programs designed to raise awareness and build skills to reduce healthcare disparities. Project deliverables include: 1) tailored narratives customized according to different healthcare inequality beliefs (for use in educational approaches, such as web-based training, where individually tailored training through branching is technically possible); 2) untailored narratives designed to enhance motivation for all providers, regardless of underlying beliefs (for use in situations where tailorig is not possible, such as Grand Round presentations) and 3) a communication toolkit, cataloging communication and intervention strategies to reduce disparities. Background. Racial disparities have been documented extensively both within and outside the Veteran Affairs healthcare system across a wide range of clinical areas and service types. Although a number of factors have been shown to contribute to disparities, including site of care, recent reports have concluded that healthcare providers likely contribute to a portion of these disparities. There is broad consensus that increasing the ability of clinicians and other healthcare employees to address disparities is a critical part of eliminating disparities, and there has been a surge of training activities and programs in response. What is missing, however, are empirically-based communication strategies for getting providers motivated to reduce disparities, particularly the sizable number that do not believe that providers contribute to racial differences in healthcare quality and who, due to a larger system of beliefs, might be resistant to messages about their own potential to contribute to disparities. This gap is a significant impediment to the successful implementation of disparities-reduction training programs aimed at providers, as motivation has been shown to be a critical piece of behavior change. Objectives. Aim 1 is to conduct semi-structured interviews with two groups of providers, stratified by whether they attribute healthcare inequalities more to factors internal or external to patients, to explore provider responses to narratives that vary in the extent to which external causes of healthcare disparities are emphasized. Aims 2a and 2b are to use a factorial experiment to test the hypothesis that narratives that are congruent with providers' beliefs about the cause of racial differences in healthcare quality will be most effective at increasing (2a) providers' readiness to take action to reduce disparities and (2b) providers' participation in one of two online "disparities reduction" training programs. Aim 2c is to identify the narrative type that leads to the highest level of participation in disparities-reduction training across all providers. Methods. Aim 1 will be addressed through a qualitative study (Phase 1) consisting of individual interviews with providers from 3 VA facilities (N = 60). Providers will be preselected based on their beliefs ascertained through a brief mixed-mode survey (intranet survey with mail follow-up) containing a screening question assessing providers' attributions of healthcare inequality and the interviews will be stratified into those two groups based on their responses to that screening question. Interviews will be transcribed and analyzed. This survey will also contain items that will be used to validate the screening question. For Aim 2 we will conduct a factorial experiment (intranet survey with mail follow-up), where VA providers will complete the screening question, read one of 2 types of narratives, learn about actions providers can take to reduce disparities, complete a measure assessing readiness to take action to reduce disparities, and receive an invitation to participate in disparities- reduction training programs. Participation will be assessed with a follow-up survey a month after completion of the initial survey.