Disparities in Trust: COVID-19's Impact on Minority Veterans' Healthcare Experiences

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Background: Patients’ trust in their healthcare system has a profound impact on their health and well-being and, as 1 of 4 overall key goals set by the Secretary of the Department of Veteran Affairs (VA), is a high priority for VA. Our previous research found lower levels of trust and higher perceived discrimination amongst Black and Latinx Veterans obtaining VA medical care compared to White Veterans. Considering the disproportionate impact of the pandemic on minority communities and the overlap between racial and digital divides, it is important to better understand the negative healthcare experiences of Black and Latinx Veterans in the aftermath of COVID-19. This information will be critical to improve care through targeted recommendations. Significance/Impact: Considering the disproportionate impact of COVID-19 on minority Veterans, the potential differential effects of a radically transformed healthcare environment, and the need to implement widespread vaccination and booster programs, our proposal focuses on an important VA priority. Our proposed research is highly responsive to the call to ensure the VA meets its strategic goal of inspiring Veterans to trust the healthcare system, as well as to HSR&D’s priority for actionable health equity research. VA also recognizes the importance of understanding the source of racial/ethnic disparities in trust with VA medical care in order to develop targeted recommendations to improve minority trust with VA health care. Innovativeness: The proposed Disparities In Care Experiences (DICE) study uses a novel mixed methods design that integrates the insights and richness of qualitative data collection with the precision of quantitative data analysis. DICE will be able to traverse from detection, to understanding, to forming the basis for interventions using Veterans’ own recommendations. Specific Aim 1. To examine the associations between Veterans’ race/ethnicity and their trust in the VA by conducting the DICE quantitative telephone survey with 1,050 Black, Latinx, and White male and female Veterans from 25 VA Medical Centers who used VA outpatient or telehealth services, or had care deferred. Specific Aim 2. To explore Veterans’ experiences contributing to trust in the VA by adding open -ended qualitative questions to the DICE quantitative telephone surveys for a subset of 150 male and female Veterans from our Aim 1 sample and to elicit actionable recommendations for improving Black and Latinx trust in VA. Specific Aim 3. Using the Aim 1 survey results and the Aim 2 Veteran recommendations, we will work with our operational partners and a key vendor to develop and disseminate a toolkit and training to empower VA stakeholders to improve the healthcare system to engender trust amongst Black and Latinx Veterans. Methodology: Using racial/ethnic stratification we will survey 1,050 Veterans at 25 VA medical centers on their experience of trust in VA. One hundred and fifty Veterans will also be asked open-ended questions about sources of trust/distrust across 12 domains of health care. We will use survey and qualitative methods to analyze the data from Aims 1 and 2, respectively. A toolkit development group will examine the Veteran recommendations and using a modified Delphi approach will create a toolkit designed to improve Black and Latinx Veterans’ trust in VA. Implementation/Next steps: We will partner with the Office of Health Equity, the Veteran Experience Office, the office of Analytics and Performance Integration, and vendor Dynamic Integration Services to ensure that the VA is thoroughly trained and responsive to the recommendations resulting from this work.