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

信任差异：COVID-19 对少数族裔退伍军人医疗保健体验的影响

• 批准号: 10679392
• 负责人: SUSAN L. ZICKMUND
• 金额: --
• 依托单位: VA SALT LAKE CITY HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10679392
• 关键词: Address; African American; COVID-19 impact; Caring; Communities; Cultural Sensitivity; Data; Disparity; Ethnic Origin; Family; Fright; Future; Goals; Health; Health Disparities Research; Health Personnel; Healthcare; Healthcare Systems; Hearing; Human Resources; Individual; Intervention; Interview; K-Series Research Career Programs; Knowledge; Latinx; Latinx population; Learning; Measures; Medical; Medical Research; Methodology; Methods; Minority; Outcome; Parents; Pathway Analysis; Pathway interactions; Patient Self-Report; Patients; Persons; Positioning Attribute; Provider; Qualitative Methods; Race; Regimen; Research; Sampling; Scientist; Shapes; Social Network; Societies; Source; Structure; Subgroup; Surveys; System; Training; Trust; Veterans; Vulnerable Populations; Work; care seeking; cognitive interview; distrust; experience; health disparity; high risk; implementation strategy; improved; indexing; innovation; interest; intergenerational; marginalization; marginalized population; military veteran; novel; patient population; patient response; peer; perceived discrimination; response; transmission process; treatment adherence

Background: Patients who distrust their healthcare providers are less likely to seek care or comply with medical regimens, potentially exacerbating negative downstream impacts on overall health. Previous research on Veterans’ experiences of healthcare has found low trust and high perceived discrimination among Latinx Veterans. Nuances unique to Latinx populations have been understudied in the context of medical distrust. Given the demographic transformation of the US Armed Forces and increasing population of Latinx Veterans expected to seek VA care, it is important to better understand Latinx Veterans’ healthcare experiences and how those experiences may contribute to medical distrust. Significance/Impact: Research findings will provide evidence to support strategies for improved implementation of healthcare practices that are more sensitive to race and ethnicity and can reduce medical distrust and improve engagement with VA care by the already vulnerable, high-risk Latinx Veteran population. Innovation: While prior studies hint at factors contributing to medical distrust in patients overall, research has yet to investigate this phenomenon among Latinx patients specifically. We lack data that explores possible connections between medical distrust and specific health outcomes, and we need studies that comprehensively examine connections and contradictions between quantitative survey responses and qualitative interview remarks. This proposal’s conceptualization of medical distrust as central to our research question and mixed-methods approach makes the proposed study both novel and necessary. Specific Aims: Through this work we will better understand how medical distrust may influence health outcomes in Latinx Veterans, the extent to which knowledge and information about VA gained from social networks influences medical distrust, and Latinx Veterans’ definitions of medical distrust. Aim 1. Describe the association between medical distrust and health outcomes among Latinx patients. We will estimate the association between patient indication of medical distrust and self-reported health outcomes. Aim 2. Assess social network influence on medical distrust among Latinx Veterans. We will examine the extent to which positive and negative social network influence is associated with medical distrust by combining results from semi-structured interviews and quantitative close-ended surveys. Aim 3. Seek Latinx Veteran input on current measure of medical distrust and cultural sensitivity. We will also conduct semi-structured cognitive interviews with 25 Latinx Veterans participating in the parent study to learn patients’ perspectives on how medical distrust is currently measured. Methodology: Participating Veterans will complete a survey and semi-structured interview asking about their sources of medical distrust in 12 domains of health care. Findings from these surveys and interviews will be analyzed using quantitative methods (for close-ended survey responses) and qualitative methods (for open- ended responses from interviews (Aim 3)). A concurrent mixed-methods approach will also be employed to generate a more complete assessment of findings (Aims 1 & 2). Next Steps/Implementation: Study findings will inform a future VA Career Development Award proposal to develop strategies for implementation of healthcare practices that are more sensitive to race and ethnicity.

背景：不信任医疗保健提供者的患者不太可能寻求护理或遵守 医疗方案，有可能加剧下游对整体健康的负面影响。以前的研究 《关于退伍军人的医疗保健经历》发现拉美裔美国人信任度低，歧视程度高 退伍军人。在医疗不信任的背景下，拉丁裔群体特有的细微差别一直未得到充分研究。 鉴于美国武装部队的人口结构转型和拉丁裔退伍军人人数的增加 预计寻求退伍军人管理局护理，重要的是更好地了解Latinx退伍军人的医疗保健经验和 这些经历可能会如何导致医疗不信任。 意义/影响：研究结果将为支持改进战略提供证据 实施对种族和民族更敏感的医疗保健做法，可以减少医疗费用 不信任和改善已经脆弱的、高风险的拉丁裔退伍军人群体对退伍军人管理局护理的参与度。 创新：虽然先前的研究暗示了导致患者整体医疗不信任的因素，但研究已经 然而，还没有专门研究拉丁裔患者中的这种现象。我们缺乏探索可能性的数据 医疗不信任和特定健康结果之间的联系，我们需要研究 全面考察定量调查答复和调查结果之间的联系和矛盾 定性的采访评论。这项提议将医疗不信任概念化作为我们研究的中心 问题和混合方法使本研究具有新颖性和必要性。 具体目标：通过这项工作，我们将更好地了解医疗不信任如何影响健康 拉丁裔退伍军人的结果，关于退伍军人的知识和信息从社会中获得的程度 网络影响医疗不信任，以及拉丁裔退伍军人对医疗不信任的定义。 目的1.描述拉丁裔患者的医疗不信任与健康结局之间的关系。 我们将评估患者对医疗不信任的迹象与自我报告的健康状况之间的关系。 结果。 目的2.评估社会网络对拉丁裔退伍军人医疗不信任的影响。我们将研究 积极和消极的社会网络影响与医疗不信任的关联程度 半结构化访谈和定量封闭式调查的结果。 目的3.征求拉美裔老兵对当前医疗不信任和文化敏感性的意见。我们 还将对参与父母研究的25名Latinx退伍军人进行半结构化认知访谈 了解患者对目前如何衡量医疗不信任的看法。 方法：参与的退伍军人将完成一项调查和半结构化访谈，询问他们的 12个医疗保健领域的医疗不信任的来源。这些调查和访谈的结果将是 使用定量方法(针对封闭式调查答复)和定性方法(针对开放式调查答复)进行分析 结束访谈答复(目标3))。还将采用并行混合方法来 对调查结果进行更全面的评估(目标1和2)。 下一步/实施：研究结果将为未来退伍军人管理局职业发展奖提案提供参考 制定实施对种族和民族更加敏感的医疗保健做法的战略。