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

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，可能加剧对整体健康的负面下游影响。以前的研究 退伍军人的医疗保健经验发现，拉丁裔之间的信任度低，歧视感高 老兵在医学不信任的背景下，拉丁裔人群特有的细微差别一直没有得到充分研究。 鉴于美国武装部队的人口结构转型和拉丁裔退伍军人的人口增加， 预计寻求VA护理，重要的是要更好地了解拉丁裔退伍军人的医疗保健经验， 这些经历如何导致对医疗的不信任 重要性/影响：研究结果将提供证据，以支持改善 实施对种族和民族更加敏感的医疗保健做法， 不信任和改善已经脆弱的，高风险的拉丁裔退伍军人群体与VA护理的接触。 创新：虽然先前的研究暗示了导致患者对医疗不信任的因素，但研究表明， 还没有专门在拉丁裔患者中调查这种现象。我们缺乏数据来探索 医疗不信任与特定健康结果之间的联系，我们需要研究， 全面审查定量调查答复之间的联系和矛盾， 定性访谈评论。这项建议的概念化的医疗不信任的核心，我们的研究 问题和混合方法的方法使得所提出的研究既新颖又必要。 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，在多大程度上知识和信息VA获得社会 网络影响医疗不信任，和拉丁美洲退伍军人的医疗不信任的定义。 目标1。描述Latinx患者之间的医疗不信任和健康结果之间的关联。 我们将评估患者对医疗不信任的表现与自我报告的健康状况之间的关联 结果。 目标二。评估社交网络对拉丁裔退伍军人医疗不信任的影响。我们会研究 积极和消极的社会网络影响与医疗不信任的程度， 半结构化访谈和定量封闭式调查的结果。 目标3。寻求拉丁美洲退伍军人对医疗不信任和文化敏感性的当前措施的投入。我们 我还将对25名参加父母研究的拉丁裔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来源。这些调查和访谈的结果将 使用定量方法（封闭式调查答复）和定性方法（开放式调查答复）进行分析， 结束访谈的答复（目标3）。还将采用并行混合方法， 对调查结果进行更全面的评估（目标1和2）。 下一步/实施：研究结果将为未来的VA职业发展奖提案提供信息， 制定战略，实施对种族和族裔更加敏感的保健做法。

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.