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C19 20-205 – HSR&D Study

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C19 20-205
Veterans Experiences During the COVID-19 Pandemic
Angela Fagerlin PhD MA
Salt Lake City, UT
Funding Period: July 2020 - March 2021

BACKGROUND/RATIONALE:
COVID-19 continues to upend life across the globe. Currently, half the world's population have received stay-at-home orders to avoid contact with others in order to slow the spread of the coronavirus. In the U.S., federal guidelines to engage in physical distancing (originally referred to as social distancing) were initially
announced by the Trump administration on March 16th, and have been extended to at least April 30th. This marks an unprecedented national response to a pandemic that continues to have an untold effect on American's lives. Regrettably, adherence to stay-at-home orders is mixed, resulting in increased infections and deaths. Additionally, there is evidence of increased prevalence and deaths in areas with larger proportions of under-represented minorities and people with lower incomes. Apart from social and medical concerns, Veterans also deal with many mental and emotional challenges
post-deployment, making COVID-19-related stressors such as isolation and emotional coping especially difficult. Common challenges that Veterans face include: (1) interpersonal issues like adjusting to changed relationships and troublesome interactions; (2) psychological difficulties like anxiety, existential concerns, irritation and anger, depression and suicidal ideation, and posttraumatic symptoms; and (3)
physical/behavior problems like coping with physical injuries, sleep disturbances, substance misuse, readjusting to less structure, and risk-taking behaviors4. Following deployment, symptoms relating to Posttraumatic Stress Disorder (PTSD) may impact Veterans coping abilities. While we are currently overwhelmed by the mortality and morbidity of COVID-19, we will soon need to be addressing the impact of the pandemic on chronic illness and mental health. Addressing the difficulties that Veterans experience when confronted with the COVID-19 pandemic will assist us in identifying Veteran specific vulnerabilities and allow us to enhance care for this population over the duration of the pandemic and during possible future COVID-19 waves.

OBJECTIVE(S):
The objectives of this study are to: (1) identify challenges and facilitators of Veterans engaging in physical distancing during the COVID-19 pandemic, and their psycho-social predictors to understand Veteran needs during a 2nd COVID-19 wave, (2) identify Veterans' access to medical care within and outside of the VHA during the COVID-19 pandemic; specifically, their experience with telehealth and non-
COVID-19-related care, and (3) assess the impact of social isolation on loneliness and emotional coping during the COVID-19 pandemic

METHODS:
Research Design: This longitudinal study surveyed 1060 Veterans who have previously consented to receive surveys from Internet survey panels (via Qualtrics Survey). Participants completed 3 surveys, approximately one month apart. 746 Veterans completed the 2nd survey and 688 completed the 3rd and final survey.

Primary Outcome Measures: Primary outcome measures are (1) challenges and facilitators of physical distancing, (2) physical distancing behavior, (3) healthcare access, (4) telehealth experiences, and (5) mental health (e.g., loneliness, anxiety, depression, coping, substance abuse). Secondary Outcome Measures: Secondary outcome measures include (1) social support, (2) COVID-19 risk perceptions, (3) COVID-19 attitude toward government response, and (4) vaccination intentions.
Individual Difference Measures: Individual difference measures used as predictors of outcome variables include: (1) Standard demographics, (2) health literacy, (3) subjective numeracy, (4) General health, (5) self- reported comorbidity, (6) use of VA healthcare, (7) trust in healthcare and (8) trust in science.

FINDINGS/RESULTS:
We completed our data collection in March 2021. We have just begun to analyze the data. We have currently focused on two main evaluations of the data, as described below. Many additional analyses will be completed in the near future.

Vaccine Attitudes and Uptake

We found high levels of COVID-19 vaccine interest and uptake (following the EUAs and rollout in December 2020): 52% of Veterans in our sample had received 2 doses of a COVID-19 Vaccine, whereas as 23% had received 1 dose (25% hadn't received a vaccine yet). However, we also found that respondents had concerns about potential side effects from COVID-19 vaccines and about the vaccine development process. We tested a number of messaging strategies aiming to promote confidence and interest in COVID-19 vaccines, as well as providing reassurance about their safety, and the development process.

Successful strategies for messaging about COVID-19 vaccine side effects included focusing on the low likelihood of side effects, and framing post-vaccine symptoms as a good sign that the vaccine is working as well as messages acknowledging uncertainty about the efficacy of COVID-19 vaccines. Unfortunately, our messages about the vaccine development process and comparing the risks of COVID-19 to the risks from a COVID-19 vaccine were not successful at improving intentions to get vaccinated, getting vaccinated sooner, the perceived safety of COVID-19 vaccines, or worry about vaccine-related side effects.

We also found that adherence with recommended health behaviors (e.g., avoiding large gatherings and mask wearing in public) remained consistently high, even with respondents after they had received 1 or 2 doses of a COVID-19 vaccines.

Use of Telehealth
Nearly 50% of Veterans in our sample indicated they had used telehealth at least once during the COVID-19 pandemic. Preliminary results suggest being Black, having one or more comorbidities, and having insurance increased the likelihood of using telehealth. Midwesterners (p<0.001, OR 0.58) and Southerners (p=0.005, OR 0.69) were less likely to use telehealth.


IMPACT:
Impacts are not currently available, but will be shared with relevant stakeholders when data analysis is complete.

PUBLICATIONS:
None at this time.

DRA: Mental, Cognitive and Behavioral Disorders
DRE: None at this time.
Keywords: Outcomes - Patient, Socioeconomic Factors
MeSH Terms: None at this time.

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