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ECV 00-083 – HSR&D Study

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ECV 00-083
Determinants of VA Ambulatory Care Use Among Native American Veterans
Vallentine M. Villa PhD MA MS
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
West Los Angeles, CA
Funding Period: July 2001 - June 2003

BACKGROUND/RATIONALE:
While there are studies on the health and service use of Native Americans in general, there is a dearth of research on the health and ambulatory care use of the Native American veteran population. Existing studies have focused primarily on the prevalence and treatment of posttraumatic stress disorder (PTSD), and the use of traditional versus cultural health services. Native American veterans are thus the focus of the current study, which will enhance our understanding of health and access issues associated with VA ambulatory care use among this population.

OBJECTIVE(S):
This project draws upon experts in the Department of Veterans Affairs, the University of California, Los Angeles, and leaders of the Native American community to understand levels of ambulatory care use among Native American veterans. The primary goal of this study is to identify factors related to culture and veteran identity (extent to which an individual identifies with being a veteran) that significantly influence VA ambulatory care access and utilization among Native American veterans. Specific objectives are to: (a) identify how ambulatory care use by Native American veterans differs from non-Native American veterans; (b) identify sociodemographic, health-related, and military service predictors of ambulatory care use among Native American veterans; (c) understand how factors related to minority group status and veteran identity influence the use of ambulatory care services among Native American veterans; and (d) apply these findings to prescribe program and practitioner interventions to improve access of Native American veterans to ambulatory care services.

METHODS:
We conducted interviews with small groups of Native American veterans in urban and rural areas. The small group interviews were used to obtain detailed information related to Native American identity, veteran identity, military experience, cultural perceptions, and health services use. The information obtained in the small group interviews was incorporated into guidelines developed to improve access and utilization of VA outpatient clinics for all minority veterans.
Data Analysis: All focus groups were audiotaped. Audiotapes were transcribed verbatim and transferred into QSR Nudist software. Research investigators listened to all tapes and reviewed all transcripts and recorders’ notes. From this review, an independent summary was generated of the major conceptual domains. The initially identified content domains have been reviewed jointly, and a coding structure will be developed using the conceptual domain categories and subcategory specifications within each. The transcripts were transferred into QSR Nudist and coded independently by four research investigators by assigning keywords to groups of text. Content, consistency, and consensus of opinions were examined within and among ethnic groups. Content was grouped by code, with distinctions and similarities among groups identified. The research staff’s independent analysis of the focus-group transcripts generated the preliminary results detailed in the following section. The following broad content domains have been identified across the nine focus groups: Access to Health Services; Knowledge of Benefits; Health Problems; Use of Health Care - VA, IHS, non-VA Services; and Satisfaction with Care. The results were pooled so that neither specific sites nor individual participants can be identified.

FINDINGS/RESULTS:
Taken together, our findings reveal that Native American veterans have experienced problems in accessing care, receiving appropriate care, and coordinating care within the VA health care system. Lack of information regarding eligibility for services, lack of affordable transportation, costs, excessive wait times, paperwork, and delayed access to needed services have all contributed to difficulties for Native Americans seeking treatment at the VA. Adding to the lack of access is a lack of knowledge about what services and benefits are available. Many veterans reported not knowing what services exist, where services can be obtained, and whether they are eligible for those services. Native American veterans show high levels of diabetes, alcoholism, and PTSD, conditions that require ongoing medical management. Therefore, lack of access or delayed access to needed medical care has the potential to render an at-risk population vulnerable to myriad complications associated with these conditions.

IMPACT:
Findings from this study can guide the VA in developing outreach programs to successfully address the complex issues of both structural and cultural barriers to health care access for the Native American veteran population.

PUBLICATIONS:

Conference Presentations

  1. Bayhylle R, Reifel N, Louie J, Harada N. Information needs of Native American veterans. Paper presented at: Indian Health Service Research Annual Conference; 2003 May 30; Scottsdale, AZ.
  2. Reifel N, Bayhylle R, Harada N, Villa V. Native American veterans' choices for health care: VA or IHS? Paper presented at: Indian Health Service Research Annual Conference; 2003 May 30; Scottsdale, AZ.


DRA: Health Systems
DRE: Epidemiology
Keywords: Access, Ethnic/cultural, Primary care
MeSH Terms: Ethnic Groups

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