Veterans' Perceptions of VA Healthcare by Race and Sex

BACKGROUND:
Equitable healthcare is a major tenet of VA’s mission; however, disparities persist in health and care due to non-clinical differences such as race and sex. Therefore, understanding Veterans’ experience within the VA healthcare system is an essential part of VA’s plan to advance health equity. Investigators in this qualitative study focused on examining how Veterans’ perceptions of VA healthcare – and suggestions for change – may differ by race and sex. Investigators used a technique called freelisting – an anthropologic method that elicits responses in list form. Participants were first asked a question, then, in response, were asked to list all words and comments that first came to mind. The length of individual lists, item order in those lists, and item frequency across lists were used to calculate a salience score for each item. This allowed for a comparison of salient words and topics within and across different groups. Veterans were asked about their current perceptions of VA care, challenges over the past year, virtual care, and experiences (if any) of racism. They were also asked for any suggestions for change. This study was conducted in one urban VAMC from August 2, 2021 to February 9, 2022. Investigators assessed data from 49 Veterans with a diagnosis of chronic hypertension, comparing responses by race (24 Black and 25 White) and sex (24 men and 25 women).

FINDINGS:

• Overall, there were differences in the perceived quality of interactions within the VA healthcare system by race and sex, with more positive experiences more likely to be reported by Veterans of White race and male sex.
• Some positive responses were salient across race and sex, including “good medical care” and telehealth as a “comfortable/great option,” as were some negative items, including “long waits/delays in getting care” and “transportation/traffic challenges.”
• Associations of VA with anxiety, stress, and fear were salient for all groups. However, it is unclear whether these were responses to extraordinary circumstances during the pandemic or were more deeply rooted experiences with VA care.
• Courteous and respect were salient for White but not Black Veterans – and men but not women.
• While telehealth was seen as a good option, the perception of technology problems differed by race (reported by Black Veterans) and sex (reported by men), suggesting a digital divide.

IMPLICATIONS:

• Divergent experiences of interpersonal care by race and sex provide insights for improving equitable, patient-centered VA healthcare.

LIMITATIONS:

• This study was limited to a single VA medical center and only included Veterans enrolled and receiving VA medical services for a particular condition (hypertension).

AUTHOR/FUNDING INFORMATION:
This study was supported by HSR, and Dr. Keddem is supported by an HSR Career Development Award (CDA). Drs. Keddem, Sorrentino, Jenkins, and Long are part of HSR’s Center for Health Equity Research and Promotion (CHERP).

Lee N, Keddem S, Sorrentino A, Jenkins K, and Long J. Health Equity in the Veterans Health Administration from Veterans’ Perspectives by Race and Sex. JAMA Network Open. February 19, 2024;7(2)e2356600.