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Veteran identity and race/ethnicity: Influences on VA outpatient care utilization

Harada ND, Villa V, Washington D, Dhanani S, Makinodan T. Veteran identity and race/ethnicity: Influences on VA outpatient care utilization. Paper presented at: VA HSR&D National Meeting; 2002 Feb 1; Washington, DC.


Objectives: (1) To explore veteran identity and how it varies by race/ethnicity, and (2) to identify aspects of veteran identity that significantly influence preferences for, and use of, VA outpatient care. 'Veteran identity' is a new concept, which we define as veterans' self-concept that derives from his/her military experience within a sociohistorical context. Methods: Focus groups were conducted at community sites to explore concepts related to veteran identity, race/ethnicity, military experience, and health services use. The focus groups informed the development of a telephone survey, which was administered to 3,227 veterans of four racial/ethnic groups in the VISN 22, covering Southern California and Southern Nevada. The theoretical framework guiding the study was the Behavioral Model of Health Care Utilization. Dependent variables include: (1) preference for VA health services, (2) VA-only outpatient use, and (3) number of outpatient visits within the previous 12 months. Independent variables include sociodemographic, health status, and veteran identity characteristics. Bivariate statistics were conducted to determine associations of veteran identity characteristics and race/ethnicity. Logistic regression was used to determine the influence of veteran identity characteristics on preferences for, and use of, VA outpatient care. Results: Veteran identity variables were significantly associated with race/ethnicity. Veterans who were members of veterans' organizations (OR = 2.3), and who reported that being a veteran influenced their daily lives (OR = 2.1), were more than twice as likely to prefer VA health services to non-VA healthcare. Black and Hispanic veterans were more likely than White veterans to prefer the VA for outpatient care (OR = 2.6 and 2.4, respectively). Controlling for veteran identity, sociodemographic, and health status characteristics, Black veterans were more likely to be a VA outpatient user than White veterans (OR = 2.6). Veterans who were members of veterans' organizations were twice as likely to use VA outpatient care than non-members (OR = 1.97). Conclusions: Race/ethnicity and veteran identity factors significantly influence use of VA outpatient care. Impact statement: Veterans who highly identify with their veteran status may prefer the VA for healthcare, suggesting a wider pool of veterans who would use the VA than is currently served by the VA system. Further studies should investigate the appropriateness of, and reasons for, racial/ethnic differences in use of outpatient care.

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