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Minority veterans' perception of VA healthcare: a view toward improvement

Washington DL, Damron-Rodriguez J, Villa VM, Ju H, Harada N. Minority veterans' perception of VA healthcare: a view toward improvement. Paper presented at: VA HSR&D National Meeting; 2000 Mar 1; Washington, DC.


Objectives: The goal of the Veteran Identity Program (VIP) is to understand how factors related to ethnicity and veteran identity influence utilization of ambulatory care and other healthcare services in the VA. Further, it seeks to identify how these factors vary across racial/ethnic groups and to apply these findings to prescribe program and practitioner interventions to improve access of minority veterans to ambulatory care. Methods: As part of a four year triangulated research design, the VIP project conducted 16 focus groups of users and non-users of the VA healthcare system (n = 178). The design included sampling by two major war cohorts (WWII and Vietnam) and by race/ethnicity (African-American, Asian, Caucasian and Hispanic). Focus groups were held at eight different community sites and facilitated by trained non-VA facilitators of the same racial/ethnic background as participants. Reasons that veterans use or do not use the VA, as well as suggestions for improvement, were assessed. Content analysis of transcriptions was performed using NUDIST, a qualitative software program. Facilitators and barriers to VA use were ranked and illustrative quotes were identified. Veterans' perception of their military experience was compared to their perception of VA healthcare. Findings: Racial/ethnic and war cohort differences were noted for both perceptions of VA healthcare and suggestions for improvement. Groups with higher positive evaluations of the military had higher assessments of VA healthcare. Caucasians and Asians of all war cohorts, and African-American Vietnam veterans were the most critical of the VA system. The top five barriers or reasons to not use the VA included: employees (including physicians), poor information regarding services, waiting time for and at appointments, denied access, and inconvenience. Illustrative statements include: 'The way we became Americans is being WWII veterans. So there's no reason why we've not been given ID cards. I hope you leave that on (the) record.' (Asian WWII veteran); 'The guys who did what it took to become disabled deserve the benefit. They're being told by people who have no idea what went on, 'so what, and we don't care.'' (Caucasian Vietnam veteran); 'I go to a private doctor. They're more accountable for what they do. At the VA you see doctors that are given to you…it wasn't my health that they were concerned about.' (African-American WWII veteran). A common theme in both positive and negative statements was the expectation that the VA should provide specific services that are veteran related, and in a manner that particularly acknowledges their veteran experience, and how it varies by background. Conclusions: Veterans' military and racial/ethnic experiences frame their perception of the VA healthcare system, and how negatively or positively they feel about using VA health care services. Impact Statements: This qualitative data will be used to frame questions for a survey of 3,200 veterans in VISN 22, in order to formulate interventions from the veteran's perspective for improved access. Customer service training which aims to increase provider and staff sensitivity to minority veteran's sense of identity based on their unique military experiences deserves examination as a strategy to increase access and satisfaction.

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