Disparities in Trust: COVID-19's Impact on Minority Veterans' Healthcare Experiences

Background: Patients who distrust their healthcare providers are less likely to seek care or comply with medical regimens, potentially exacerbating negative downstream impacts on overall health. Previous research on Veterans' experiences of healthcare has found low trust and high perceived discrimination among Latinx Veterans. Nuances unique to Latinx populations have been understudied in the context of medical distrust. Given the demographic transformation of the US Armed Forces and increasing population of Latinx Veterans expected to seek VA care, it is important to better understand Latinx Veterans' healthcare experiences and how those experiences may contribute to medical distrust. Significance/Impact: Research findings will provide evidence to support strategies for improved implementation of healthcare practices that are more sensitive to race and ethnicity and can reduce medical distrust and improve engagement with VA care by the already vulnerable, high-risk Latinx Veteran population. Innovation: While prior studies hint at factors contributing to medical distrust in patients overall, research has yet to investigate this phenomenon among Latinx patients specifically. We lack data that explores possible connections between medical distrust and specific health outcomes, and we need studies that comprehensively examine connections and contradictions between quantitative survey responses and qualitative interview remarks. This proposal's conceptualization of medical distrust as central to our research question and mixed-methods approach makes the proposed study both novel and necessary. Specific Aims: Through this work we will better understand how medical distrust may influence health outcomes in Latinx Veterans, the extent to which knowledge and information about VA gained from social networks influences medical distrust, and Latinx Veterans' definitions of medical distrust. Aim 1. Describe the association between medical distrust and health outcomes among Latinx patients. We will estimate the association between patient indication of medical distrust and self-reported health outcomes. Aim 2. Assess social network influence on medical distrust among Latinx Veterans. We will examine the extent to which positive and negative social network influence is associated with medical distrust by combining results from semi-structured interviews and quantitative close-ended surveys. Aim 3. Seek Latinx Veteran input on current measure of medical distrust and cultural sensitivity. We will also conduct semi-structured cognitive interviews with 25 Latinx Veterans participating in the parent study to learn patients' perspectives on how medical distrust is currently measured. Methodology: Participating Veterans will complete a survey and semi-structured interview asking about their sources of medical distrust in 12 domains of health care. Findings from these surveys and interviews will be analyzed using quantitative methods (for close-ended survey responses) and qualitative methods (for open- ended responses from interviews (Aim 3)). A concurrent mixed-methods approach will also be employed to generate a more complete assessment of findings (Aims 1 & 2). Next Steps/Implementation: Study findings will inform a future VA Career Development Award proposal to develop strategies for implementation of healthcare practices that are more sensitive to race and ethnicity.