Mental health disparities and communication among African-American Veterans

非裔美国退伍军人的心理健康差异和沟通

• 批准号: 8784837
• 负责人: JOHANNE ELIACIN
• 金额: --
• 依托单位: RLR VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-10-01 至 2015-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8784837
• 关键词: Address; Affect; African American; Area; Attitude; Characteristics; Client satisfaction; Clinical Nurse Specialists; Code; Communication; Country; Data; Decision Aid; Decision Making; Effectiveness; Evaluation; Freedom; Future; Goals; Health; Health Care Costs; Health Communication; Health Personnel; Healthcare; Healthcare Systems; Intervention; Interview; Lead; Measures; Mediator of activation protein; Medical center; Mental Health; Mental Health Services; Mental disorders; Methods; Minority; Minority Groups; Modeling; Nurse Practitioners; Outcome; Outpatients; Participant; Patient Participation; Patient Self-Report; Patient-Centered Care; Patients; Pharmaceutical Preparations; Population; Process; Provider; Psychiatric therapeutic procedure; Psychiatrist; Quality of Care; Recovery; Reporting; Research; Strategic Planning; Veterans; Work; comparative; cost; design; ethnic minority population; evidence base; experience; health care quality; health disparity; improved; intervention program; physical conditioning; preference; racial and ethnic; research study; shared decision making; theories; therapy design; therapy development

DESCRIPTION (provided by applicant): Recent reviews of health disparities in the VA healthcare system showed that significant racial disparities persist across all sections in the VA, which affect health care costs, quality of care, patient satisfaction, and the health of veterans. Patient-provider communication has been identified as one of the key mediators for racial health disparities in physical and mental health. Yet, the views and experiences of ethnic minority veterans regarding health communications, especially in mental health, remain understudied. The lack of research in this area perpetuates a critical gap in our understanding of how ethnic minority groups understand and experience treatment decision-making. It also limits the VA's efforts to provide quality and culturally competent mental health services to ethnic minority groups, a fast growing veteran population. This study seeks to investigate the processes, facilitators, and barriers to mental health treatment decisions for African-American veterans with the goals of informing future efforts to improve mental health communication and reduce health disparities in the VA. The specific aims of the revised study are fourfold. In Aim 1, we will examine how African-Americans describe their understanding and process of mental health treatment decisions; and assess their preferred methods for making these decisions, which may or may not include shared decision- making. In Aim 2, we will specifically investigate how African American veterans with mental illness define and conceptualize shared decision-making as a model of decision making. In Aim 3, we will use mixed methods to compare how decisions are made among White (data from a previous study) and African American veterans with mental illness. In Aim 4, we will develop preliminary models for an intervention aimed at improving shared decision-making and reducing mental health disparities among African-American veterans. To accomplish Aim 1 of the study, we will conduct qualitative interviews with 45 African- American veterans receiving outpatient psychiatric care at the Richard L. Roudebush VAMC. The interviews will focus on participants' views, experiences, and preferences for treatment decisions with their psychiatric treatment providers (prescribers: psychiatrists and nurse practitioners). To achieve Aim 2, the qualitative interview will include questions that explore participants' conceptualization of shared decision-making. To complete Aim 3, participants will complete self-report measures that assess patient-provider working alliance, attitudes towards medication, and activation. The quantitative data will help to triangulate our findings by providing systematic information on factors that affect patient provider relationship and communication. We will also compare our findings to a previous study on shared decision-making with 41 White veterans and their psychiatric treatment providers (Marianne Matthias, PI). In Aim 4, we will collect preliminary data from the interviews to inform the design of an intervention that we will develop and assess in future studies. The qualitative data will be coded and analyzed using an inductive approach informed by grounded theory. Statistical analyses of the self-report measures will provide summaries of patient characteristics and comparative data between African-American and White veterans.

描述（由申请人提供）： VA医疗保健系统中对健康差异的最新评论表明，VA的所有部分都存在重大的种族差异，这会影响医疗保健成本，护理质量， 患者满意度和退伍军人的健康。患者提供者的沟通已被确定为身心健康中种族健康差异的关键调解人之一。 然而，少数民族退伍军人对健康传播的看法和经历，尤其是在心理健康方面，仍在研究中。在这一领域缺乏研究使我们对少数民族如何理解和体验治疗决策的理解持续了一个危险的差距。这也限制了VA为向少数民族提供质量和文化胜任的心理健康服务的努力，这是一个快速增长的退伍军人人口。这项研究旨在调查非裔美国退伍军人心理健康治疗决策的过程，促进者和障碍，以告知未来的努力，以改善心理健康沟通并减少VA中的健康差异。修订研究的具体目的是四倍。在AIM 1中，我们将研究非裔美国人如何描述他们对心理健康治疗决策的理解和过程；并评估他们做出这些决定的首选方法，这些方法可能包括或可能不包括共同的决策。在AIM 2中，我们将特别研究患有精神疾病的非裔美国退伍军人如何将共同决策定义为决策模型。在AIM 3中，我们将使用混合方法来比较白人（以前的研究数据）和患有精神疾病的非裔美国退伍军人的决策。在AIM 4中，我们将开发旨在改善共同决策并减少非裔美国退伍军人心理健康差异的干预措施的初步模型。为了完成这项研究的目标1，我们将对45名在Richard L. Roudebush VAMC接受门诊精神病医生的非裔美国退伍军人进行定性访谈。访谈将重点介绍参与者与精神病治疗提供者（处方者：精神科医生和护士从业者）的治疗决策的观点，经验和偏好。为了实现目标2，定性访谈将包括探讨参与者对共同决策概念化的问题。为了完成AIM 3，参与者将完成评估患者支持者工作联盟，对药物的态度和激活的自我报告措施。定量数据将 通过提供有关影响患者的因素的系统信息来帮助三角剖分我们的发现 提供者的关系和沟通。我们还将与41名白人退伍军人及其精神病治疗提供者（Marianne Matthias，PI）进行比较与先前有关共享决策的研究。在AIM 4中，我们将从访谈中收集初步数据，以告知我们将在未来研究中开发和评估的干预措施的设计。定性数据将使用接地理论告知的归纳方法进行编码和分析。自我报告措施的统计分析将摘要非裔美国人和白人退伍军人之间的患者特征和比较数据。