VIJ Digital library
Articles

A Qualitative Study of Disability in Minority Veterans and Their Utilization of the VA Health System

Gibson Aristide
Carlos Albizu University

Published 2023-12-02

Keywords

  • VA Health System

Abstract

Over time, as the United States army increased, white and minority citizens joined the military forces. This led to the establishment of the Veterans Bureau, and later the Veterans Administration, to care for the wounded soldiers. Although the nation had developed a system to provide services to veterans since the late 1700s, there has been a decline in utilization of y veteran service members in the modern day. The purpose of this phenomenological study is to investigate the causes behind the limited use of the mental health services provided by the VHA by minority veteran service members and to propose ways to improve these services. Additionally, another purpose was to examine any cases of discrimination against minority veteran service members based on interviews with participants and previous empirical literature. After conducting multiple interviews, the status of patient satisfaction, degree of reliance on VHA medical facilities, perception of efficiency of services, and patronage XIII were analyzed. In summary, previous empirical literature had indicated that minority veteran service members were more likely to face discrimination because of racial bias. However, today, that is not largely the case. Rather, most of the minority veteran service members interviewed did not face discrimination and they were content with the health services offered. While some of the interviewees did claim that they faced some acts of discrimination, the overwhelming majority did not. These findings suggest that most minority veteran service members do not face discrimination and that they are actively interested in seeking VH healthcare services. Nevertheless, understanding minority veteran service members may enable healthcare providers to provide them with customized healthcare sections.

References

  1. Altman, B., & Bernstein, A. (2008). Disability and Health in the United States: 2001-2005. Hyattsville, MD: National Center for Health Statistics. Amputation system of care handbook. Washington (DC): VHA; 2012 Aug 15. VHA handbook 1172.03. Available from: https://vaww.va.gov/vhapublications/publications.cfm?Pub=2
  2. Arthur, C. M., Hickling, F. W., Robertson-Hickling, H., Haynes- Robinson, T., Abel, W., & Whitley, R. (2010). ‘Mad, sick, head nuh good’: mental illness stigma in Jamaican communities.
  3. Transcultural Psychiatry, 47(2), 252–75. https://doi.org/10.1177/1363461510368912
  4. Bacci, G., Burdach, S., Cotterill, S. J., Craft, A. W., Grimer,
  5. R., Jurgens, H., &. Spooner, D. (2003). Osteosarcoma FAQ. Cancer Index. Retrieved from http://www.cancerindex.org/ccw/faq/osteo.htm
  6. Baker, G. R. (2008). High performing healthcare systems: delivering quality by design. Longwoods Publishing.
  7. Barth, S. K., Kang, H. K., & Bullman, T. (2016). All-cause mortality among us veterans of the Persian gulf war: 13- Year follow-up. Public health reports (Washington, D.C.: 1974), 131(6), 822-830.
  8. Bhat, A. (n.d.). Non-Probability Sampling: Definition, Methods, and Examples. QuestionPro. Retrieved from QuestionPro:
  9. https://www.questionpro.com/blog/non-probability-sampling/
  10. Bonacich, E. (1972). A theory of ethnic antagonism: The split labor market. American Sociological Review, 37(5), 547-559.
  11. Bonacich, E. (1973). A Theory or Middleman Minorities. American Sociological Review, 38(5), 583-594.
  12. Buck, N., & Michael H. (1998). Social Exclusion in London. University of Essex, Institute for Economic and Social Research. Burchardt, T., Le Grand, J., & Piachaud, D. (2002). Degrees of exclusion: Developing a dynamic, multidimensional measure.
  13. Pp. 30-43 in Hills, Le Grand and Piachaud (Eds.).
  14. Centers for Disease Control and Prevention. (2011a).
  15. Complications of Diabetes. Diabetes Data and Trends. Retrieved on 6/23/2019 from http://www.cdc.gov/diabetes/statistics/complications_nation al.htm
  16. Cheney, A. M., Koenig, C. J., Miller, C. J., Zamora, K., Wright, P., Stanley, R., Fortney, J., Burgess, J. F., & Pyne, J. M.
  17. (2018). Veteran-centered barriers to VA mental healthcare services use. BMC Health Services Research, 18(1), 591. https://doi.org/10.1186/s12913-018-3346-9
  18. Cohen, T. (2014). Audit: More than 120,000 veterans waiting or never got care. CNN 10th June 2014. Available at https://edition.cnn.com/2014/06/09/politics/va- audit/index.html
  19. Copeland, L. A., McIntyre, R. T., Stock, E. M., Zeber, J. E., MacCarthy, D. J., & Pugh, M. J. (2014). Prevalence of suicidality among Hispanic and African American veterans following surgery. American journal of public health, 104 Suppl 4(Suppl 4), S603-8.
  20. Copeland, L. A., Zeber, J. E., Sako, E. Y., Mortensen, E. M.,
  21. Pugh, M. J., Wang, C. P., Restrepo, M. I., Flynn, J., MacCarthy, A. A., & Lawrence, V. A. (2015). Serious mental illnesses associated with receipt of surgery in retrospective analysis of patients in the Veterans Health Administration. BMC surgery, 15,
  22. https://doi.org/10.1186/s12893-015-0064-7
  23. Corporation, R. (2019). 36-Item Short Form Survey (SF-36) Scoring Instructions. Retrieved from rand.org:
  24. https://www.rand.org/health-care/surveys_tools/mos/36-item- short-form/scoring.html
  25. Corporation, R. (2019). Terms and Conditions for Using the 36- Item Short Form Survey (SF-36). Retrieved from rand.org: https://www.rand.org/health-care/surveys_tools/mos/36-item- short-form/terms.html
  26. Creswell, J. W., & Poth, C. N. (2016). Qualitative inquiry and research design: Choosing among five approaches. Sage publications.
  27. Crossman, A. (2019). Understanding Purposive Sampling. ThoughtCo. Retrieved from ThoughtCo: https://www.thoughtco.com/purposive-sampling-3026727
  28. DeLisa, J. A., & Kerrigan, C. K. (1998). Gait analysis in the science of rehabilitation (First ed.): Diane Publishing Co.
  29. Department of Veteran Affairs – FY (2017). Agency Financial Report, Section Three. Available at https://www.va.gov/oig/pubs/VAOIG-2017-MMC.pdf
  30. Department of Veterans Affairs (2013). American Consumer
  31. Satisfaction Index 2013: Customer Satisfaction Inpatient
  32. Survey. Washington DC: VA
  33. Department of Veterans Affairs Office of the Inspector General. Healthcare inspection: Prosthetic limb care in VA facilities. Washington (DC): VA Office of Inspector General; 2012 Mar 8. Report No. 11–02138–116. Available from: http://www.va.gov/oig/pubs/VAOIG- 11-02138-116.pdf Department of Veterans Affairs. (n.d.). Mission statement.
  34. Dilworth-Anderson, P., Williams, I. C., & Gibson, B. E. (2002).
  35. Issues of race, ethnicity, and culture in caregiving research: A 20-year review (1980–2000). The Gerontologist, 42(2), 237–272.
  36. Dowrick, C., Gask, L., Edwards S., Aseem, S., Bower, P.,
  37. Burroughs, H., Catlin, A., Chew-Graham, C., Clarke, P.,
  38. Gabbay, M., Gowers, S., Hibbert, D., Kovandzic, M., Lamb,
  39. J., Lovell, K., Rogers, A., Lloyd-Williams, M., Waheed, W., & the AMP Group. (2009). Researching the mental health needs of hard-to-reach groups: managing multiple sources of evidence. BMC Health Services Research, 9, p226.
  40. Dunlop D., Manheim L., Song J. & Chang R. (2002) Gender and ethnic/racial disparities in healthcare utilization among older adults. Journals of Gerontology: Social Sciences, 57B (4), S221–
  41. S23
  42. Elmendorf, D. et al. (2010). Potential Costs of Veterans’ Health Care. Congressional Budget Office, October 2010. Retrieved from https://www.cbo.gov/sites/default/files/111th- congress-2009-2010/reports/2010_10_7_vahealthcare.pdf
  43. Elmendorf, D. et al. (2014). Comparing the Costs of the
  44. Veterans’ Healthcare System with Private Sector Costs. Washington DC: Congressional Budget Office. Retrieved from https://www.cbo.gov/sites/default/files/113th-congress- 2013-2014/reports/49763-VA_Healthcare_Costs.pdf
  45. Evans, M. (1998). “Behind the Rhetoric: The Institutional Basis of Social Exclusion and Poverty.” IDS Bulletin, 29(1), 4249.
  46. Fausti, S.A., Wilmington, D.J., Gallun, F. J., Myers, P. J., & Henry, J. A. (2009). Auditory and vestibular dysfunction associated with blast-related traumatic brain injury. Journal of Rehabilitation Research Development. 46(6), 797– 810.
  47. Federation of American Scientists (2015). A Guide to Military
  48. Casualty Statistics: Operation Inherent Resolve, Operation
  49. New Dawn, Operation Iraqi Freedom, and Operation Enduring Freedom. Congressional Research Service; Available at https://www.fas.org/sgp/crs/natsec/RS22452.pdf.
  50. Ferguson, J. A., Adams, T. A., Weinberger, M., Busby, H. K., Ferguson, J. A., & Roudebush, R. L. (1998). Racial differences in cardiac catheterization use and appropriateness. American Journal of the Medical Sciences, 315(5), 302-306. https://doi.org/10.1016/S0002- 9629(15)40336-2
  51. Ferguson, J. A., Tierney, W. M., Westmoreland, G. R., Mamlin, L. A., Segar, D. S., Eckert, G. J., Zhou, X. H., Martin, D. K., & Weinberger, M. (1997). Examination of racial differences in management of cardiovascular
  52. disease. Journal of the American College of Cardiology, 30(7),
  53. –1713. https://doi.org/10.1016/s0735-1097(97)00365-3
  54. Finlay, A. K., Stimmel, M., Blue-Howells, J., Rosenthal, J.,
  55. McGuire, J., Binswanger, I., Smelson, D., Harris, A. H., Frayne, S. M., Bowe, T., & Timko, C. (2017). Use of veterans health administration mental health and substance use disorder treatment after exiting prison: The healthcare
  56. for reentry veterans program. Administration and policy in mental health, 44(2), 177–187. https://doi.org/10.1007/s10488-
  57. -0708-z
  58. Fletcher, D. D., Andrews, K. L., Hallett, J. W., Jr, Butters, M. A., Rowland, C. M., & Jacobsen, S. J. (2002). Trends in rehabilitation after amputation for geriatric patients with vascular disease: Implications for future health resource allocation. Archives of physical medicine and rehabilitation, 83(10), 1389–1393. https://doi.org/10.1053/apmr.2002.34605
  59. Fotieo, G. G., Reiber, G. E., Carter, J. S., & Smith, D. G. (1999). Diabetic amputations in the VA: are there opportunities for interventions? Journal of rehabilitation research and development, 36(1), 55–59. Fox, A. B., Meyer, E. C., & Vogt, D. (2015). Attitudes about the
  60. VA health-care setting, mental illness, and mental health treatment and their relationship with VA mental health service use among female and male OEF/OIF veterans. Psychological Services, 12(1), 49-58. http://dx.doi.org/10.1037/a0038269
  61. Frey, W. H. (2019). Six maps that reveal America 's expanding racial diversity. Brookings.
  62. Fujiura, G. T., Magana, S., Li, H., & Parish, S. L. (2016).
  63. Healthcare Costs for Americans with I/DD: A National Analysis of Access and Spending 2002-2011 Based on the MEPS/NHIS. Gary, F. A. (2005). Stigma: barrier to mental healthcare among
  64. ethnic minorities. Issues Mental Health Nursing. 26, 979–
  65. Gibbs, D. A. (1997). Focus Groups. Social Research Update.
  66. Retrieved from https://openlab.citytech.cuny.edu/her- macdonaldsbs2000fall2015b/files/2011/06/Focus-Groups_Anita-
  67. Gibbs.pdf
  68. Giunta, N., Chow, J., Scharlach, A. E., & dal Santo, T. S.
  69. (2004). Racial and ethnic differences in family caregiving in California. Journal of Human Behavior in the Social Environment, 9(4), 85–109.
  70. Gollust, S. E., Cunningham, B. A., Bokhour, B. G., Gordon, H.
  71. S., Pope, C., Saha, S. S., Jones, D. M., Do, T., & Burgess, D.
  72. J. (2018). What causes racial healthcare disparities? A mixedmethods study reveals variability in how healthcare providers perceive causal attributions. Inquiry: a journal of medical care organization, provision and financing, 55, 46958018762840. https://doi.org/10.1177/0046958018762840
  73. Griffin, R. (2014). Interim report: Review of patient wait times, scheduling practices, and alleged patient deaths at the phoenix healthcare system. Washington, DC: VA Office of
  74. Inspector General, Veterans Health Administration,
  75. Department of Veterans Affairs, May 28, 2014. 14–02603-
  76. https://www.va.gov/oig/pubs/VAOIG-14-02603-178.pdf Hale-Gallardo, J., Jia, H., Delisle, T., Levy, C. E., Osorio, V., Smith, J. A., & Hannold, E. M. (2017). Enhancing health and independent living for veterans with disabilities by leveraging community-based resources. Journal of Multidisciplinary Healthcare, 10, 41-47. https://doi.org/10.2147/JMDH.S118706
  77. Hamwoy, R. (2010). Failure to Provide: Healthcare at the Veterans Administration. Independent Institute. Retrieved from https://www.independent.org/publications/policy_reports/det ail.asp?id=9277
  78. Holmes, J., Powell-Griner, E., Lethbridge-Cejku, M., & Heyman, K. (2009). Aging differently: Physical limitations among adults aged 50 years and over: United States, 2001-2007. NCHS Data Brief, (20), 1-8.
  79. Ibrahim, S. A., Siminoff, L. A., Burant, C. J., & Kwoh, C. K.
  80. (2002). Differences in expectations of outcome mediate African American/white patient differences in "willingness" to consider joint replacement. Arthritis & Rheumatology, 46(9): 2429-2435.
  81. https://doi.org/10.1002/art.10494
  82. Iezzoni, L. I. (2016). Stigma and persons with disabilities. In:
  83. Stigma and Prejudice. New York, NY: Springer International Publishing. 3-21. https://doi.org/10.1007/978-3-319-27580- Iezzoni, L. I., Kurtz, S. G., & Rao, S. R. (2014). Trends in U.S. adult chronic disability rates over time. Disability and health journal, 7(4), 402–412. https://doi.org/10.1016/j.dhjo.2014.05.007
  84. Jia, H., Pei, Q., Sullivan, C. T., Cowper Ripley, D. C., Wu, S.
  85. S., Bates, B. E., Vogel, W. B., Bidelspach, D. E., Wang, X., &
  86. Hoffman, N. (2016). Poststroke rehabilitation and restorative care utilization: A comparison between VA community living centers and va-contracted community nursing homes. Medical care, 54(3), 235–242. https://doi.org/10.1097/MLR.0000000000000494
  87. Jones, A. L., Hausmann, L. R. M., Haas, G. L., Mor, M. K., Cashy, J. P., Schaefer, J. H., & Gordon, A. J. (2017). A national evaluation of homeless and nonhomeless veterans' experiences with primary care. Psychological
  88. services, 14(2), 174–183.
  89. https://doi.org/10.1037/ser0000116
  90. Jones, A. L., Mor, M. K., Cashy, J. P., Gordon, A. J., Haas, G. L., Schaefer, J. H., Jr, & Hausmann, L. R. (2016).
  91. Racial/Ethnic Differences in Primary Care Experiences in Kizer, K. W., Demakis, J. G., & Feussner, J. R. (2000). Reinventing VA health care: Systematizing quality improvement and quality innovation. Medical care, I7-I16.
  92. Kizer, K. W., Fonseca, M. L., & Long, L. M. (1997). The veterans’ healthcare system: Preparing for the twenty-first century. Journal of Healthcare Management, 42(3), 283.
  93. Kruger, R. A. (2002). Designing and Conducting Focus Group Interviews. St. Paul, _Minnesota: University of Minnesota.
  94. Legro, M. W., Reiber, G., del Aguila, M., Ajax, M. J., Boone, D. A., Larsen, J. A., & Sangeorzan, B. (1999). Issues of importance reported by persons with lower limb amputations and prostheses. Journal of Rehabilitation Research and Development, 36(3), 155-
  95. Retrieved from http://www.rehab.research.va.gov/jrrd/index.html
  96. Lewis E. Kazis, S. (2000). The Veterans SF-36 Health Status
  97. Questionnaire: Development and Application in the Veterans
  98. Patient-Centered Medical Homes among Veterans with Mental Health and Substance Use Disorders. Journal of general internal medicine, 31(12), 1435–1443. https://doi.org/10.1007/s11606-016-
  99. -1
  100. Keating, F., & Robertson, D. (2004). Fear, black people and mental illness: a vicious circle?. Health & social care in the community, 12(5), 439–447. https://doi.org/10.1111/j.13652524.2004.00506.x
  101. Health Administration. Medical Outcomes Trust.
  102. Loury, G. C. (1987). Why Should We Care about Group Inequality?
  103. Social Philosophy and Policy, 5, 249-71.
  104. Loury, G. C. (1999). Social Exclusion and Ethnic Groups: The
  105. Challenge to Economics Annual World Bank Conference on
  106. Development Economics NY: The International Bank for
  107. Reconstruction and Development / THE WORLD BANK
  108. Mayfield, J. A., Reiber, G., Maynard, C., Czerniecki, J.M., Caps, M. T. & Sangeorzan, B.J. (2000). Trends in lower limb amputation in the Veterans Health Administration, 19891998.
  109. Journal of Rehabilitation Research and Development, 37(1), 23-
  110. Mayo-Smith, M. (2008). Access Issues Within VA Offer Challenges, Research Opportunities. Translating research into quality healthcare for veterans. HSR & D Forum, 1-5. Retrieved from https://www.hsrd.research.va.gov/publications/internal/foru m07_08.pdf
  111. Medley, A. (2008). Methods in Cultural Domain Analysis.
  112. Retrieved from John Hopkins Bloomberg School of Public
  113. Health: http://ocw.jhsph.edu/courses/QualitativeDataAnalysisNDFs/Se ssion11.pdf.
  114. Meehan S. (2005). Health services research: critical measurement issues. Health services research, 40(5 Pt 2), 1571–1572. https://doi.org/10.1111/j.1475-6773.2005.474.x
  115. Memon A, T. K. (2016). Perceived barriers to accessing mental health services among Black and minority ethnic (BME) communities: a qualitative study in Southeast England. BMJ Open.
  116. Memon, A., Taylor, K., Mohebati, L. M., Sundin, J., Cooper, M., Scanlon, T. & de Visser, R. (2016). Perceived barriers to accessing mental health services among black and minority ethnic (BME) communities: A qualitative study in Southeast England. BMJ
  117. Open 6: e012337. https://doi.org/10.1136/bmjopen-2016012337
  118. Mohr, D. C., Eaton, J. L., Meterko, M., Stolzmann, K. L., & Restuccia, J. D. (2018). Factors that contribute to veterans not using Veterans Affairs (VA) health care. Public Health Reports,
  119. (1), 93-100.
  120. Morgan, R. O., Teal, C. R., Reddy, S. G., Ford, M. E., & Ashton, C. M. (2005). Measurement in Veterans Affairs Health Services research: Veterans as a special population. Health services research, 40(5 Pt 2), 1573–1583. https://doi.org/10.1111/j.1475-
  121. 2005.00448.x
  122. Naderifar, M., Goli, H., & Ghaljaie, F. (2017). Snowball sampling: A purposeful method of sampling in qualitative research. Strides in Development of Medical Education, 14(3). https://doi.org/10.5812/sdme.67670
  123. National Institute for Mental Health in England (2003). Inside outside: Improving mental health services for black and minority ethnic communities in England. London: National Institute for Mental Health in England.
  124. Nelson, K. M., Starkebaum, G. A., & Reiber, G. E. (2007).
  125. Veterans using and uninsured veterans not using Veterans Affairs (VA) health care. Public health reports (Washington, D.C. :
  126. , 122(1), 93–100. https://doi.org/10.1177/003335490712200113
  127. Neubeck, K. J., and Noel, A. C. (2001). Welfare Racism: Playing the Race Card against America’s Poor. Abingdon, United
  128. Kingdom: Routledge.
  129. Oster, C., Morello, A., Venning, A., Redpath, P., & Lawn, S. (2017). The health and wellbeing need of Veterans: a rapid review. BMC Psychiatry. 17, 414. https://doi.org/10.1186/s12888-
  130. -1547-0
  131. Palinkas, L. A., Horwitz, S. M., Green, C. A., Wisdom, J. P., Duan, N., & Hoågwood, K. (2015). Purposeful sampling tor qualitative data collection and analysis in mixed method implementation research. Administration and Policy in Mental
  132. Health and Mental Health Services Research, 42, 533- 544. https://doi.org/10.1007/s10488-013-0528-y
  133. Panangala, S. V. (2013). Congressional Research Service,
  134. Healthcare for Dependents and Survivors of Veterans. Retrieved from https://www.everycrsreport.com/files/20130404_RS22483_d54a5
  135. fd4957e9c5376c7289772a5db20dfb5882.pdf
  136. Panangala, S. V. (2013). Healthcarefor Dependents and Survivors of Veterans. Congressional Research Service.
  137. Pear, R. (2014). History and Context of an Embattled Department of Veterans Affairs. New York Times, May 21, 2014.
  138. Pencak, W. (2009). Encyclopedia of the Veteran in America. ABC-
  139. CLIO
  140. Peterson, K., Anderson, J., Boundy, E., Ferguson, L., McCleery,
  141. E., & Waldrip, K. (2018). Mortality Disparities in Racial/Ethnic
  142. Minority Groups in the Veterans Health Administration: An
  143. Evidence Review and Map. American journal of public health,
  144. (3), e1–e11. https://doi.org/10.2105/AJPH.2017.304246
  145. Pollard, K. M., & O'Hare, W. P. (n.d.). America's Racial and Ethnic Minorities. Retrieved from PRB: https://www.prb.org/americasracialandethnicminorities/ Questionnaire design. (n.d.). Retrieved from Foodborne Disease Outbreaks: Guidelines for Investigation and Control: https://www.who.int/foodsafety/publications/foodborne_disea
  146. se/Annex_4.pdf Rabiee, F. (2004). Focus-group interview and data analysis.
  147. Proceedings of the Nutrition Society, 63(4), 655-660. https://doi.org/10.1079/PNS2004399 Retrieved from https://govinfo.library.unt.edu/npr/library/status/mission/ mva.htm
  148. Richard Arvin Overton. (n.d.). Retrieved from Wikipedia: https://en.wikipedia.org/wiki/Richard_Arvin_Overton Rucker, M. (2016). 3 straightforward methods for analyzing qualitative interview data. Retrieved from Unstick.me:
  149. https://unstick.me/3-straightforward-methods-for-analyzing- qualitative-interview-data/
  150. S, S. (2014). Snowball Sampling. Retrieved from Statistics How To:
  151. https://www.statisticshowto.datasciencecentral.com/snowball -sampling/
  152. Selim, A. J., Rogers, W., Fleishman, J. A., Qian, S. X., Fincke, B. G., Rothendler, J. A., & Kazis, L. E. (2009). Updated U.S. population standard for the Veterans RAND 12-item Health Survey (VR-12). Quality of life research: an international journal of quality of life aspects of treatment, care and rehabilitation,
  153. (1), 43–52. https://doi.org/10.1007/s11136-008-9418-2
  154. Statistics, N. C. (2016, April). 2014 Minority Veterans Report. Retrieved from United States Department of Veterans Affairs: https://www.va.gov/vetdata/docs/SpecialReports/Minority_Vet erans_2014.pdf
  155. Stewart. (2006). Analyzing focus Group Data. Retrieved from Sage Pub: https://www.sagepub.com/sites/default/files/upm- binaries/11007_Chapter_7.pdf
  156. Strom, T. Q., Possis, E., & Gavian, M. (2012). Cultural and Ethical Considerations When Working With Military Personnel and Veterans: A Primer for VA Training Programs