Reviews of disparities in the VA healthcare system showed that significant racial and ethnic healthcare 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 a significant contributor to health and mental healthcare disparities. Specifically, lower level of participation in shared decision-making (SDM) among racial and ethnic minority patients and providers? lower level of empathy towards minority patients contribute to racial and ethnic differences in patient-provider communication. Despite robust evidence documenting the important role of poor communication in healthcare disparities, few interventions have been developed to improve patient-provider communication among minority groups. Moreover, interventions to reduce mental healthcare disparities are lacking. This study seeks to improve patient-provider communication, specifically minority Veterans? participation in SDM to reduce mental health disparities. SDM is a patient-provider communication strategy, widely recognized for engaging patients in their own healthcare and is associated to positive patients? health outcomes. Current efforts to improve patients? participation in SDM, especially in mental healthcare, are limited by lack of understanding and integration of patients? social contexts in their treatment, such as their lived experiences ? an important barrier to address, and inadequate attention to precursors to SDM such as patient engagement. Therefore, the primary objectives of this study are to 1) (Aim 1) adapt the George Washington University (GWU) patient navigation intervention, a health disparity evidence-based intervention in cancer care, to increase minority Veterans? participation in SDM; 2) (Aim 2) refine and evaluate the intervention; and 3) (Aim 3) use systems redesign methods to conduct pre-implementation planning to facilitate effective intervention implementation in VA mental health settings. We will use an ecological framework that emphasizes sociocultural contexts in health communication and the Consolidated Framework for Implementation Research (CFIR) to guide the development and implementation of the proposed intervention. To accomplish Aim 1, we will elicit iterative feedback from Veterans, providers, peers, and other stakeholders from multiple VA facilities within VISN 10, in conjunction with an ethnographic study of Veterans and peers in mental health services.
In Aim 2, we will evaluate the intervention at one site on a sample of (N=50) Veterans and using a randomized controlled trial design that will consist of an experimental (intervention) and control (treatment as usual) groups. We will refine the intervention based on this pilot study, and lay the foundation for a multi-sited, hybrid I randomized controlled trial (RCT) to determine its effectiveness in improving patient activation, patient engagement, and SDM.
In Aim 3, we will use system redesign methods, guided by CFIR, to conduct pre-implementation planning. We will assess systems- level processes that could impact the future implementation of the proposed intervention. Qualitative data from the study will be coded and analyzed using an inductive/deductive approach, informed by our ecological and CFIR frameworks. Statistical analyses of the self-reported measures will provide patient outcomes data. Findings from this study will contribute to the VA?s efforts to improve patient-provider communication and reduce VA mental healthcare disparities. This study could affect the delivery of mental healthcare to minority Veterans in the VA.