Veterans Affairs Providers' Beliefs About the Contributors to and Responsibility for Reducing Racial and Ethnic Health Care Disparities

Abstract

Purpose: Providers' beliefs about the causes of disparities and the entities responsible for addressing these disparities are important in designing disparity-reduction interventions aimed at providers. This secondary analysis of a larger study is aimed at evaluating perceptions of providers regarding the underlying causes of racial health care disparities and their views of who is responsible for reducing them. Methods: We surveyed 232 providers at 3 Veterans Affairs (VA) Medical Centers. Results: Sixty-nine percent of participants believed that minority patients in the United States receive lower quality health care. Most participants (64%) attributed differences in quality of care for minority patients in the VA health care system primarily to patients' socioeconomic status, followed by patient behavior (43%) and provider behaviors (33%). In contrast, most participants believed that the VA and other health care organizations (75%) and providers (70%) bear the responsibility for reducing disparities, while less than half (45%) believed that patients were responsible. Among provider-level contributors to disparities, providers' poor communication was the most widely endorsed (48%), while differences in prescribing of medications (13%) and in provision of specialty referrals (12%) were the least endorsed. Conclusions: Although most providers in the study did not believe that providers contribute to disparities, they do believe that they, along with health care organizations, have the responsibility to help reduce them. Interventions might focus on directly offering providers concrete ways that they can help reduce disparities, rather than focusing on simply raising awareness about disparities and their contributions to them.

Encountering the social determinants of health on a COVID-19 ICU: Frontline providers’ perspectives on inequality in a time of pandemic

“…We also noted that many nurses mentioned that they had grown up in the Boston area, and that this was the basis of their familiarity with the neighborhoods from which their patients came; if the nursing workforce is particularly aware of local (e.g., neighborhood) contexts, this might also be a source of insight into the impacts of the social determinants of health. Second, most studies of health care providers’ causal attributions for racial inequalities in health and health care have focused on illness overall ( Roberts-Dobie et al., 2013 ), specific chronic conditions, such as cardiovascular disease ( Lurie et al., 2005 ) and diabetes ( Sequist et al., 2008 ), and/or on quality of care ( Eliacin et al., 2019 ; Gollust et al., 2018 ). It is possible that health care providers are more likely to identify the social determinants of health as contributors to inequalities in the context of infectious disease.…”

“…Although the social determinants of health are complex and multilevel, there is clear evidence that health care organizations and providers contribute to racial inequalities in health; as such, health care organizations and providers have a critical role to play in eliminating them ( Schulman et al., 1999 ; Smedley et al., 2003 ; van Ryn & Fu, 2003 ; Williams & Wyatt, 2015 ). Towards this end, health care systems, state and federal agencies, and professional organizations have developed an array of educational and training materials for health care providers, on topics such as implicit bias, structural competence, and access to care ( Eliacin et al., 2019 ; Metzl & Hansen, 2014 ; Neff et al., 2017 ; Ross et al., 2010 ; Woolsey & Narruhn, 2020 ).…”

“…Both to support the development of effective educational interventions and to assess whether and how providers may see themselves as part of the solution to the problem of racial health inequalities, scholars have sought to understand providers' “causal attributions” for health and illness ( Burgess et al., 2019 ; Eliacin et al., 2019 ; Malat et al., 2013 ). Much of this research is grounded in insights from social psychology, which suggest that an “individual's causal attributions for problems are important contributors to their beliefs about solutions” ( Gollust et al., 2018 : 2; see also Shostak et al., 2009 ).…”

Racial disparity in healthcare utilization among patients with Irritable Bowel Syndrome: results from a multicenter cohort

“…11 In a 2019 VA study, 69% of providers believed that minority patients in the United States receive lower quality health care, indicating that they are aware of the issue. 12 The majority of providers attributed differences in quality of care for minority patients to patients' SES and behavior. Most providers did not believe that providers contribute to disparities.…”

Veterans’ perceptions of racial bias in VA mental healthcare and their impacts on patient engagement and patient-provider communication

“…Many have argued that healthcare workforce diversity is important for the provision of culturally competent care, expansion of healthcare access for the underserved, and enrichment of the pool of policymakers to meet the needs of a diverse patient population [70,71]. Yet, a recent study indicates that VA providers do not believe that workforce diversity is important for fostering health equity in their organization [72]. This study provides additional support for developing workforce diversity in the VA healthcare system to help create an identity-safe environment.…”