BACKGROUND/RATIONALE:
Ineffective communication between patients of racial and ethnic minority backgrounds and their providers is a significant contributor to healthcare disparities, including mental healthcare disparities. Minority patients across care settings consistently rate the quality of communication with their clinicians as poorer than White patients, and studies describe these interactions as marked by conflicts, perceptions of discrimination, clinicians' dominance, and exclusion of patients in treatment decisions. This is problematic because suboptimal patient-provider communication has been linked to poorer health outcomes, lower patient satisfaction, and reduced patient-engagement. Despite efforts to improve patient-provider interactions, disparities in patient-provider communication persist among minority patients.

Moreover, lower levels of participation in shared decision-making (SDM) by minority patients is recognized as a significant contributor to racial and ethnic differences in patient-provider communication. Current efforts to improve patients' participation in SDM are limited by lack of understanding and integration of patients' social contexts in their treatment, and inadequate attention to precursors to SDM, such as patient engagement. While it is well established that effective communication is critical for patient-centered care and the reduction of healthcare disparities, few interventions have been developed and/or implemented to improve patient-provider communication among minority groups.

OBJECTIVE(S):
The study objectives are to adapt and pilot the George Washington University (GWU) patient navigation intervention, an evidence-based, healthcare disparity intervention in cancer care, to increase minority Veterans' participation in SDM (Aims 1 & 2). To facilitate intervention implementation in VA mental health settings, we will use system redesign methods to conduct pre-implementation planning (Aim 3). These study aims will be guided by an ecological approach to health communication and the Consolidated Framework for Implementation Research (CFIR).

METHODS:
Aim 1: We will elicit iterative feedback from various stakeholders at multiple VA facilities within VISN 10, in conjunction with an ethnographic study of Veterans and peers in mental health services, to adapt the GWU patient navigation intervention to be delivered by VA peer specialists to minority Veterans in mental healthcare. Aim 2: We will conduct a pilot RCT of the intervention developed in Aim 1 using a sample of (N=50) Veterans at one site to assess the intervention's effects on SDM and other patient level outcomes. We will also evaluate pre-implementation outcomes. Aim 3: Leveraging findings from Aims 1 & 2, we will use systems redesign methods to identify provider and systems-level barriers and facilitators to intervention implementation. We will examine clinical and operational processes, such as work flow, at two sites within VISN 10. This aim will identify practices that need to be modified or integrated into the intervention to ensure its effective implementation and sustainability.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
Findings from this study will contribute to the VA's efforts to improve patient-provider communication and reduce VA mental health care disparities. This study could affect the delivery of mental health care to minority Veterans in the VA.

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External Links for this Project

NIH Reporter

Grant Number: IK2HX002283-01A1
Link: https://reporter.nih.gov/project-details/9394601

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PUBLICATIONS:

Journal Articles

1. Eliacin J, Polsinelli A, Cameron KA, Saykin AJ, Wang S. Black Americans' perceptions of Alzheimer's disease, a healthy brain, and strategies for brain health promotion. PEC innovation. 2024 Dec 1; 4:100282. [view]
2. Matthias MS, Adams J, Burgess DJ, Daggy J, Gowan TM, Perkins AJ, Eliacin J. Effects of the COVID-19 Pandemic on Black Veterans' Mental Health: A Qualitative Investigation. Journal of health care for the poor and underserved. 2022 Jan 1; 33(3):1275-1290. [view]
3. Eliacin J, Hathaway E, Wang S, O'Connor C, Saykin AJ, Cameron KA. Factors influencing the participation of Black and White Americans in Alzheimer's disease biomarker research. Alzheimer's & dementia (Amsterdam, Netherlands). 2022 Dec 7; 14(1):e12384. [view]
4. Eliacin J, Patterson SM, Mendez DM, Burgess DJ, Traylor MH, Borden MY, Slaven JE, Matthias MS. Findings from a Peer-Facilitated, Social Isolation Intervention in the Veterans Health Administration Healthcare System: A Mixed-Methods, Pilot Feasibility Study. Journal of general internal medicine. 2023 Dec 1; 38(16):3460-3471. [view]
5. Matthias MS, Burgess DJ, Eliacin J. Healthcare Access and Delivery During the COVID-19 Pandemic for Black Veterans with Chronic Pain: a Qualitative Study. Journal of general internal medicine. 2023 Mar 1; 38(4):1024-1029. [view]
6. Rollins AL, Eliacin J, Russ-Jara AL, Monroe-Devita M, Wasmuth S, Flanagan ME, Morse GA, Leiter M, Salyers MP. Organizational conditions that influence work engagement and burnout: A qualitative study of mental health workers. Psychiatric Rehabilitation Journal. 2021 Sep 1; 44(3):229-237. [view]
7. Eliacin J, Burgess D, Rollins AL, Patterson S, Damush T, Bair MJ, Salyers MP, Spoont M, Chinman M, Slaven JE, Matthias MS. Outcomes of a peer-led navigation program, PARTNER-MH, for racially minoritized Veterans receiving mental health services: a pilot randomized controlled trial to assess feasibility and acceptability. Translational behavioral medicine. 2023 Sep 12; 13(9):710-721. [view]
8. Eliacin J, Matthias MS, Burgess DJ, Patterson S, Damush T, Pratt-Chapman M, McGovern M, Chinman M, Talib T, O'Connor C, Rollins A. Pre-implementation Evaluation of PARTNER-MH: A Mental Healthcare Disparity Intervention for Minority Veterans in the VHA. Administration and policy in mental health. 2021 Jan 1; 48(1):46-60. [view]
9. Eliacin J, Matthias MS, Cunningham B, Burgess DJ. Veterans' perceptions of racial bias in VA mental healthcare and their impacts on patient engagement and patient-provider communication. Patient education and counseling. 2020 Sep 1; 103(9):1798-1804. [view]
10. Eliacin J, Matthias MS, Cameron KA, Burgess DJ. Veterans' views of PARTNER-MH, a peer-led patient navigation intervention, to improve patient engagement in care and patient-clinician communication: A qualitative study. Patient education and counseling. 2023 Sep 1; 114:107847. [view]

DRA: Mental, Cognitive and Behavioral Disorders
DRE: TRL - Applied/Translational
Keywords: none
MeSH Terms: none