Whole Health in VA Mental Health: A Randomized Controlled Trial of Omnis Salutis

Project Background: In health care, social and cultural factors such as Veteran identity and culture (VIC) and racial identity and culture (RIC) influence patient and provider behaviors, beliefs, concepts of health and wellness, as well as approaches to power sharing and decision making. This can create partnerships or

conflicts and influence the provision of patient-centered care (PCC). Key elements of Veteran culture are hierarchical power structures and resilience. However, research has noted that these values can lead to maladaptive behavior in civilian settings. For example a Veteran’s focus on being self-reliant may inhibit their

willingness to seek treatment. Qualitative interviews with VA providers have echoed these cultural barriers to PCC, with many noting that they felt patients were reluctant or unable to engage in PCC and providers acknowledging that they generally did not understand why disengagement occurred. Similarly RIC plays a role

in PCC. In a sample of 231 patients, Black patients reported greater medical mistrust than White patients, which was associated with lower willingness to accept provider recommendations. When providers used patient centered communication techniques the relationship between medical mistrust and provider mistrust

was weakened, though not eliminated, for all racial groups. Conversely, a study utilizing standardized patients (SP) found that when Black SPs demonstrated behaviors such as asking questions or voicing concerns or opinions it disrupted racially biased interpersonal treatment associated with provider implicit bias.

Impact on Veteran Health Care: VA is transforming to Whole Health (WH), health care that is “personalized, proactive, and patient-driven; and engages and inspires Veterans to their highest possible level of health and well-being.” Research on WH in VA provided implementation insights and initial outcomes but there is currently

no research on potential racial disparities or the impact of Veteran culture. The proposed project is part of the next generation of WH research, which will explore nuances of implementing WH with diverse Veterans and identify strategies to engage hesitant Veterans in WH. Failure to consider how Veterans’ VIC and RIC and

related lived experiences with providers orients them toward health care is not patient-centered and may undermine the efficacy of WH PCC education and activation. Diversity Project Objectives: Omnis Salutis is a WH PCC Veteran education and activation intervention currently being tested in a randomized control trial in an RR&D Merit. In the proposed research 15 Black-

identifying Veterans and 15 White-identifying Veterans who were randomized to Omnis Salutis will participate in one-time qualitative interviews. Aim one will explore perceived barriers and facilitators to Veterans’ participation in WH related to their VIC and RIC. Aim two will understand similarities and distinctions in barriers

and facilitators among Black-identifying and White-identifying Veterans. Finally aim three will identify VIC- and RIC-informed guidance about what promotes or prevents participation in Whole Health. Diversity Project Methods: VA investigators will partner with investigators from Howard University (HU), a

Minority Serving Institution (MSI). The team will use narrative inquiry approach, a method to investigate how people make meaning of their lives and experiences in socio-cultural contexts, to create a semi-structured interview guide, conduct interviews, and analyze data. After each interview the interviewer will complete an

analytic memo. Then a study team pair will use dynamic thematic content analysis procedures to process and analyze each interview. This approach will allow researchers to engage in inductive and deductive reasoning that will capture the semantic and latent meaning of the participants' perceptions and experiences in the

interviews. This strategy of inquiry aims to understand the nuances and complexities of lived experiences in a storied form and what these experiences mean to the individual. Additionally, the study team has a detailed plan to promote partnerships with scientists associated with HU to enhance diversity in VA research.