All ETDs from UAB

Advisory Committee Chair

Ann E Montgomery

Advisory Committee Members

Michelle Hilgeman

Kimberly McCall

Janet Turan

Teneasha Washington

Document Type

Dissertation

Date of Award

2022

Degree Name by School

Doctor of Philosophy (PhD) School of Public Health

Abstract

Purpose: This study focuses on factors related to healthcare seeking behaviors and utilization of Veterans Affairs primary care services by female African American Veterans. The purpose of this mixed methods study is to assess what factors influence seeking care at VA healthcare facilities. Research Design: This study used a modified explanatory sequential mixed methods design to assess health services utilization and healthcare experiences of African American female Veterans. This research utilized items from the Health Belief model as a guiding framework to highlight factors that could impact VA healthcare utilization. Methodology: Health services utilization analysis used national data from the study, “Identifying and Measuring Risk for Homelessness Among Veterans” (IIR 13-334) from the timeframe of October 2015-September 2018. Logistic regression was used to assess what factors predict primary care and linear regression was used to assess what factors influence the frequency of PC use (n=321,682). Race, health conditions, and generation were controlled for when assessing PC outcomes. Healthcare experience was measured iv by collecting primary health care experience information via individual qualitative interviews (n=20). During this phase of data collection, a thematic analysis was conducted to identify barriers and facilitators to accessing care. Results: The logistic regression model to predict primary care use showed that African American female Veterans were less likely to use primary care, this model also identified two factors that increased the odds of PC use: a diagnosis of obesity (��β=1.94) and hypertension-uncomplicated (hypertensionU)(��β=1.42). The linear regression model showed that the three largest predictors in frequency of PC use for the entire sample were hypertensionU (β=1.38), obesity (β=1.19), and psychosis (β=.92). Healthcare experience results illustrated the following areas should be a focus for improvement: communication, scheduling, support services. Significance: This study will assist providers and administrators in understanding how African American female Veterans’ healthcare experiences affect their utilization of VA services. This includes what factors contribute to their decisions to access care within the VA healthcare system. Administrators and providers can use this information to tailor care and services that can contribute to increased utilization by African American female Veterans.

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