Community Perceptions of Health Equity: A Qualitative Study.

INTRODUCTION: Notable inequities in patient experiences exist in the healthcare system. Communities with a large concentration of blacks and immigrants are often marginalized rather than centralized in the healthcare system. These inequities may fuel distrust and exacerbate adverse outcomes, thereby widening the health gap. Addressing differences in patients' experiences of care is paramount for reducing health inequities. METHODS: In this qualitative study, we used a purposive sampling method to recruit 62 participants to conduct 10 FGs (44 participants total) and 18 key informant interviews with stakeholders across Central Brooklyn. RESULTS: The data revealed three primary themes: Trust, Discrimination, and Social Determinants of Health (SDOHs). Each theme comprised subthemes as follows: For Trust, the subthemes included (1) confidence in the healthcare professional, (2) provider empathy, and (3) active participation in healthcare decisions. Regarding Discrimination, the subthemes involved (1) racism and identity, as well as (2) stigma related to diagnosis, disease state, and pain management. Lastly, for Social Determinants of Health, the key subtheme was the acknowledgment by providers that patients encounter competing priorities acting as barriers to care, such as housing instability and food insecurity. For the first theme, participants' interactions with the healthcare system were prompted by a necessity for medical attention, and not by trust. The participants reported that experiences of discrimination resulting from identity and stigma associated with diagnosis, disease state, and pain management amplified the disconnect between the community, the patients, and the healthcare system. This also exacerbated the poor healthcare experiences suffered by many people of color. For SDOHs, the participants identified housing, food security, and other various social factors that may undermine the effectiveness of the healthcare that patients receive. CONCLUSIONS: Improvements in the health system, based on feedback from patients of color regarding their unique care experiences, are important initiatives in combating inequities in healthcare.

Mental health in deployed and nondeployed veteran men and women in comparison with their civilian counterparts.

OBJECTIVE: We investigated the mental health of deployed and nondeployed veterans compared with civilians, exploring gender differences. METHODS: We sampled 41,903 respondents from the Behavioral Risk Factor Surveillance System survey. Respondents self-reported how many of the previous 30 days mental health was not good; 14 days or more indicated adverse mental health. RESULTS: Women exhibited greater prevalence of adverse mental health than men among civilians (odds ratio [OR] = 1.783 (1.653, 1.924), p < 0.001), deployed veterans [OR = 1.879 (1.019, 3.467), p = 0.043], and nondeployed veterans [OR = 2.621 (1.796, 3.825), p < 0.001]. Compared with civilian status, deployed status was associated with adverse mental health for men [OR = 1.361 (1.055, 1.755), p = 0.018] and possibly women [OR = 1.521 (0.930, 2.487), p = 0.095]. Compared with civilian status, nondeployed status was associated with adverse mental health for women [OR = 1.525 (1.152, 2.018), p = 0.003], but not for men [OR = 1.169 (0.943, 1.448), p = 0.155]. We controlled for age, general health, employment status, marital status, education, race/ethnicity, and state of residence. CONCLUSIONS: Adverse mental health affects male and female combat veterans, as well as women in noncombat military occupations.