How Are Race, Cultural, and Psychosocial Factors Associated With Outcomes in Veterans With Spinal Cord Injury?

Arch Phys Med Rehabil, 2017 · DOI: 10.1016/j.apmr.2016.12.015 · Published: September 1, 2017

Simple Explanation

This study looks at how race, culture, and social factors affect the quality of life, satisfaction, and community involvement of veterans with spinal cord injuries (SCI). It aims to help doctors understand the specific challenges faced by veterans with SCI and to identify areas where interventions can reduce disparities in outcomes. The researchers compared demographic, medical, cultural, and psychosocial characteristics between white (WH) and African American (AA) veterans with SCI. They also assessed how these factors relate to quality of life (QOL), satisfaction with services, and participation in society. The study found that while some differences exist between AA and WH veterans, cultural and psychosocial factors significantly impact their satisfaction and QOL. Demographic and medical factors primarily affect community participation. These findings suggest that healthcare approaches should be tailored to each veteran's specific needs and background.

Study Duration

03/2011–10/2013

Participants

422 Veteran wheelchair users with SCI (171 African American, 251 White)

Evidence Level

Cross-sectional cohort study

Key Findings

1
AA Veterans reported poorer physical QOL, but better mental QOL than did WH Veterans.
2
Psychosocial factors were predominantly associated with patients’ QOL outcomes and satisfaction with service, but demographic and medical factors were predominantly associated with participation outcomes.
3
A stronger negative association between anxiety and mental QOL for AA than for WH was observed. Higher self-esteem was associated with better social integration for WH but not AA Veterans.

Research Summary

This study examined the association of Veterans’ demographic, medical, cultural, and psychosocial factors with QOL outcomes across several VAMCs. AA Veterans with SCI were less likely to be married, had significantly less education, lower levels of employment, lower total family income, and were less likely to have private insurance compared to WH. Race rarely remained a significant predictor of SCI patient outcomes once other demographic, cultural, and psychosocial factors were considered in the analysis. cultural and psychosocial factors were the predominant variables associated with patients’ satisfaction with service and QOL outcomes, demographic and medical factors were predominantly associated with CHART outcomes. Attempts to improve the outcomes of Veterans with SCI should focus on a tailored approach that emphasizes patients’ assets (e.g., building their sense of self-esteem or increasing their feelings of mastery), while providing services targeted to their specific limitations (e.g., reducing depression and anxiety), and that this targeted approach may need to be tailored differently to WH and AA Veterans.

Practical Implications

Tailored Healthcare Approaches

Healthcare providers should adopt patient-centered approaches that consider demographic, medical, cultural, and psychosocial factors when treating Veterans with SCI.

Focus on Psychosocial Assets

Interventions should focus on building patients' strengths, such as self-esteem and mastery, while addressing their limitations, like depression and anxiety.

Address Racial Disparities

Healthcare strategies should be tailored differently for White and African American Veterans to address specific needs and disparities effectively.

Study Limitations

1
Cross-sectional design limits causal inferences.
2
Limited to comparisons between AA and WH participants due to small sample sizes of other racial/ethnic groups.
3
Findings may not be generalizable beyond the Veteran population with SCI.

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