V. E. Chong1, R. N. Smith1, L. Ashley4, A. C. Marks4, T. Corbin2, J. Rich3, G. P. Victorino1 1UCSF-East Bay,Surgery,Oakland, CALIFORNIA, USA 2Drexel University College Of Medicine,Philadelphia, PA, USA 3Drexel University School Of Public Health,Philadelphia, PA, USA 4Youth ALIVE!,Oakland, CALIFORNIA, USA
Introduction: Young men of color are disproportionately affected by interpersonal violence, which has lasting effects in the form of post-traumatic stress disorder (PTSD) and other pre-clinical symptoms of behavioral health issues. In developing services that address young men of color and their post-injury needs, their voices are often overlooked. As such, we conducted an exploratory research study using qualitative methods to investigate young men of color’s experiences with health care after suffering injury due to interpersonal violence. We aimed to identify portals of care through which young men of color seek help and to understand their relationships with these portals of care.
Methods: We conducted three focus group interviews with young men of color ages 18-30 using semi-structured interview guides we developed based on pertinent issues from the literature on trauma and PTSD. Focus group audiotapes were transcribed and the text was transformed to lines and stanzas. Analysis was performed via NVivo qualitative research software. The interview text was coded for recurring themes and reviewed by three study personnel. We subsequently administered a trauma symptoms screening to 69 young men of color. The screening tool was self-developed based on feedback from the focus groups and included 3 of the 4 variables in the validated Primary Care PTSD (PC-PTSD) screen.
Results: Our focus group participants sought health care from a variety of sources. They distinguish between institutions that provide “life-saving” treatment, like trauma centers, and those that provide post-injury services, such as pain management and prescriptions. After injury, these young men often turned to “folk medicine” to treat their maladies, repeatedly describing their use of marijuana, alcohol, and cough syrup with codeine. They preferred obtaining these post-injury services through non-traditional providers, such as cannabis clubs and family members, as they described attempts to access these services at “life-saving” institutions as “a waste of time” and fraught with experiences of patient-provider misalignment. Lastly, among the young men we interviewed in the trauma symptom screening portion, 90% reported at least two symptoms of trauma, including sleep disruption, re-experiencing, focus problems, hyperarousal, and dissociation. Further, 16% of participants had screens suggestive for PTSD.
Conclusion: Focus groups and interviews with young men of color who have been victims of violence reveal their views of the problems in their health care, their need for alternative systems of care, the disconnect between their expressed needs and the perceptions of providers, and the powerful impact of stress on their well-being. To better align our services with the expectations and needs of our patients, their concerns should be addressed and solutions integrated into quality improvement efforts.