Provider Stigma and Demographic Factors Associated with Quality of Care Toward U.S. Military Veterans

Background/Purpose: Healthcare disparities in the United States continue to persist despite ongoing efforts to improve equitable healthcare delivery (National Academies of Sciences, Engineering, and Medicine [NASEM], 2017). Within these healthcare systems, provider factors, such as stigma, implicit bias and discriminatory attitudes, contribute to these disparities by influencing their clinical practice, patient engagement and quality of care (Ndugga et al., 2025). Military veterans face additional barriers to accessing and utilizing healthcare services, including mental health stigma, challenges with navigating both VA and civilian healthcare systems, and negative perceptions or misunderstandings from civilian providers (NASEM, 2017). There is limited data exploring how healthcare providers’ stigmatizing beliefs toward U.S. military veterans may influence their perceptions of healthcare delivery. This study examined whether provider stigma, social dominance orientation, and demographic characteristics, are associated with perceived quality of care delivery for veteran patients.

Methods: This study used publicly available data, Civilian and Healthcare Provider Perceptions of U.S. Military Veterans, which was originally collected from a survey with 329 outpatient, private, healthcare providers across the United States on their perceptions of U.S. military veterans. This study used a multiple linear regression analysis as the main data analytic method to examine the association between provider attitudes and perceived quality of care for U.S. military veterans, while controlling for demographic characteristics. Perceived quality of care was operationalized as providers’ self-reported assessment of their care delivery, including consumer outcomes, patient-centered interactions, timeliness of service delivery, and engagement in safe care practices. The study looked at multiple aspects of provider attitudes, including their veteran related stigma, Post-Traumatic Stress Disorder (PTSD)-related stigma, and social dominance orientation (i.e., endorsement of hierarchical beliefs). Demographic variables included in the analytic model were provider age, gender, race, education level, and marital status.

Results: The study participants (N=422) were 39.6 years old on average (SD=14.59). The majority of them identified as female (79.4%) and White (73.9%), and had at least some college education (88.4%). The regression model was statistically significant (F(9, 412) = 13.42, p<.001), explaining approximately 22.7% of the variance in perceived quality of care. Higher levels of veteran-related stigma (B=-3.42, p<.001), PTSD-related stigma (B=-1.0-1, p=.020), and social dominance orientation (B=-2.09, p<.001) were significantly associated with lower perceived quality of care. Additionally, providers who identified as female (B=-3.41, p=.033) and non-White (B=-4.09, p= .002) were likely to have lower perceived quality of care scores. Other demographic variables, including age, education level, and marital, were found to be statistically insignificant predictors.

Conclusion: The findings of this study showed that stigmatizing beliefs and hierarchical attitudes may function as barriers to equitable care for veteran populations. This emphasizes the importance of addressing provider bias and stigma in both civilian and veteran healthcare settings to improve equitable care delivery. Given that many veterans receive care outside of the veteran healthcare system, improving civilian providers’ understanding of military culture and reducing stigmatizing beliefs may be essential for enhancing patient and provider interactions and overall care experiences.