# Whole Health in VA Mental Health: A Randomized Controlled Trial of Omnis Salutis

> **NIH VA I01** · BALTIMORE VA MEDICAL CENTER · 2024 · —

## Abstract

Project Background: In health care, social and cultural factors such as Veteran identity and culture (VIC) and
racial identity and culture (RIC) influence patient and provider behaviors, beliefs, concepts of health and
wellness, as well as approaches to power sharing and decision making. This can create partnerships or
conflicts and influence the provision of patient-centered care (PCC). Key elements of Veteran culture are
hierarchical power structures and resilience. However, research has noted that these values can lead to
maladaptive behavior in civilian settings. For example a Veteran’s focus on being self-reliant may inhibit their
willingness to seek treatment. Qualitative interviews with VA providers have echoed these cultural barriers to
PCC, with many noting that they felt patients were reluctant or unable to engage in PCC and providers
acknowledging that they generally did not understand why disengagement occurred. Similarly RIC plays a role
in PCC. In a sample of 231 patients, Black patients reported greater medical mistrust than White patients,
which was associated with lower willingness to accept provider recommendations. When providers used
patient centered communication techniques the relationship between medical mistrust and provider mistrust
was weakened, though not eliminated, for all racial groups. Conversely, a study utilizing standardized patients
(SP) found that when Black SPs demonstrated behaviors such as asking questions or voicing concerns or
opinions it disrupted racially biased interpersonal treatment associated with provider implicit bias.
Impact on Veteran Health Care: VA is transforming to Whole Health (WH), health care that is “personalized,
proactive, and patient-driven; and engages and inspires Veterans to their highest possible level of health and
well-being.” Research on WH in VA provided implementation insights and initial outcomes but there is currently
no research on potential racial disparities or the impact of Veteran culture. The proposed project is part of the
next generation of WH research, which will explore nuances of implementing WH with diverse Veterans and
identify strategies to engage hesitant Veterans in WH. Failure to consider how Veterans’ VIC and RIC and
related lived experiences with providers orients them toward health care is not patient-centered and may
undermine the efficacy of WH PCC education and activation.
Diversity Project Objectives: Omnis Salutis is a WH PCC Veteran education and activation intervention
currently being tested in a randomized control trial in an RR&D Merit. In the proposed research 15 Black-
identifying Veterans and 15 White-identifying Veterans who were randomized to Omnis Salutis will participate
in one-time qualitative interviews. Aim one will explore perceived barriers and facilitators to Veterans’
participation in WH related to their VIC and RIC. Aim two will understand similarities and distinctions in barriers
and facilitators among Black-identifying and White-...

## Key facts

- **NIH application ID:** 10818895
- **Project number:** 3I01RX003938-01A1S1
- **Recipient organization:** BALTIMORE VA MEDICAL CENTER
- **Principal Investigator:** Samantha Hack
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 3
- **Project period:** 2022-11-01 → 2026-10-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10818895

## Citation

> US National Institutes of Health, RePORTER application 10818895, Whole Health in VA Mental Health: A Randomized Controlled Trial of Omnis Salutis (3I01RX003938-01A1S1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10818895. Licensed CC0.

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