Barriers to Accessing Care Among Rural Women Veterans: A Qualitative Study with Veterans, Peer Specialists, and Primary Care Professionals

Overview

Journal Psychol Serv

Specialties Health Services
Psychiatry
Psychology

Date 2024 Jun 6

PMID 38842851

Authors

Ellen Poleshuck

Emily Johnson

Derrecka Boykin

Ariella Davis

Jennifer S Funderburk

Natalie Hundt

Catherine Cerulli

Kyle Possemato

Affiliations

Soon will be listed here.

Abstract

Rural women veterans are less likely than men and nonrural veterans to access Veterans Health Administration (VHA) care. This qualitative study describes rural women veterans' barriers to accessing care and explores whether participants viewed a peer specialist intervention as having the potential to facilitate access to care. We recruited rural veterans who identified as women with psychological distress and social needs, women peer specialists, and VHA primary care professionals working with rural veterans. We conducted two veteran focus groups, two peer specialist focus groups, and 11 individual Patient Aligned Care Team professional interviews using semistructured interview questions. One of the veteran focus groups was exclusive to veterans of color. We used a rapid qualitative data analysis approach to analyze the results. Data analysis revealed barriers affecting perceived access to services for rural women veterans, especially veterans of color, including transportation, finances, childcare, long travel distance to clinics, lack of access to gender-specific services, ineligibility for services, and lacking information about available resources. Participants also reported challenges accessing community services outside of the VHA. The rural women veterans reported a strong preference for gender-specific services. Leveraging existing VHA resources with rural women veterans may mitigate some of the identified barriers. In particular, participants agreed that increasing availability of peer specialists who are both women and veterans could bridge some perceived barriers to accessing care among rural women veterans. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

References

Wagner C, Dichter M, Mattocks K . Women Veterans' Pathways to and Perspectives on Veterans Affairs Health Care. Womens Health Issues. 2015; 25(6):658-65. DOI: 10.1016/j.whi.2015.06.009. View

Cordasco K, Mengeling M, Yano E, Washington D . Health and Health Care Access of Rural Women Veterans: Findings From the National Survey of Women Veterans. J Rural Health. 2016; 32(4):397-406. DOI: 10.1111/jrh.12197. View

Ingelse K, Messecar D . Rural Women Veterans' Use and Perception of Mental Health Services. Arch Psychiatr Nurs. 2016; 30(2):244-8. DOI: 10.1016/j.apnu.2015.11.008. View

Mattocks K, Casares J, Brown A, Bean-Mayberry B, Goldstein K, Driscoll M . Women Veterans' Experiences with Perceived Gender Bias in U.S. Department of Veterans Affairs Specialty Care. Womens Health Issues. 2019; 30(2):113-119. DOI: 10.1016/j.whi.2019.10.003. View

Shepardson R, Johnson E, Possemato K, Arigo D, Funderburk J . Perceived barriers and facilitators to implementation of peer support in Veterans Health Administration Primary Care-Mental Health Integration settings. Psychol Serv. 2018; 16(3):433-444. PMC: 7905501. DOI: 10.1037/ser0000242. View

Tsai J, Kasprow W, Kane V, Rosenheck R . National comparison of literally homeless male and female VA service users: entry characteristics, clinical needs, and service patterns. Womens Health Issues. 2013; 24(1):e29-35. DOI: 10.1016/j.whi.2013.09.007. View

Vogt D, Bergeron A, Salgado D, Daley J, Ouimette P, Wolfe J . Barriers to Veterans Health Administration care in a nationally representative sample of women veterans. J Gen Intern Med. 2006; 21 Suppl 3:S19-25. PMC: 1513162. DOI: 10.1111/j.1525-1497.2006.00370.x. View

Kimerling R, Bastian L, Bean-Mayberry B, Bucossi M, Carney D, Goldstein K . Patient-centered mental health care for female veterans. Psychiatr Serv. 2015; 66(2):155-62. PMC: 4776740. DOI: 10.1176/appi.ps.201300551. View

Maisel N, Haskell S, Hayes P, Balasubramanian V, Torgal A, Ananth L . Readying the workforce: evaluation of VHA's comprehensive women's health primary care provider initiative. Med Care. 2015; 53(4 Suppl 1):S39-46. DOI: 10.1097/MLR.0000000000000298. View

10.

Allicock M, Haynes-Maslow L, Johnson L, Carpenter W, Vines A, Belle D . Peer Connect for African American breast cancer survivors and caregivers: a train-the-trainer approach for peer support. Transl Behav Med. 2017; 7(3):495-505. PMC: 5645281. DOI: 10.1007/s13142-017-0490-4. View

11.

Montgomery A, Tsai J, Blosnich J . Demographic Correlates of Veterans' Adverse Social Determinants of Health. Am J Prev Med. 2020; 59(6):828-836. DOI: 10.1016/j.amepre.2020.05.024. View

12.

Kroenke K, Spitzer R, Williams J . The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001; 16(9):606-13. PMC: 1495268. DOI: 10.1046/j.1525-1497.2001.016009606.x. View

13.

Marshall V, Stryczek K, Haverhals L, Young J, Au D, Ho P . The Focus They Deserve: Improving Women Veterans' Health Care Access. Womens Health Issues. 2021; 31(4):399-407. DOI: 10.1016/j.whi.2020.12.011. View

14.

Averill J . Matrix analysis as a complementary analytic strategy in qualitative inquiry. Qual Health Res. 2002; 12(6):855-66. DOI: 10.1177/104973230201200611. View

15.

Druss B, Zhao L, von Esenwein S, Bona J, Fricks L, Jenkins-Tucker S . The Health and Recovery Peer (HARP) Program: a peer-led intervention to improve medical self-management for persons with serious mental illness. Schizophr Res. 2010; 118(1-3):264-70. PMC: 2856811. DOI: 10.1016/j.schres.2010.01.026. View

16.

Eliacin J, Burgess D, Rollins A, Patterson S, Damush T, Bair M . Outcomes of a peer-led navigation program, PARTNER-MH, for racially minoritized Veterans receiving mental health services: a pilot randomized controlled trial to assess feasibility and acceptability. Transl Behav Med. 2023; 13(9):710-721. DOI: 10.1093/tbm/ibad027. View

17.

Spitzer R, Kroenke K, Williams J, Lowe B . A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006; 166(10):1092-7. DOI: 10.1001/archinte.166.10.1092. View

18.

Poleshuck E, Wittink M, Crean H, Juskiewicz I, Bell E, Harrington A . A Comparative Effectiveness Trial of Two Patient-Centered Interventions for Women with Unmet Social Needs: Personalized Support for Progress and Enhanced Screening and Referral. J Womens Health (Larchmt). 2019; 29(2):242-252. PMC: 7045559. DOI: 10.1089/jwh.2018.7640. View

19.

Johnson E, Poleshuck E, Possemato K, Hampton B, Funderburk J, Grewal H . Practical and Emotional Peer Support Tailored for Life's Challenges: Personalized Support for Progress Randomized Clinical Pilot Trial in a Veterans Health Administration Women's Clinic. Mil Med. 2022; . DOI: 10.1093/milmed/usac164. View

20.

Davidson L, Chinman M, Sells D, Rowe M . Peer support among adults with serious mental illness: a report from the field. Schizophr Bull. 2006; 32(3):443-50. PMC: 2632237. DOI: 10.1093/schbul/sbj043. View