Veteran-centered barriers to VA mental healthcare services use

BMC Health Services Research

卷:18

Christopher J. Koenig¹  Ann M. Cheney²  Jeffrey M. Pyne³  Regina Stanley³  John Fortney⁴  Kara Zamora⁵  Patricia Wright⁶  Christopher J. Miller⁷  James F. Burgess⁷ 

[1] Department of Communication Studies, San Francisco State University;

[2] Department of Social Medicine, Population, and Public Health, Center for Healthy Communities, School of Medicine, University of California;

[3] HSR&D Center of Innovation, Central Arkansas VA Health Care System;

[4] Health Services Research and Development, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System;

[5] San Francisco Veterans Affairs Health Care System;

[6] School of Nursing, University of Arkansas for Medical Sciences;

[7] The Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System;

关键词: Cultural domain analysis;    Health care services use;    Mental health;    Patient-centered care;    Qualitative research;    Veterans;   

DOI  :  10.1186/s12913-018-3346-9

来源: DOAJ

【 摘 要 】

Abstract Background Some veterans face multiple barriers to VA mental healthcare service use. However, there is limited understanding of how veterans’ experiences and meaning systems shape their perceptions of barriers to VA mental health service use. In 2015, a participatory, mixed-methods project was initiated to elicit veteran-centered barriers to using mental healthcare services among a diverse sample of US rural and urban veterans. We sought to identify veteran-centric barriers to mental healthcare to increase initial engagement and continuation with VA mental healthcare services. Methods Cultural Domain Analysis, incorporated in a mixed methods approach, generated a cognitive map of veterans’ barriers to care. The method involved: 1) free lists of barriers categorized through participant pile sorting; 2) multi-dimensional scaling and cluster analysis for item clusters in spatial dimensions; and 3) participant review, explanation, and interpretation for dimensions of the cultural domain. Item relations were synthesized within and across domain dimensions to contextualize mental health help-seeking behavior. Results Participants determined five dimensions of barriers to VA mental healthcare services: concern about what others think; financial, personal, and physical obstacles; confidence in the VA healthcare system; navigating VA benefits and healthcare services; and privacy, security, and abuse of services. Conclusions These findings demonstrate the value of participatory methods in eliciting meaningful cultural insight into barriers of mental health utilization informed by military veteran culture. They also reinforce the importance of collaborations between the VA and Department of Defense to address the role of military institutional norms and stigmatizing attitudes in veterans’ mental health-seeking behaviors.

【 授权许可】

Unknown