Factors impacting rural Pacific Island veterans’ access to care: A qualitative examination.

Abstract

Pacific Island veterans suffer from greater severity of posttraumatic stress disorder (PTSD) compared with Caucasian veterans but face substantial barriers to mental health care. However, the factors that may dissuade or facilitate veterans in the Pacific Islands from seeking mental health care are not known. The main aim of this study was to identify how internal and external factors interact to impact wounded warriors' access to and use of mental health services. Veterans residing in 5 rural Pacific Island locations were mailed recruitment materials. Other veterans were made aware of the project by key stakeholders in their communities. Thirty-seven male veterans (across 5 focus groups) and 1 female veteran (via individual interview) participated. The study utilized an analytic design in which taped focus group discussions were transcribed verbatim and coded for major themes. Results indicated that most veterans identified Veterans Affairs (VA) as a positive source for health care. However, common concerns acknowledged were as follows: (a) difficulty navigating the VA system, (b) time associated with receiving care, (c) family stigma, (d) community stigma, (e) cultural differences, and (f) a lack of knowledge about VA services and benefits. Facilitators of care included the following: (a) individual knowledge and self-efficacy, (b) networking with other veterans, (c) family support, and (d) rural community support. All factor levels interacted in subtle ways to ultimately impact access to care. Next steps are described, including projects designed to better meet the needs of rural Pacific Island veterans. (PsycINFO Database Record

Facilitators and Barriers to Seeking Mental Health Care Among Primary Care Veterans With Posttraumatic Stress Disorder

“…In addition to primary care veterans, another group who may encounter additional barriers to care is rural veterans. In qualitative studies, rural veterans have described self‐reliance, stigma, problems with treatment navigation, and lack of trust in providers as barriers to care, whereas perceived need for care, support from other veterans, warm hand‐offs from medical to mental health providers, and continual access to providers served as facilitators (Fischer et al., ; Whealin, Nelson, Kawasaki, & Mahoney, ). It is unknown if treatment barriers and facilitators differ between rural and urban primary care patients with PTSD.…”

Culture as a Double-Edged Sword: The Posttraumatic Experience of Indigenous Ethnic Minority Veterans

“…The participation of indigenous minority soldiers in combat is a neglected research area, although, recently, the challenging and complex needs of soldiers, who belong to these groups, are gaining recognition (McDonald, 2017; Whealin, Nelson, Kawasaki, & Mahoney, 2017). Updated research emphasizes the importance of identifying the unique cultural protective and risk factors (O’Keefe & Reger, 2017) for the development of culturally adapted treatment interventions (Whealin, Yoneda, et al, 2017).…”

A culturally adapted family intervention for rural Pacific Island veterans with PTSD.

“…Our findings indicated that there were a high number of untreated veterans with PTSD in rural locales. To gain firsthand knowledge of the clinical needs and preferences of these veterans, qualitative data were collected via focus groups with veterans of from all war eras and their family members (Whealin, Nelson, Kawasaki, & Mahoney, 2017). Representative rural locations were targeted on four Hawaiʻian islands, as well as in U.S. territories of the Western Pacific and Northern Marianas Islands.…”

“…Representative rural locations were targeted on four Hawaiʻian islands, as well as in U.S. territories of the Western Pacific and Northern Marianas Islands. Nine focus groups were also held with Veteran family members (Whealin, Nelson & Kawasaki, 2017). Focus group data revealed a strong need for basic education about coping with PTSD for both veterans and family members.…”