Affiliation:
1. Center for Access & Delivery Research and Evaluation (CADRE) and the VA Office of Rural Health (ORH) Veterans Rural Health Resource Center‐Iowa City (VRHRC‐IC) Iowa City VA Health Care System Iowa City Iowa USA
2. Department of Psychiatry University of Iowa Carver College of Medicine Iowa City Iowa USA
3. Department of Internal Medicine University of Iowa Carver College of Medicine Iowa City Iowa USA
Abstract
AbstractPurposeSince the Choice Act in 2014, many Veterans have had greater options for seeking Veteran Affairs (VA)‐purchased care in the community. We investigated factors that influence rural Veterans’ decisions regarding where to seek care.MethodsWe utilized semi‐structured telephone interviews to query Veterans living in rural or highly rural areas of Midwestern states about their health care options, preferences, and experiences. Interviews were recorded and transcribed, thematically coded, and deductively analyzed using a socioecological approach.FindingsForty rural Veterans (20 men/20 women) ages 28–76 years completed interviews in 2019. We found that rural Veterans often spoke about their relationships and interactions with providers as an important factor in deciding where to seek care. They expressed three socioecological qualities of patient–provider relationships that affected their decisions: (1) personal level—rural Veterans traveled longer distances for more compatible patient–provider relationships; (2) interpersonal level—they sought stable patient–provider relationships that encouraged familiarity, trust, and communication; and (3) organizational level—they emphasized shared identities and expertise that fostered a sense of belonging with their provider. Participants also described how impersonal interactions, status differences, and staff turnover impacted their choice of provider and were disruptive to patient–provider relationships.ConclusionsRural Veterans’ interview responses suggest exploring innovative ways to measure socioecological dimensions (i.e., personal, interpersonal, and organizational) of access‐related decisions and patient–provider relationships to better understand health care barriers and needs. Such measures align with the VA's Whole Health approach that emphasizes person‐centered care and the value of social relationships to Veterans’ health.
Funder
U.S. Department of Veterans Affairs
Office of Rural Health
Subject
Public Health, Environmental and Occupational Health
Reference58 articles.
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