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Newsletter | South Central MIRECC

Banner of the SC MIRECC communique newsletter

Summer 2019, Volume 21, Issue 3 - In this Issue

Introducing the 2019 TRIPS Awardees
RtoP | Veteran-Centered Barriers to Use of VA Mental Health Services
New Grants for Research on Suicide Prevention Funded in New Orleans
Affiliates Share Research Results Across the Country
Houston Affiliates Receive Local and National Honors
Newest Clinical Education Products
Recent Publications
Pilot Study Grant Award Application Opportunity
Research Methods and Analysis Consultation Services Available

Research to Practice | Veteran-Centered Barriers to Use of VA Mental Health Services

Summary by Sonora Hudson, MA and Derrecka Boykin, PhD

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Researchers at the Boston, San Francisco, Central Arkansas and Puget Sound VA Medical Centers, along with others, recently published results of a participatory, mixed-methods project examining Veteran-centered barriers to using VHA mental healthcare services. The study included 10 sites, urban and rural, in three Veterans Integrated Service Networks in Maine, Arkansas, and Northern California. The researchers recruited Veterans who used VHA services but not necessarily specialty mental health services and screened positive for at least one behavioral health problem (depression, PTSD, or at-risk alcohol use) during a routine VHA primary care appointment within the past year.

Researchers used cultural domain analysis to identify Veteran-perceived barriers to use of VHA mental health services, in addition to qualitative, semi structured interviews to understand how these barriers influence mental health service use. Veterans completed a brief sociodemographic survey and reported on the severity of their mental health symptoms for the three disorders being examined. Measures included the Patient Health Questionnaire, the PTSD Checklist Civilian version and the AUDIT-C. Sixty-six (of 80) Veterans participated in the cultural domain analysis. An effort was made to recruit from different service eras and races and ethnicities, in addition to overrecruiting women Veterans.

Cultural domain analysis is a multistep, iterative process that examines how members of a shared cultural background define aspects of that culture into a single idea. In the first step, a sample of 23 Veterans generated a complete list of 238 words and brief phrases during an unstructured, open-ended free-list exercise. This list was narrowed down to 46 unique words and brief phrases.

In the next step, a new sample of 29 Veterans sorted these items into as many or as few piles as necessary before labeling the piles. Pile sort data were then analyzed using multidimensional scaling and cluster analysis to identify meaningful dimensions.

Finally, a third sample of 14 Veterans were asked during a qualitative interview to explain why items were clustered together and their relationship to Veterans’ healthcare experiences. Researchers also asked these Veterans to label each pile, which resulted in different descriptive titles.

Five dimensions of barriers were identified:

  1. Worry and concern about what others think
  2. Financial, personal, and physical obstacles
  3. Confidence in the VHA
  4. Challenges of navigating VA benefits and healthcare services; and
  5. Privacy, security issues and abuse of services.


Researchers interpreted the results as demonstrating that part of the problem for lack of use of VHA mental health services can be attributed to military socialization, which encourages soldiers to endure challenges without complaint and perceives asking for help as a weakness. Systemic challenges were also manifest (staffing shortages, challenges in making appointments, etc.). In addition, some Veterans distrusted the VHA system because it is a government entity, including being wary of providers’ use of computers to maintain sensitive information.

Researchers concluded that the Department of Defense and VHA need to collaborate more to ease the transition of troops from active-duty status into their Veteran phase and to address Veterans’ mistrust of the system, noting that distrust issues may impede the use of technology with some Veterans.

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*MIRECC affiliates in bold

Citation: Cheney AM, Koenig CJ, Miller CJ, Zamora K, Wright P, Stanley R . . . Pyne JM (2018). Veteran-centered barriers to VA mental healthcare services use. BMC Health Services Research, 18, 591.


Last updated: July 25, 2019