Search Results (20)

Transportation is often cited as a significant barrier to healthcare access by Veterans, particularly those from minority groups, who have disabilities, or live in rural areas. Autonomous shuttles (AS) offer a potential solution, yet limited research has explored Veterans’ experiences with this technology. This study qualitatively investigated Veterans’ lived experiences with AS through focus groups, enrolling participants aged 18+ from Gainesville, The Villages, and Lake Nona, Florida. Via a directed content analysis, six key themes were identified: Perceived Benefits, Safety, Experience with Autonomous Vehicles (AV), AS Experience, AV Adoption, and Perception Change. Among 26 participants (aged 30–85; 77% men; 88% urban residents), prominent themes included Safety (n = 161), Perceived Benefits (n = 153), and AS Experience (n = 118), with predominantly positive counts in all themes except AS Experience. Participants acknowledged safety advantages and multitasking potential of AS over human-operated vehicles while recommending improvements to the shuttle’s slow speed, availability and convenience. While the AS ride was positively received overall, some participants noted issues with comfort and braking, emphasizing the need for further technological enhancements. Real-world exposure to AS appeared to influence acceptance positively, offering insights for policymakers and industry stakeholders aiming to optimize AS deployment for mobility-vulnerable Veterans. Full article

Community-based systems present a key option for water services, especially in rural areas. Our goal is to achieve a state-of-the-art understanding of joint rural water supply development in Finland over 150 years. A mixed-methods approach was used: a literature survey and a questionnaire to selected experts. Based on the literature, a table including 23 decisions considered the most influential strategic events from 1872 to 2022 was produced. The table was sent to 10 selected experts known to be deeply familiar with the theme, all of whom replied. Joint rural water services in Finland have evolved based on demand through co-operative principles. The first documented scheme was constructed in 1872, while governmental financial support to rural water services started in 1951. It expanded in various forms until it dramatically declined in recent years. Multi-locality may increase the need for these services in the future. The expert survey revealed the following most influential long-term decisions: the first official water co-operative established in 1907, the land reform for immigrants and war veterans introduced in 1945, the Committee for Rationalisation of Households established in 1950, the start of domestic manufacturing of plastic pipes in 1954, and the Water Act enacted in 1962 to start water pollution control. This paper reminds us that urban and rural services are not contradictory but can supplement each other. Full article

The Department of Veterans Affairs’ (VA’s) transportation system plays an important role in ensuring access to transportation services for veterans, particularly those in rural or underserved areas. However, concerns remain regarding the effectiveness of collaboration among the various VA transportation stakeholders. Persistent transportation challenges hinder veterans’ access to essential healthcare services and resources. Electric autonomous ride-sharing services (ARSSs) offer a promising opportunity to enhance transportation access; however, their current limitations and the perspectives of VA transportation personnel must be considered. This study explored the current perspectives of the VA transportation system and assessed ARSSs as an innovative and sustainable alternative through interviews with eight VA transportation stakeholders representing seven transportation sectors. Our findings revealed the VA’s strengths, including personalized service, flexible accommodations, and collaborative care models, but also identified challenges, including limited funding, staff shortages, volunteer constraints, and restrictive eligibility criteria. The introduction of ARSSs was identified as an opportunity to alleviate some of these constraints by reallocating human resources and improving access to essential services, although concerns remain regarding ARSSs’ ability to accommodate veterans with disabilities and address rural route complexities. Effective communication strategies and streamlined coordination were key recommendations for improving service delivery and expanding transportation access for veterans. Full article

Background: Access to healthcare is a significant challenge for rural veterans, especially those with chronic conditions; yet, research on their specific barriers remains limited. This study had three objectives: (1) to develop and validate the Rural Access to Care and Services Scale (RACSS) as a simple tool to assess access to physical, mental, and social care and services; (2) to examine whether minority veterans face greater barriers to care; and (3) to test whether RACSS scores are associated with psychosocial outcomes as theoretically expected. Methods: Data were collected from 500 rural veterans in the U.S. through a survey assessing demographic information, service-connected disability status, clinical conditions, and access to healthcare. First, the RACSS was developed and validated using Exploratory Factor Analysis (EFA) and Confirmatory Factor Analysis (CFA). Second, to assess the reliability of the RACSS, internal consistency was evaluated using Cronbach’s alpha. Finally, independent sample t-tests were conducted to explore the relationships between access to healthcare and services and participants’ minority status. Results: The scale demonstrated a one-factor structure with excellent model fit indices and high internal consistency (α = 0.89). Veterans from minoritized racial and ethnic groups reported significantly higher difficulties in accessing healthcare and services. Conclusions: The RACCS provides a reliable tool to measure access to healthcare and services among rural veterans. The findings highlight the critical need for targeted interventions to improve access to healthcare and services, especially for veterans from minoritized racial and ethnic groups. Enhancing healthcare and service delivery in rural areas is essential to reducing disparities and improving health outcomes for this underserved population. Full article

Background/Objectives: The study’s objective was to determine whether social isolation serves as a mediator in the cross-sectional relationship between food insecurity, both as a short-term and longer-term situation, with resource use and depressive symptoms as outcomes. Methods: This cross-sectional design study utilized secondary survey data, including 30-day and 12-month food security measured by the U.S. Household Food Security Survey Module. The Baron–Kenny mediation approach was used to determine whether social isolation mediated the relationship between food security, depressive symptoms, and resource use (p ≤ 0.05). Results: Social isolation mediates the association between both 30-day and 12-month food security with depressive symptoms but not resource use. Conclusions: Acknowledging and targeting social isolation, policies, and interventions that integrate peer support and community outreach to promote food security could support rural veterans food security and mental health. Full article

Veterans often face transportation barriers, but advances in technology enable real-world testing of shared autonomous electric vehicles as potential energy-efficient solutions. While previous research has assessed civilians’ perceptions of autonomous vehicles (AVs), veterans—due to unique military experiences and health conditions—represent a distinct demographic. This study investigates veterans’ perceptions of autonomous shuttles (ASs) to assess whether these innovations may foster sustainable transportation behaviors. Leveraging data from the Autonomous Vehicle User Perception Survey (AVUPS), this study assessed AS perceptions among 77 veterans across four Florida cities before and after exposure. Results indicated significant increases in intention to use and total acceptance and a decrease in perceived barriers, with no change in well-being. Urban veterans showed improvements across multiple subscales, while rural veterans only showed reduced perceived barriers. Those with initially low total acceptance scores demonstrated greater improvements, particularly in intention to use and perceived barriers. The analysis of survey items showed increased trust, greater willingness to multitask, improved safety perceptions, and reduced concerns about declining driving abilities and hesitations toward AVs, with the latter three items remaining significant after correction. Overall, AS exposure positively influenced veterans’ perceptions, and the results point to the potential of ASs as a sustainable transportation option for veterans. Full article

Veterans living in rural areas of the United States face various health challenges that demand timely access to care to improve their well-being and quality of life. Telehealth (i.e., the use of telecommunications technology to connect people with care providers remotely) has become vital in addressing the accessibility gap for people constrained by vehicle ownership, income, geographic isolation, and limited access to specialists. This study aims to examine the current evidence on rural veterans’ use of telehealth for their healthcare needs, evaluates the cost savings associated with telehealth, as well as veterans’ use of telehealth during COVID-19. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic search was conducted on three databases (Google Scholar, PubMed, and Scopus) to select relevant articles published from 2017 to 2023. A total of 36 articles met the inclusion criteria and were categorized into three objectives: veterans’ medical conditions managed through telehealth (n = 24), veterans’ transportation cost savings using telehealth (n = 4), and telehealth use during the COVID-19 pandemic (n = 8). The results indicated that telehealth is a viable option for managing various medical conditions of rural veterans, including complex ones like diabetes and cancer. Additionally, telemedicine was a useful platform in bridging the healthcare accessibility gap during disasters or pandemics like COVID-19 evident from its increased usage during the pandemic. Lastly, telehealth was associated with cost and time savings between USD 65.29 and USD 72.94 per visit and 2.10 and 2.60 h per visit, respectively. However, the feasibility of telehealth for veterans’ medical conditions such as rheumatism, cancer, HIV, and diabetes is underexplored and calls for further investigation post-COVID-19. Lastly, the limited literature on rural veterans’ transportation cost savings using different mobility options—taxi, Uber, public transportation, and rides from friends and family—is another critical gap. Full article

Military sexual trauma-related post-traumatic stress disorder (PTSD) is highly prevalent and costly among women veterans, making the need for effective and accessible treatment of critical importance. Access to care is a key mechanism of mental health disparities and might affect differential response to treatment. The goal of this study was to estimate an individualized treatment rule based on readily available individual characteristics related to access to care to optimize allocation to in-person vs. telehealth delivery of prolonged exposure for PTSD in military sexual trauma survivors. The following variables were used as prescriptive factors: age, race, disability status, socioeconomic status, rural vs. urban status, and baseline PTSD level. The rule was estimated using a machine-learning approach, Outcome Weighted Learning. The estimated optimal rule outperformed a one-size-fits-all rule where everyone is universally assigned to telehealth; it led to markedly lower mean PTSD levels following 6 months from treatment ($V$d_opt − $V$_Telehealth = −14.55, 95% CI: −27.24, −1.86). However, the rule did not significantly discriminate for in-person therapy ($V$d_opt − $V$_In-person = −11.86, 95% CI: −25.83, 2.12). Upon further validation with larger and more diverse samples, such a rule may be applied in practice settings to aid clinical decision-making and personalization of treatment assignment. Full article

Suicide is a significant public health problem, with disproportionate rates in rural areas. Rural communities face substantial structural and cultural barriers to suicide prevention. This study aimed to gain a deeper understanding of the need for suicide prevention and gauge the appropriateness of prevention efforts in the context of a rural Georgia county by leveraging existing community resources and knowledge. Twenty one-on-one, semi-structured interviews and two focus groups were conducted, with participants recruited via purposive snowball sampling. Data analysis included qualitative deductive and inductive content analysis from individual interviews and focus groups with community stakeholders. The findings highlight how rural contexts exacerbate drivers of death by suicide and how the substantial loss of community members to suicide contributes to the ongoing crisis and reduces available support. Access to mental health care often depended on a connection to an established public system such as schools, a military base, or Veterans Administration. There were perceived gaps in crisis and post-crisis services, with participants actively trying to address these gaps and build community support through coalition building. This study contributes knowledge to contextual drivers of suicide in rural areas beyond individual-level risk factors. Community-engaged suicide prevention research in rural areas is promising, but there is a need to develop interventions to best support coalition building and capacity development. Full article

Veterans face difficulties accessing vital health and community services, especially in rural areas. Autonomous vehicles (AVs) can revolutionize transportation by enhancing access, safety, and efficiency. Yet, there is limited knowledge about how Veterans perceive AVs. This study fills this gap by assessing Veterans’ AV perceptions before and after exposure to an autonomous shuttle (AS). Using a multi-method approach, 23 participants completed pre- and post-AS Autonomous Vehicle User Perception Survey (AVUPS), with 10 participants also taking part in post-AS focus groups. Following exposure to the AS, differences were observed for three out of the four AVUPS domains: an increase in Intention to Use (p < 0.01), a decrease in Perceived Barriers (p < 0.05), and an increase in Total Acceptance (p = 0.01); Well-being remained unchanged (p = 0.81). Feedback from focus groups uncovered six qualitative themes: Perceived Benefits (n = 70), Safety (n = 66), Shuttle Experience (n = 47), AV Adoption (n = 44), Experience with AVs (n = 17), and Perception Change (n = 10). This study underscores AVs’ potential to alleviate transportation challenges faced by Veterans, contributing to more inclusive transportation solutions. The research offers insights for future policies and interventions aimed at integrating AV technology into the transportation system, particularly for mobility-vulnerable Veterans in rural and urban settings. Full article

Mortality due to COVID-19 has been correlated with laboratory markers of inflammation, such as C-reactive protein (CRP). The lower mortality during Omicron variant infections could be explained by variant-specific immune responses or host factors, such as vaccination status. We hypothesized that infections due to Omicron variant cause less inflammation compared to Alpha and Delta, correlating with lower mortality. This was a retrospective cohort study of veterans hospitalized for COVID-19 at the Veterans Health Administration. We compared inflammatory markers among patients hospitalized during Omicron infection with those of Alpha and Delta. We reported the adjusted odds ratio (aOR) of the first laboratory results during hospitalization and in-hospital mortality, stratified by vaccination status. Of 2,075,564 Veterans tested for COVID-19, 29,075 Veterans met the criteria: Alpha (45.1%), Delta (23.9%), Omicron (31.0%). Odds of abnormal CRP in Delta (aOR = 1.85, 95% CI:1.64–2.09) and Alpha (aOR = 1.94, 95% CI:1.75–2.15) were significantly higher compared to Omicron. The same trend was observed for Ferritin, Alanine aminotransferase, Aspartate aminotransferase, Lactate dehydrogenase, and Albumin. The mortality in Delta (aOR = 1.92, 95% CI:1.73–2.12) and Alpha (aOR = 1.68, 95% CI:1.47–1.91) were higher than Omicron. The results remained significant after stratifying the outcomes based on vaccination status. Veterans infected with Omicron showed milder inflammatory responses and lower mortality than other variants. Full article

Rural veterans have poorer health, use healthcare services less often than their urban counterparts, and have more prevalent food insecurity than average U.S. households. Food insecurity and resource use may be influenced by modifiable psychological attributes such as grit and help-seeking behaviors, which may be improved through interventions. Grit and help-seeking have not been previously evaluated among rural veterans. Thus, this cross-sectional study evaluated the hypothesis that grit and help-seeking were associated with food insecurity and the use of resources. Food security, resource use, grit, and help-seeking behavior were assessed among rural veterans (≥18 years) from five food pantries in southern Illinois counties (n = 177) from March 2021 to November 2021. Adjusted multiple regression was used to estimate the relationship between the odds of food insecurity and the use of resources with grit and help-seeking scores. Higher grit scores were significantly associated with lower odds of food insecurity (OR = 0.5, p = 0.009). No other associations were detected. The results provided evidence to inform the content of future educational interventions to improve food insecurity and address health disparities among rural veterans by addressing grit. The enhancement of psychological traits such as grit is related to food security and has the potential to benefit other aspects of well-being. Full article

Suboptimal antibiotic prescribing may be more common in patients living in rural versus urban areas due to various factors such as decreased access to care and diagnostic testing equipment. Prior work demonstrated a rural health disparity of overprescribing antibiotics and longer durations of antibiotic therapy in the United States; however, large-scale evaluations are limited. We evaluated the association of rural residence with suboptimal outpatient antibiotic use in the national Veterans Affairs (VA) system. Outpatient antibiotic dispensing was assessed for the veterans diagnosed with an upper respiratory tract infection (URI), pneumonia (PNA), urinary tract infection (UTI), or skin and soft tissue infection (SSTI) in 2010–2020. Rural–urban status was determined using rural–urban commuting area codes. Suboptimal antibiotic use was defined as (1) outpatient fluoroquinolone dispensing and (2) longer antibiotic courses (>ten days). Geographic variation in suboptimal antibiotic use was mapped. Time trends in suboptimal antibiotic use were assessed with Joinpoint regression. While controlling for confounding, the association of rurality and suboptimal antibiotic use was assessed with generalized linear mixed models with a binary distribution and logit link, accounting for clustering by region and year. Of the 1,405,642 veterans diagnosed with a URI, PNA, UTI, or SSTI and dispensed an outpatient antibiotic, 22.8% were rural-residing. In 2010–2020, in the rural- and urban-residing veterans, the proportion of dispensed fluoroquinolones declined by 9.9% and 10.6% per year, respectively. The rural-residing veterans were more likely to be prescribed fluoroquinolones (19.0% vs. 17.5%; adjusted odds ratio (aOR), 1.03; 95% confidence interval (CI), 1.02–1.04) and longer antibiotic courses (53.8% vs. 48.5%; aOR, 1.19, 95% CI, 1.18–1.20) than the urban-residing veterans. Among a large national cohort of veterans diagnosed with URIs, PNA, UTIs, and SSTIs, fluoroquinolone use and longer antibiotic courses were disproportionally more common among rural- as compared to urban-residing veterans. Outpatient antibiotic prescribing must be improved, particularly for rural-residing patients. There are many possible solutions, of which antibiotic stewardship interventions are but one. Full article

Background: The proportion of women Veterans are increasing and, as such, access to high-quality breast cancer care is important. Prior studies have shown that rural location, age, and a mental health diagnosis negatively impact breast cancer screening rates. Methods: We aimed to retrospectively assess the impact of these risk factors on breast cancer screening adherence rates among Veterans at our institution. Women who were eligible for breast cancer screening per the United States Preventative Services Taskforce guidelines were included. Results: Of 2321 women, overall adherence was 78.2%. There were no significant differences in screening rates between races, various age groups, geographical distribution, and having anxiety or post-traumatic stress disorder (PTSD). However, Veterans with a diagnosis of depression were more likely to adhere to screening guidelines. Having multiple mental health diagnoses was also not a negative risk factor. Conclusions: Our Veteran population’s adherence rates are higher than the national average and rural location, race, age, and certain mental health disorders did not negatively affect adherence to screening mammography. Though more research is needed, screening reminders from our women’s health coordinator may have improved adherence rates and lowered disparities. Full article

The purpose of this qualitative study was to explore perspectives of Whole Health (WH) coaches at the Veterans Health Administration (VHA) on meeting the needs of rural Veterans during the COVID-19 pandemic. The evaluation design employed a qualitative description approach, employing focus groups and in-depth interviews with a convenience sample of WH coaches across the VHA system. Fourteen coaches who work with rural Veterans participated in either one of three focus groups, individual interviews, or both. The focus group data and in-depth interviews were analyzed separately using thematic analysis, and findings were then merged to compare themes across both datasets. Four primary themes were identified: bridging social risk factors for rural Veterans, leveraging technology to stay connected with Veterans at-a-distance, redirecting Veterans to alternate modes of self-care, and maintaining flexibility in coaching role during COVID-19. One overarching theme was also identified following a post-hoc analysis driven by interdisciplinary team discussion: increased concerns for Veteran mental health during COVID-19. Coaches reported using a variety of strategies to respond to the wide-ranging needs of rural Veterans during the pandemic. Implications of findings for future research and practice are discussed. Full article