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2023 HSR&D/QUERI National Conference Abstract

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1026 — "I didn't really feel like a human being. I felt more like an ant": Veterans' experiences seeking food assistance

Lead/Presenter: Nipa Kamdar,  COIN - Houston
All Authors: Kamdar NP (COIN- Houston), Haltom, Trenton (COIN- Houston) Smith, John (Combined Arms)

Objectives:
Food insecurity affects 1 in 4 post-9/11 Veterans and contributes to health inequity; yet little is known about Veterans' experiences seeking food assistance. Thus, our objective was to build a journey map of post-9/11 Veterans' experiences seeking food assistance. The journey map visually documents common phases, duration of time, and actions Veterans go through while food insecure and seeking help. The map also captures their emotions, pain points, and opportunities to improve care/service for Veterans who are food insecure.

Methods:
Journey maps were constructed using thematic analysis of in-depth, semi-structured qualitative interviews conducted with food insecure, post-9/11 Veterans (N = 30). We sampled by gender, children in the household, and rurality. Veterans were recruited from community settings and VHA clinics in the Houston area.

Results:
The journey map consists of four phases: (1) Food insecurity over the life course, (2) Steps to food assistance, (3) Sources of assistance, and (4) Journey outcome. Regarding Veterans' experiences with food insecurity (phase 1), most Veterans were food insecure because of financial instability attributed to employment issues, interpersonal violence, or poor mental health. Few reported screening for food insecurity from VA staff or clinicians. As Veterans began taking steps to food assistance (phase 2), they struggled to find food assistance on their own. Many expressed feelings of isolation during this time. A common source of frustration was the lack of knowledge on where to find resources or who to ask. Some Veterans languished in food insecurity for years before they finally connected with the support they needed. As they slowly identified sources of assistance (phase 3), they felt most comfortable when they received information or assistance from other Veterans. Another common source of assistance was food pantries. Veterans expressed gratitude for food pantries, though food quality often fell below expectations. Thus, many Veterans limited their use of food pantries unless they had no other option. Nearly all Veterans applied for the Supplemental Nutrition Assistance Program (SNAP); however, the majority failed to qualify because their VA disability payments placed their income above eligibility criteria. Some did qualify, but they only received the minimum $20 per month. For these reasons, SNAP was another source of frustration. After exhausting their resources (phase 4), Veterans turned to adopting coping strategies to meet their food needs. These strategies included rationing and skipping meals. They also struggle to meet other needs (e.g., transportation, childcare, and housing). Ultimately, many of the Veterans continue to live in financial "limbo" and remain food insecure. Opportunities to improve experiences and outcomes for Veterans who are food insecure range from quick wins such as providing resource lists in VHA lobbies, to policy-level changes with SNAP.

Implications:
The burden of finding assistance rests on Veterans, and current solutions (i.e., food pantries and federal assistance programs) inadequately address their needs resulting in chronic food insecurity.

Impacts:
Veterans who are food insecure need comprehensive services that address food and other social risks factors to reduce the burden and stressors that subsequently contribute to health inequity.