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2023 HSR&D/QUERI National Conference Abstract

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1035 — Unmet Social Needs Among Rural Veterans: Lived experiences, impacts on health, and recommendations for VA interventions

Lead/Presenter: Ida Griesemer,  COIN - Bedford/Boston
All Authors: Griesemer I (Center for Healthcare Organization and Implementation Research, Boston), Palmer, J (Center for Healthcare Organization and Implementation Research, Boston) MacLaren, RZ (Center for Healthcare Organization and Implementation Research, Boston) Ostrow, R (Center for Healthcare Organization and Implementation Research, Boston) Harvey, K (Center for Healthcare Organization and Implementation Research, Boston) Li, M (Center for Healthcare Organization and Implementation Research, Bedford) Linksy, A (Center for Healthcare Organization and Implementation Research, Boston) Mohr, D (Center for Healthcare Organization and Implementation Research, Boston) Gurewich, D (Center for Healthcare Organization and Implementation Research, Boston)

Objectives:
More than one in three Veterans served by the US Department of Veteran Affairs (VA) live in rural America, where there are striking differences from urban areas with respect to the social and economic conditions that drive health and health outcomes. As VA seeks to develop interventions to address social needs, such as housing and food insecurity, there is a need to better understand the unique circumstances of rural Veterans including how unmet social needs manifest and can be mitigated. In partnership with VA’s Office of Rural Health, we conducted a qualitative study examining rural Veterans’ lived experiences of unmet social needs.

Methods:
We recruited rural Veterans who had indicated in a 2020 national mail survey on unmet social needs their willingness to participate in a qualitative telephone interview. The survey assessed 9 needs: work, finances, housing, food, utilities, transportation, legal, neighborhood safety, and loneliness. Interviews were with Veterans who were purposefully sampled by race (White vs. non-White) and number of unmet social needs (1 vs. 2-3 vs. 4+). We used a semi-structured interview guide grounded in four conceptual domains: three from Andersen’s Health Services Utilization model (i.e., need factors, predisposing factors, enabling factors) and one derived de novo on opportunities and suggestions for improvement in VA’s response. Interviews were recorded and transcribed. We conducted hybrid (i.e., inductive/deductive) thematic analysis using rapid assessment procedures.

Results:
We interviewed 30 participants from March through June 2022. The study sample was 10% female, 50% non-White, and varied with respect to number of needs (1: n = 6; 2-3: n = 13; 4+: n = 11). Key findings include: (1) Unmet needs were associated with stress for some Veterans, which exacerbated health issues; (2) Coping strategies included maintaining gratitude for what one has, self-reliance/stoicism, accessing family and community support, and connecting with Veteran Service Organizations; (3) Barriers to getting help with unmet needs included limited dissemination of information about available resources, transportation challenges, mistrust of government, and the view that other Veterans need help more; and (4) Veterans had mixed views on VA’s role beyond that of serving as a source of medical care, with some struggling to conceive of a VA role in addressing social needs, but many expressing an interest in learning about available resources.

Implications:
Unmet social needs can create stress in rural Veterans’ lives and negatively impact their physical and mental health. Respondents expressed hesitancy about seeking assistance from the VA or other institutions, preferring self-reliance or the help of family and community members. While some viewed social needs as outside the purview of health care, many were open and receptive to learning about resources that might alleviate their burden of unmet social needs.

Impacts:
This study yielded recommendations from Veterans for how VA can better address unmet social needs by more actively disseminating information on social need resources within and external to VA, being attentive to Veterans’ attitudes about seeking assistance, and leveraging Veteran-serving organizations as partners in social needs interventions.