"This Is What I Acquired in the Military, I Want to Keep It at the VA": Healthcare Perspectives and Preferences Among Rural American Indian/Alaska Native Women Veterans.

Good MK, Ball DD, Kramer BJ, Davila H, Howren MB, Sadler A, Birdwell S, Culley M, Duncan V, Pawiki LH, Woodard K, Mengeling M. "This Is What I Acquired in the Military, I Want to Keep It at the VA": Healthcare Perspectives and Preferences Among Rural American Indian/Alaska Native Women Veterans. The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association. 2026 Mar 1; 42(2):e70177, DOI: 10.1111/jrh.70177.

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Abstract:

PURPOSE: American Indian and Alaska Native (AI/AN) women use VA healthcare and reside in rural areas at higher proportions than other women Veterans. To support an investigation of ways to improve healthcare access and outcomes among rural AI/AN women Veterans, we conducted listening sessions on healthcare experiences, needs, and preferences. METHODS: We conducted in-person, group interview-style listening sessions using a qualitative descriptive approach. Our sample was based on states with relatively high numbers of AI/AN women Veterans. Specific sites were identified in consultation with the VA Office of Tribal Government Relations. Eleven listening sessions were conducted in eight states. Sessions were audio-recorded, transcribed, coded, and analyzed with a thematic content approach. FINDINGS: Participants reported intentional decisions about choosing VA care for health conditions they considered a direct result of military service. Examples of reasons Veterans avoided using VA included preferences for culturally based treatment services and provider cultural awareness. The relative proximity of Indian Health Service/Tribal Health Program (IHS/THP) clinics compared to VA clinics was noted in decisions for primary and acute care needs. CONCLUSIONS: Aspects of women''s prior military service were directly connected with present-day health concerns and choices about where to seek care. Results suggest AI/AN women actively select VA care for military-related conditions and use IHS/THPs for other health concerns. Healthcare systems should recognize this dual use as a Veteran-driven pattern and continue to strengthen care coordination across VA and IHS/THPs, building on existing efforts to support information sharing and continuity of care.