Going It Alone: Post-9/11 Veteran Nonuse of Healthcare and Social Service Programs During Their Early Transition to Civilian Life
Abstract: Transitioning from military to civilian life is challenging for a substantial number of veterans.Successful transitions require veterans to function well in various well-being domainsincluding employment, education, financial, health, and social relationships. There are manyprograms and services designed to assist veterans transition to civilian life. However, veter-ans rarely avail themselves of supportive resources. This study examined veteran nonuse ofprograms and services within the first three months of their transition to civilian life. Resultsrevealed that male veterans often reported that they did not need programs. Femaleveterans and veterans from the lowest enlisted ranks were more likely to report that theydid not know if they were eligible for support programs. A small percentage of veteransindicated they had not found the right program or did not know where to go to get help.Veterans need clear information about available programs, eligibility requirements, where tolocate them, and how to identify which programs will benefit them. Future research shouldfocus on what predicts veteran use of programs and services, how use changes over time,and how programs and services should be advertised/marketed to different veteran popula-tions, particularly those at risk for poor transition outcomes.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.