Veteran health and health care in the United States and Texas: A mixed methods approach

Veteran health and health care have seldom been examined using a mixed methods approach. It is critical to understand the many influences on these issues since veteran health and health care is complex by nature. The purpose of this research was to: (1) examine general self-rated health disparities and mental health diagnosis disparities between the adult and veteran populations in the U.S. for 2008; (2) to determine how VA health care facilities are distributed spatially in relation to the VA-using veteran population in Texas from 2007 to 2009; and (3) to gain a better perspective on veteran health and health care issues in San Antonio, Texas. The theoretical model used to frame these associations was the vulnerability model. The methods used to examine these three goals were logistic regression models, point pattern analyses, and qualitative case studies, respectively. Results of logistic regression analyses indicate that veterans are more at risk of reporting poor self-rated health and a mental health diagnosis than non-veterans. Additionally, traditional predisposing, enabling, and need factors (e.g. gender, race/ethnicity, health behaviors, social support, place of residence, etc.) of the vulnerability model were associated with poor self-rated health and/or a mental health diagnosis for both veteran and non-veteran populations. Results from the exploratory spatial analyses found that the majority of VA health care facilities were located in major metropolitan areas, while many of the most concentrated VA-using veteran populations were located in less urban and more rural areas. However, spatial mismatches were identified only between the distance of CBOC facilities and high concentrations of VA-using veteran populations in Texas. Finally, qualitative analyses show that there is common mistrust and apprehension of using the VA for health care due to staff and appointment issues from both veterans and their family members. Most participants indicated an interest in using these facilities, but few had confidence in the VA to provide the timely care the patients desired. Only through more research on these complex and multilevel problems will we be able to understand the more particular aspects regarding veteran health and health care needs.