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Health and Health Care Use of American Indian/Alaska Native Women Veterans: A Scoping Review
Mary K Good1, Heather Davila1, Daniel Ball1
1VA Office of Rural Health (ORH), Veterans Rural Health Resource Center-Iowa City (VRHRC-IC), Iowa City VA Health Care System, Iowa City, Iowa; Center for Access & Delivery Research and Evaluation (CADRE), Iowa City VA Health Care System, Iowa City, Iowa; Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa.
Background:
American Indian/Alaska Native (AI/AN) women serve in the U.S. military, use Veterans Health Administration (VA) health care, and reside in rural areas at the highest rates compared with other women veterans. However, little is known about their unique health care needs, access, and health care use.
Objective:
We assessed the existing literature on the health and health care use of U.S. AI/AN women veterans.
Methods:
Online databases were searched to identify studies. Study characteristics extracted included health care topic, study design, overall sample size and number of AI/AN women veterans, and funding source. We screened 1,508 publications for inclusion; 28 publications were ultimately retained.
Results:
Health care access and use were the most common health care research topics (39%), followed by mental health (36%) and physical health (25%). Few studies considered the impact of rurality. Most studies found significant differences between AI/AN women veterans and other women veterans or AI/AN men veterans. Publication dates ranged from 1998 to 2023, with 71% published after 2010. The majority of studies (75%) were secondary analyses of extant health care data. More than three-quarters of studies (82%) were funded federally (e.g., VA). Many studies were based on VA administrative data, resulting in a gap in knowledge regarding AI/AN women veterans who are not eligible for, or choose not to use, VA health care.
Conclusion:
Research to inform the health and health care of AI/AN women veterans is limited, especially in terms of known AI/AN and women veterans' prevalent health concerns (e.g., diabetes, hypertension), women's health and reproduction, and how AI/AN women veterans access, use, and confront barriers to health care. Moreover, there is scarce research specific to cultural, tribal, and regional factors that likely affect access and use of particular health care systems or that can affect perspectives on illness that impact long-term treatment adherence and patient outcomes.
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