"They Make It So Hard on You": How Rurality Shapes Veterans' Health Experiences When Managing Gulf War Illness

Area of Science:

• Medical Sociology
• Health Services Research
• Veterans Health

Background:

• Gulf War illness (GWI) presents persistent, multi-system symptoms impacting daily function.
• Rural Veterans with GWI encounter unique health care navigation challenges due to geographic barriers.
• Limited understanding exists regarding how rural Veterans manage GWI and access care.

Purpose of the Study:

• To explore how rurality influences the healthcare experiences of Veterans with Gulf War illness.
• To identify specific challenges and facilitators in healthcare access for rural GWI patients.

Main Methods:

• Qualitative study using Health Experiences Research methodology.
• Secondary qualitative analysis of semi-structured interviews with 15 Veterans diagnosed with GWI.
• Inductive thematic analysis of interviews conducted between November 2018 and August 2021.

Main Results:

• Rural residence exacerbated care coordination issues for Veterans with GWI.
• Managing GWI symptoms was made more difficult by the burden of travel distance.
• Rural settings offered support but also presented significant barriers to accessing specialized healthcare.

Conclusions:

• Rurality significantly intersects with GWI management, intensifying healthcare access barriers for Veterans.
• Expanding telehealth services and provider/patient training can mitigate time and distance challenges.
• Integrating clinical practice guideline recommendations into decision support can improve GWI recognition and treatment consistency.