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

Jespersen BV, Lafferty M, Montague K, Ono S, Helfand M, Nugent SM. "They Make It So Hard on You": How Rurality Shapes Veterans' Health Experiences When Managing Gulf War Illness. Journal of general internal medicine. 2025 Jan 17 DOI: 10.1007/s11606-025-09352-6.

Related HSR&D Project(s)

• SDR 17-151 – Listening to Gulf War Vets: A Qualitative Inquiry into the Health Experience and Treatment of those with Chronic Multisymptom Illness

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Abstract:

BACKGROUND: Gulf War illness (GWI) is characterized by multiple, persistent symptoms (e.g., fatigue, musculoskeletal pain, concentration problems, and gastrointestinal disorders) across more than one body system that are severe enough to interfere with daily functioning. For Veterans in rural areas, the confluence of geographic barriers and GWI may create unique challenges when navigating health care, given the range of specialty care needed to support GWI. However, little is known about how rural Veterans manage their GWI symptoms and navigate health care systems. OBJECTIVE: To examine how Veterans with GWI perceive rurality to influence their health care experiences. DESIGN: A cross-sectional qualitative study utilizing Health Experiences Research methodology. PARTICIPANTS: Veterans with GWI, who served in the active-duty US military, National Guard, or Reserves during the 1990-1991 Gulf War (GW) and who connected rurality to their health care experiences during interviews. APPROACH: Secondary qualitative analysis and inductive thematic analysis of semi-structured interviews, conducted between November 2018 and August 2021, with Veterans about their military and health experiences over time. KEY RESULTS: Fifteen (n = 15) Veterans with GWI connected rurality to their health care experiences and quality of life. Three themes emerged from their interviews: (1) GWI and rural residence amplified problems with care coordination; (2) Managing GWI made distance especially burdensome; and (3) Rural contexts facilitated wellness and support, while creating barriers to accessing care. CONCLUSION: Our findings suggest that rurality intersects with GWI management in ways that compound barriers to health care access for Veterans. VA can address time and distance barriers by continuing to expand specialty telehealth services and telehealth training for providers and patients. VA could also incorporate recommendations from the VA/DoD clinical practice guidelines into point-of-care decision support to enhance recognition of GWI and improve consistency of treatment, which may contribute to trust-building among GW Veterans.