Experiences of Homeless Vietnam Veterans in Deciding to Access or Not Access Healthcare

Homeless Vietnam Veterans (HVV) report their health status as poor, indicating a multitude of health concerns, including physical and psychological problems, post-traumatic stress disorder (PTSD), and alcohol or drug dependencies. Prompt attention to health care may improve the prognosis; however, HVV tend to delay seeking medical attention. The purpose of this study was to explore the process utilized by HVV to make the decision to access or to not access health care services. According to inclusion criteria of the study, all participants served in the US military during the Vietnam War.

Eleven HVV were interviewed to understand the decision-making process about accessing health care services. Using Grounded Theory Methodology with Symbolic Interactionism as the philosophical framework, semi-structured interviews were conducted. Data analysis was performed according to Straussian methodology and included open, axial, and selective coding.

Three predominant categories surfaced: military experiences, substance use, and access issues. A lesser category of homelessness with informal communication via the grapevine was also identified. The core category is healthcare decision-making. A description of processes used by HVV in accessing health care was used to create a preliminary theory.

Based on the data, healthcare decision-making seems to occur within the context of military experiences; substance use; homelessness, where communication occurs via the grapevine, and access issues with difficulty with mobility, convenience, quality, and system inefficiencies. While none of these concepts alone appear to be the primary trigger for healthcare decision-making in HVV, healthcare decision-making certainly occurs within the context of the collective of these concepts.

Therefore, the preliminary HVV Health Care Utilization Theory is that HVV have an alternate view of wellness and health. Rather than health being the absence of disease, it is surviving in the presence of disease.  The environment of homelessness enhances diminished or compromised wellness. Camaraderie is important in the homeless environment, where information sharing occurs via informal networks- as through the grapevine. When HVV enter the healthcare environment, especially when using VA facilities, HVV experience more burden than benefit because of access issues.