Using an Adapted Case Study Approach to Understand Rural Veteran Experiences in Patient Engagement and Patient-Centered Care Research
How to best engage rural veterans in mental health care is challenging and a topic of public health concern. Rural-dwelling veterans experience greater mental health burden and poorer outcomes than their urban counterparts, making rural veteran engagement in mental health care a public health concern. In this article, we describe how institutional notions of “patient engagement” align with or diverge from rural veteran patient experiences of engagement in mental health care. Using an adapted case study approach developed for our study, we detail the mental health care experiences of three rural-dwelling veteran participants. These case studies illustrate varied forms of mental health care engagement, including use of community resources and self-management activities, that might not be recognized by clinicians as contributing to mental health treatment. Our findings highlight how critical gaps in institutional definitions of care engagement fail to acknowledge veterans’ experiences.
2. Patton MQ. Qualitative Research & Evaluation Methods: SAGE Publications, Inc; 2001.
3. Stake RE. Multiple Case Study Analysis: The Guilford Press; 2005.
4. Yin RK. Case Study Research and Applications: Design and Methods: SAGE Publications; 2017.
5. Merriam SB. Qualitative Research and Case Study Applications in Education: Revised and Expanded from Case Study Research in Education Jossey-Bass; 2007.
6. Creswell JW, Poth CN. Qualitative Inquiry and Research Design. 3rd ed: SAGE Publications, Inc.; 2012.
7. Gardner A. Compendium of Five Case Studies: Lessons for Interprofessional Teamwork in Education and Work place Learning Environments 2011‐2016. Veterans Health Administration, Affiliations OoA; 2017.
8. Emerson AM. Strategizing and Fatalizing: Self and Other in the Trauma Narratives of Justice-Involved Women. Qual Health Res. 2018;28(6):873-87.
9. Sobo EJ. Culture and Meaning in Health Services Research: An Applied Approach. New York, NY: Taylor and Francis; 2009.
10. Abraham TH, Koenig CJ, Zamora K, Hill C, Uddo M, Kelly AP, et al. Situating mental health work in place: Qualitative findings from interviews with Veterans in Southeastern Louisiana and Northern California. Health Place. 2017;47:63-70.
11. Koenig CJ, Abraham T, Zamora KA, Hill C, Kelly PA, Uddo M, et al. Pre-Implementation Strategies to Adapt and Implement a Veteran Peer Coaching Intervention to Improve Mental Health Treatment Engagement Among Rural Veterans. J Rural Health. 2016;32(4):418-28.
12. Wallace AE, Weeks WB, Wang S, Lee AF, Kazis LE. Rural and urban disparities in health-related quality of life among veterans with psychiatric disorders. Psychiatr Serv. 2006;57(6):851-6.
13. Zivin K, Kim HM, McCarthy JF, Austin KL, Hoggatt KJ, Walters H, et al. Suicide mortality among individuals receiving treatment for depression in the Veterans Affairs health system: associations with patient and treatment setting characteristics. Am J Public Health. 2007;97(12):2193-8.
14. Fortney JC, Burgess JF, Jr., Bosworth HB, Booth BM, Kaboli PJ. A re-conceptualization of access for 21st century healthcare. J Gen Intern Med. 2011;26 Suppl 2:639-47.
15. Ramsey C, Dziura J, Justice AC, Altalib HH, Bathulapalli H, Burg M, et al. Incidence of Mental Health Diagnoses in Veterans of Operations Iraqi Freedom, Enduring Freedom, and New Dawn, 2001-2014. Am J Public Health. 2017;107(2):329-35.
16. Teich J, Ali MM, Lynch S, Mutter R. Utilization of Mental Health Services by Veterans Living in Rural Areas. J Rural Health. 2017;33(3):297-304.
17. US Department of Veterans Affairs. Rural Veterans 2017 [Available from: https://www.ruralhealth.va.gov/aboutus/ruralvets.asp
18. US Department of Veterans Affairs. Uniform Mental Health Services in VA Medical Centers and Clinics. 2008.
19. Harpaz-Rotem I, Rosenheck RA. Serving those who served: retention of newly returning veterans from Iraq and Afghanistan in mental health treatment. Psychiatr Serv. 2011;62(1):22-7.
20. Seal KH, Maguen S, Cohen B, Gima KS, Metzler TJ, Ren L, et al. VA mental health services utilization in Iraq and Afghanistan veterans in the first year of receiving new mental health diagnoses. J Trauma Stress. 2010;23(1):5-16.
21. Barello S, Graffigna G, Vegni E. Patient engagement as an emerging challenge for healthcare services: mapping the literature. Nurs Res Pract. 2012;2012:905934.
22. Harpaz-Rotem I, Rosenheck RA, Pietrzak RH, Southwick SM. Determinants of prospective engagement in mental health treatment among symptomatic Iraq/Afghanistan veterans. J Nerv Ment Dis. 2014;202(2):97-104.
23. Hearne CR. Predictors of Operation Enduring Freedom/Operation Iraqi Freedom veterans' engagement in mental health treatment. Mil Med. 2013;178(11):1183-7.
24. Barello S, Triberti S, Graffigna G, Libreri C, Serino S, Hibbard J, et al. eHealth for Patient Engagement: A Systematic Review. Front Psychol. 2015;6:2013.
25. Berwick DM. What 'patient-centered' should mean: confessions of an extremist. Health Aff (Millwood). 2009;28(4):w555-65.
26. Institute of Medicine Committee on Advancing Pain Research C, Education. The National Academies Collection: Reports funded by National Institutes of Health. Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research. Washington (DC): National Academies Press (US) National Academy of Sciences.; 2011.
27. Murphy KA, Ellison-Barnes A, Johnson EN, Cooper LA. The Clinical Examination and Socially At-Risk Populations: The Examination Matters for Health Disparities. Med Clin North Am. 2018;102(3):521-28. Bodenheimer T, Lorig K, Holman H, Grumbach K. Patient self-management of chronic disease in primary care. Jama. 2002;288(19):2469-75.
29. Phillips RL, Short A, Kenning A, Dugdale P, Nugus P, McGowan R, et al. Achieving patient-centred care: the potential and challenge of the patient-as-professional role. Health Expect. 2015;18(6):2616-28.
30. US Department of Veterans Affairs. VA Utilization Profile. 2016.?
31. Miles MB, Huberman AM, Saldana J. Qualitative Data Analysis: A Methods Sourcebook. 3rd ed: SAGE Publications, Inc.; 2014.
32. Charmaz K. Constructing Grounded Theory (Introducing Qualitative Methods series) SAGE Publications Ltd; 2014.
33. Malterud K, Siersma VD, Guassora AD. Sample Size in Qualitative Interview Studies: Guided by Information Power. Qual Health Res. 2016;26(13):1753-60.
34. Sandelowski M. Real qualitative researchers do not count: the use of numbers in qualitative research. Res Nurs Health. 2001;24(3):230-40.
35. CNN Library. Hurricane Katrina Statistics Fast Facts 2019 [Available from: https://www.cnn.com/2013/08/23/us/hurricane-katrina-statistics-fast-facts/index.html.
36. US Department of Veterans Affairs. Whole Health For Life. Transformation OoPCCC; 2017.
37. Tate JA, Happ MB. Qualitative Secondary Analysis: A Case Exemplar. J Pediatr Health Care. 2018;32(3):308-12.
38. Vindrola-Padros C, Vindrola-Padros B. Quick and dirty? A systematic review of the use of rapid ethnographies in healthcare organisation and delivery. BMJ Quality & Safety. 2018;27(4):321-30.
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