Exploration of the Decision-Making Process to Access and Utilize Healthcare in Women Veterans

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Previous research described the barriers that women veterans (WVs) encounter during their decision-making to access and utilize healthcare services (Hamilton et al. 2013; Haskell, 2011& Washington et al. 2011).The decision-making process for accessing and utilizing healthcare in VA and non-VA health systems by women veterans is not described in the literature. Using a grounded theory approach (Strauss et al., 1998) and embedding the Decisional Conflict Scale (DCS) to assess for decisional conflict, this study explored how and why women veterans decide to access and utilize healthcare. A purposive sample of women veterans (n = 26) was recruited through women veteran service organizations. Twenty-six semi-structured telephone interviews were conducted. The G.R.I.T. Theory of Decision-Making by Women Veterans, (grit, resilience, insight, and trust) emerged from the data as an explanatory theory with five major themes: being vulnerable, navigating the system, digging deep, managing my life as a veteran, and encountering barriers. The core concept, having inner resolve, reflects the foundation through which women veterans rely on for decision-making. Together the categories and core concept evoked grit. According to the GRIT theory, having inner resolve is central to finding strength while vulnerable, navigating the web of healthcare, continuing to dig deep while managing the role as a woman veteran in a civilian world, and mitigating barriers to accessing and utilizing healthcare. Results from administration of the DCS indicated that decisional conflict does not affect their decision to access and utilize healthcare. The GRIT theory has broad implications. Interprofessional education led by schools of nursing that includes veteran centric curriculum content will assist healthcare providers (HCPs) to understand the unique and specific needs of women veterans. Nurses and HCPs who interact with women veterans may recognize the inner resolve and grit in this population and leverage it to facilitate healthcare decision-making. Future studies to expand on the theoretical components of the G.R.I.T. theory are warranted to continue the explanation of how the inner resolve of women veterans can be enriched.


Submitted to the Faculty of the School of Nursing Of The Catholic University of America In Partial Fulfillment of the Requirements For the Degree Doctor of Philosophy.

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Creative Commons Attribution-NonCommercial 4.0 International License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License