The Department of Veterans Affairs (VA) employs numerous strategies to address food insecurity among rural veterans. This manuscript discusses findings from a quality improvement project examining factors impacting food insecurity among rural veterans.
Methods
Qualitative interviews were conducted with VA expert informants (n = 30) who worked in national program offices addressing veteran food insecurity, site visit participants (n = 57) at three VA Medical Centers (VAMCs), and rural veterans who screened positive for food insecurity at the VAMC sites (n = 10). Interviews were analyzed with analysis matrices.
Results
Current VA programming includes a national food insecurity screening initiative and connecting veterans with local community resources. Veteran participants provided suggestions for addressing veteran food insecurity, including outreach and education. In addition, these interviews demonstrate that rural veteran food insecurity is intrinsically interwoven with other social determinants of health.
Conclusions
Addressing rural veteran food insecurity must include strategies for understanding and supporting interconnected veteran needs.
Coleman-JensenARabbittMPGregoryCA, et al.Household Food Security in the United States in 2021. United States Department of Agriculture Economic Research Service, Economic ResearchReport No. ERR-309, 2022. https://www.ers.usda.gov/publications/pub-details/?pubid=104655
3.
CohenAJRudolphJLThomasKS, et al.Food insecurity among veterans: resources to screen and intervene. Fed Pract2020; 37(1): 16–23.
4.
BrostowDGunzburgerEThomasK. Food insecurity among veterans: findings from the health and retirement study. J Nutr Health Aging2017; 21: 1358–1364.
5.
ElbogenEGrazianoRLaRueG, et al.Food insecurity and suicidal ideation: results from a national longitudinal study of military veterans. Arch Suicide Res2023; 28: 644–659.
6.
NarainKBean-MayberryBWashingtonDL, et al.Access to care and health outcomes among women veterans using veterans administration health care: association with food insufficiency. Wom Health Issues2018; 28(3): 267–272.
7.
’TooleOThomasPRobertsCB, et al.Peer reviewed: screening for food insecurity in six veterans administration clinics for the homeless, June–December 2015. Prev Chronic Dis2017; 14: E04.
8.
RabbittMPSmithMD. Food insecurity among working-age veterans. Washington, DC: United States Department of Agriculture Economic Research Service, 2021. Economic Research Report No. ERR-829. https://www.ers.usda.gov/publications/pub-details/?pubid=101268
9.
WidomeRJensenABangerterA, et al.Food insecurity among veterans of the US wars in Iraq and Afghanistan. Publ Health Nutr2015; 18(5): 844–849.
10.
WrightBNMacDermid WadsworthSWellnitzA, et al.Reaching rural veterans: a new mechanism to connect rural, low-income US Veterans with resources and improve food security. J Public Health2019; 41(4): 714–723.
11.
LloydJL. From farms to food deserts: food insecurity and older rural Americans. Generations2019; 43(2): 24–32.
12.
QinYSneddonDAMacDermid WadsworthS, et al.Grit but not help-seeking was associated with food insecurity among low income, at-risk rural veterans. Int J Environ Res Publ Health2023; 20(3): 2500.
WangEAMcGinnisKGouletJ, et al.Food insecurity and health: data from the veterans aging cohort study. Publ Health Rep2015; 130(3): 261–268.
15.
CohenAJDosaDMRudolphJL, et al.Risk factors for Veteran food insecurity: findings from a National US Department of Veterans Affairs food insecurity screener. Publ Health Nutr2022; 25(4): 819–828.
16.
CuttsDCookJ. Screening for food insecurity: short-term alleviation and long-term prevention. Am J Publ Health2017; 107(11): 1699–1700.
TongASainsburyPCraigJ. Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups. Int J Qual Health Care2007; 19(6): 349–357.
23.
NevedalALReardonCMJacksonGL, et al.Implementation and sustainment of diverse practices in a large integrated health system: a mixed methods study. Implement Sci Commun2020; 1: 61.
24.
PenneyLSMoreauJMiake-LyeI, et al.Spreading the Veterans health administration's emergency department rapid access clinics (ED-RAC) innovation: role of champions and local contexts. Healthc2021; 9(2): 100516.
25.
AverillJ. Matrix analysis as a complementary analytic strategy in qualitative inquiry. Qual Health Res2002; 12(6): 855–866.
26.
GaleRWuJErhardtT, et al.Comparison of rapid vs in-depth qualitative analytic methods from a process evaluation of academic detailing in the Veterans Health Administration. Implement Sci2019; 14(1): 11–12.
27.
StockdaleMS. Analyzing focus group data with spreadsheets. Am J Health Stud2002; 18(1): 55.
28.
Vindrola-PadrosCJohnsonGA. Rapid techniques in qualitative research: a critical review of the literature. Qual Health Res2020; 30(10): 1596–1604.
29.
World Health Organization. Closing the gap in a generation: health equity through action on the social determinants of health. Commission on Social Determinants of Health2008. https://www.who.int/publications/i/item/WHO-IER-CSDH-08.1
30.
AlderwickHGottliebLM. Meanings and misunderstandings: a social determinants of health lexicon for health care systems. Milbank Q2019; 97(2): 407–419.
31.
FriedmanNLBanegasMP. Toward addressing social determinants of health: a health care system strategy. Perm J2018; 22: 18.
32.
GottliebLFichtenbergCAlderwickH, et al.Social determinants of health: what’s a healthcare system to do?J Healthc Manag2019; 64(4): 243–257.
33.
FarmerPENizeyeBStulacS, et al.Structural violence and clinical medicine. PLoS Med2006; 3(10): e449.
34.
BradleySEHeuerJNHahmB, et al.“Just food doesn’t do it”: understanding food insecurity among rural veterans in the United States. Ecol Food Nutr2024; 63: 564–584.
35.
CypelYSKatonJGSchureMB, et al.Food insecurity in US military veterans. Food Nutr Bull2020; 41(4): 399–423.
WeeksWBWallaceAEWestAN, et al.Research on rural veterans: an analysis of the literature. J Rural Health2008; 24(4): 337–344.
38.
JonesALHausmannLRMHaasGL, et al.A national evaluation of homeless and nonhomeless veterans’ experiences with primary care. Psychol Serv2017; 14(2): 174–183.
39.
PullenEOserC. Barriers to substance abuse treatment in rural and urban communities: counselor perspectives. Subst Use Misuse2014; 49(7): 891–901.
40.
SigmonSC. Access to treatment for opioid dependence in rural America: challenges and future directions. JAMA Psychiatr2014; 71(4): 359–360.
41.
Cohen-MansfieldJHazanHLermanY, et al.Correlates and predictors of loneliness in older-adults: a review of quantitative results informed by qualitative insights. Int Psychogeriatr2016; 28(4): 557–576.
42.
GurewichDShoushtariSIOstrowR, et al.Prevalence and determinants of unmet social needs among rural and urban veterans. J Health Care Poor Underserved2023; 34(1): 275–292.
43.
CusackMMontgomeryAEHarrisT, et al.Providers’ reflections on infrastructure and improvements to promote access to care for Veterans experiencing housing instability in rural areas of the United States: a qualitative study. Health Soc Care Community2022; 30(6): e6356–e6365.
44.
FergusonJMJacobsJYefimovaM, et al.Virtual care expansion in the Veterans Health Administration during the COVID-19 pandemic: clinical services and patient characteristics associated with utilization. J Am Med Inf Assoc2021; 28(3): 453–462.
45.
IzumiBTGonzalezLANessS, et al.Feasibility of using rideshare transportation to reduce barriers to participating in a clinic-based food insecurity intervention. Prog Community Health Partnersh2023; 17(2): 287–294.
46.
ValliantJCDBurrisMECzebotarK, et al.Navigating food insecurity as a rural older adult: the importance of congregate meal sites, social networks and transportation services. J Hunger Environ Nutr2022; 17(5): 593–614.
47.
GundersenCGGaraskySB. Financial management skills are associated with food insecurity in a sample of households with children in the United States. J Nutr2012; 142(10): 1865–1870.
48.
Yousefi-RiziLBaekJ-DBlumenfeldN, et al.Impact of housing instability and social risk factors on food insecurity among vulnerable residents in San Diego County. J Community Health2021; 46(6): 1107–1114.
49.
BerkowitzSASeligmanHKMeigsJB, et al.Food insecurity, healthcare utilization, and high cost: a longitudinal cohort study. Am J Manag Care2018; 24(9): 399–404.
50.
PoolerJASrinivasanMMillerZ, et al.Prevalence and risk factors for food insecurity among low-income US military veterans. Publ Health Rep2021; 136(5): 618–625.
51.
De SouzaRT. Feeding the other: whiteness, privilege, and neoliberal stigma in food pantries. Cambridge, MA: MIT Press, 2019.
52.
DickinsonM. Feeding the crisis: care and abandonment in America's food safety net. Oakland, CA: University of California Press, 2019.
53.
BrostowDPSmithAABahrainiNH, et al.Food insecurity and food worries during the COVID-19 pandemic: a point-in-time study of injured United States veterans. J Hunger Environ Nutr2023; 18(6): 889–911.
54.
HeuerJN. “I was doing the best with what I had”: exploring student veterans’ experiences with community reintegration, food insecurity, and health challenges. PhD dissertation. Florida, USA: University of South Florida, 2023.
55.
SchinkelKR. Food security among military-connected students: the relationship between service and sacrifice. PhD dissertation. Laramie, Wyoming: University of Wyoming, 2021.
56.
SchinkelKRBudowleRPorterCM, et al.Service, scholarship, and sacrifice: a qualitative analysis of food security barriers and strategies among military-connected students. J Acad Nutr Diet2023; 123(3): 454–465.
57.
DrebingCEReillyEHenzeKT, et al.Using peer support groups to enhance community integration of veterans in transition. Psychol Serv2018; 15(2): 135–145.
58.
EliacinJMatthiasMSCameronKA, et al.Veterans’ views of PARTNER-MH, A peer-led patient navigation intervention, to improve patient engagement in care and patient-clinician communication: a qualitative study. Patient Educ Counsel2023; 114: 107847.
59.
WittCDHardin-FanningF. Social norms and stigma: implications for measuring childhood food security. J Hunger Environ Nutr2021; 16(1): 82–94.
De MarchisEHTorresFichtenbergGottliebJMCLMTorresJM, et al.Identifying food insecurity in health care settings: a systematic scoping review of the evidence. Fam Community Health2019; 42(1): 20–29.
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
