title: "Tell Me What You Don't Remember": Care-Seeking Facilitators and Barriers in the Decade Following Repetitive Blast Exposure Among Army Combat Veterans.
abstract: OBJECTIVE
  This study sought to understand facilitators and barriers to care seeking among blast-exposed veterans and service members who served before the implementation of systematic screening for traumatic brain injury.
  
  
  METHODS
  Informed by principles of Grounded Theory, we used theoretical sampling and conducted 31 interviews with 15 veterans and 10 veteran family members. Data were iteratively collected and thematically analyzed.
  
  
  RESULTS
  The most critical facilitator in initiating care was encouragement--verging on insistence--from a spouse, family member, or employer. Although respondents overwhelmingly described veteran and military health systems responding inadequately to patient needs, respondents also described exceptional health professionals who stood in contrast, dedicated to providing quality care. Barriers to ongoing care included: scheduling complications; redeployments; insufficient or inaccessible documentation of blast encounters or medical history; high provider turnover interrupting therapeutic progress; and poor patient-provider relationships. Respondents described providers as generally dismissive of or insensitive to many health needs. Respondents feared the system was incapable of helping them and described stigma against mental health care seeking in personal and professional spheres.
  
  
  CONCLUSIONS
  Veterans and their families struggle to address multiple, confusing transformations after repetitive blast exposures. Complex, impersonal, and skeptical health system processes place an undue burden on care-seeking veterans and service members.
authors.affiliation: Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205.
authors.forename: Rachel P
authors.initials: RP
authors.lastname: Chase
authors.affiliation: Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205.
authors.forename: Shannon A
authors.initials: SA
authors.lastname: McMahon
authors.affiliation: Department of International Health, Johns Hopkins University Bloomberg School of Public Health, 615 North Wolfe Street, Baltimore, MD 21205.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Winch
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D000368:Aged; D001753:Blast Injuries / Q000628:therapy*; D000070642:Brain Injuries, Traumatic / Q000523:psychology / Q000628:therapy*; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D008875:Middle Aged; D066067:Military Family; D010342:Patient Acceptance of Health Care; D011369:Professional-Patient Relations; D013240:Stereotyping; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000628:therapy; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology*; D055815:Young Adult