Model System:


Reference Type:

Journal article

Accession No.:



Archives of Physical Medicine and Rehabilitation

Year, Volume, Issue, Page(s):

, 104, 3, 380-389

Publication Website:


Study compared barriers and facilitators to accessing healthcare services among service members and veterans (SMVs) stratified by traumatic brain injury (TBI) severity groups. Fifty-five SMVs (including 10 caregivers as proxies) ≥2 years post-TBI were recruited from five Veterans Affairs (VA) TBI Model Systems centers and grouped by TBI severity (mild/moderate, severe). Semi-structured interviews with SMVs and their proxy caregivers were used to document perceived healthcare access barriers and facilitators. The main facilitators included ease of communicating with providers to help SMVs identify and utilize appropriate health care, family advocates who promoted engagement in health care, ability to use government and community facilities, and online resources or equipment. Distance to services was uniformly identified as a main barrier for both groups. However, facilitators and barriers to healthcare access differed by TBI severity. SMVs with severe TBI highlighted the role of nonprofit organizations in promoting health care engagement and the availability of VA specialty residential programs in meeting healthcare needs. Having unrecognized healthcare needs in chronic stages and communication difficulties with providers were more common for those with greater TBI severity and affected quality of care. Those with mild/moderate TBI highlighted challenges associated with paying for services in the community and scheduling of services. Barriers and facilitators exist across multiple dimensions of a healthcare access framework and vary by TBI severity. The results suggest possible mechanistic links between healthcare access and SMV health outcomes.


Cotner, Bridget A.|Nakase-Richardson, Risa|O’Connor, Danielle R.|Silva, Marc A.|Hammond, Flora M.|Carlozzi, Noelle E.|Finn, Jacob A.|Chung, Joyce|Hoffman, Jeanne M.|

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