Barriers to Veterans Affairs (VA) Healthcare Utilization: Exploring the Underutilization of VA Healthcare Services Among Rural, West Texas Veterans

Rural veterans forgo Department of Veterans Affairs (VA) healthcare at disproportionate rates, and this study found that the primary barrier is not enrollment but utilization. Seven of the eight participants were already enrolled yet remained functionally outside the system. The purpose of this qualitative single-case study was to explore why rural West Texas veterans forgo and underutilize Veterans Health Administration (VHA) healthcare. Two research questions examined the perceptions contributing to that decision and the barriers preventing access. Andersen’s behavioral model of health services use provided the framework. Semistructured virtual interviews with eight rural West Texas veterans were analyzed using Braun and Clarke’s six-phase reflexive thematic analysis. Seven themes emerged across the predisposing, enabling, and need domains: military stoicism, comparative guilt, institutional mistrust, geographic and economic burden, telehealth failure, administrative friction, and clinical self-triage. These barriers compounded one another, artificially suppressing perceived need until care became an emergency. Underutilization therefore reflects organizational design failures rather than individual deficits, and recommendations address outreach, low-bandwidth telehealth, simplified enrollment, and authentic leadership practice. Keywords: rural veterans, VA healthcare, healthcare utilization, Andersen behavioral model, qualitative case study, telehealth, organizational leadership