The Impact of Socio-Ecological Environmental Factors on What Older Adults Use for Obtaining Health Information to Care for Individuals Who Have Served in the United States Military

Abstract

Family members, friends, and neighbors assist current and former United States military service members with managing health conditions. Obtaining health information to provide this assistance may not be easy. This dissertation explored socio-ecological environment factors and what older adults (aged ≥ 55 years) who assist service members with health conditions have used to obtain health information. Using a secondary analysis design, Specific Aim 1 examined the association of multi-level socio-ecological environmental factors and what older adults have used to obtain health information. Significant factors were technology adoption and skill set, social interactions, and healthcare provider interactions. Specific Aim 2 described how socio-ecological environmental factors impacted obtaining health information. Influential factors were found on 5 levels of the socio-ecological environment including: 1) first level characteristics of the caregiver which were their finances, having internet skills and having liked to use the internet, and the influence of military culture; 2) second level direct relationships with others including the service member, support groups, and exchanges with healthcare providers, healthcare organizations, and healthcare systems; 3) third level healthcare organization characteristics including appointment wait times and the availability of understandable health information; 4) fourth level electronic communications between healthcare organizations and systems, and healthcare transitions; and 5) fifth level public policy including service members meeting qualifications for the Department of Veterans Affairs healthcare benefits and the availability of patient portals (presumed due to the Health Information Technology for Economic and Clinical Health (HITECH) Act). However, methodological challenges required cautious interpretation of the results. Thus, a scoping review of online anonymous surveys was undertaken to examine the commonness of experiencing fraud and gain methodological guidance when conducting this type of survey. The scoping review concluded that guidelines are needed for researchers who use online anonymous surveys to reach populations where a sampling frame is unknown, and group members may be reluctant to participate in research. Overall, future research is needed to explore if modification to the socio-ecological factors found to be significant could make obtaining health information easier, and if offering anonymity is necessary when conducting online surveys.