“It Made Me Not Want to See him…”: The Role of Patient-Provider Communication in Influencing Rural-Dwelling Women Veterans’ Motivation to Seek Health Care for Managing Chronic Pain

ABSTRACT

Despite being high health care utilizers, many women Veterans perceive their pain condition to be poorly understood by their providers, which can be a strong demotivator for seeking care. We set out to understand the priorities rural-dwelling women Veterans have for using health care for their chronic pain, and interviewed participants about their experiences with (and priorities for seeking) health care for their chronic pain. Self-Determination Theory identifies three sources of motivation (autonomy, competence, relatedness), all of which were represented through two themes that reflect rural women Veterans’ rationale for decision-making to obtain health care for chronic pain: role of trust and competing priorities. Women described their priorities for chronic pain management in terms of their competing priorities for work, education, and supporting their family, but most expressed a desire to function in their daily life and relationships. Second, women discussed the role of trust in their provider as a source of motivation, and the role of patient-provider communication skills and gender played in establishing trust. Rural women Veterans often discussed core values that stemmed from facets of their identity (e.g. gender, military training, ethnicity) that also influenced their decision-making. Our findings provide insight for how providers may use Motivational Interviewing and discuss chronic pain treatment options so that rural-dwelling women Veterans feel autonomous, competent, and understood in their decision-making about their chronic pain. We also discuss importance of acknowledging the effects of disenfranchising talk and perpetuating gendered stereotypes related to chronic pain and theoretical implications of this work.

Acknowledgements

We would like to thank the Veterans on the Women’s Veteran Engagement Board and the CADRE Veteran Engagement Panel who provided their insight on the development of this project. The content of this paper presents the findings and conclusions of the authors and does not reflect the views or policies of the Department of Veterans Affairs or the United States Government.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This study was funded by the US Department of Veterans Affairs, Veterans Health Administration, Office of Rural Health, Veterans Rural Health Resource Center- Iowa City (project number 03609). Drs. Hadlandsmyth and Driscoll also receive partial support from the US Department of Veterans Affairs Health Services Research and Development (HSR&D) Service through the Center for Access and Delivery Research and Evaluation (CADRE) Center (CIN 13-412).