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Push-Pull Tensions: A Grounded Theory on Social Experience of Use of Healthcare Services Among Homeless Veterans


The purpose of the study was to develop, from the perspective of the user, a better understanding of the factors that influence use of healthcare services by homeless veterans in the U.S. The study employed the Grounded Theory (GT) methodology and was guided by Critical Social Theory (CST) and Symbolic Interactionism (SI) as the philosophical underpinnings. There is a scant but growing number of studies on the social experience of homeless veterans in accessing care at the Department of Veteran Affairs (VA). Understanding these issues is important because of the myriad health, psychiatric, and substance abuse problems they encounter. As many VA programs have implemented programs for homeless veterans, an investigation of the current social experience is imperative for homeless veterans. CST, or critical theory, was useful in understanding the sociopolitical and historical contexts of health and healthcare and important in understanding the power relations between the U.S. government and the homeless veterans within the healthcare setting. This approach enabled the development of knowledge from the subjective perspective. CST was useful in exploring injustices related to homeless veterans’ access to VA healthcare because this approach exposes the hidden relations of domination and powers inherent in society’s fundamental structures and ideologies. SI provided a tool to understand the social interaction of veterans acquiring healthcare. Eighteen homeless veterans were recruited and interviewed at one homeless shelter and two transitional housing programs in the Skid Row area of Los Angeles and the Westside. The qualitative methodology of GT was employed to understand the perspective of the participant or agent, which is in line with the emancipatory aims of CST. The GT developed from these data led to the focus of the theory, which is on the tensions involved in push and pull forces and the outcomes that arise as a result. Hence the theory has two major concepts: Push/pull tensions and outcomes.

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