• Brooke V Jespersen, Megan Lafferty, Kara Montague, Sarah Ono, Mark Helfand, and Shannon M Nugent.
• VA Portland Health Care System, Center to Improve Veteran Involvement in Care, 3710 SW U.S. Veterans Hospital Road, Portland, OR, 97239, USA. brooke.jespersen@va.gov.
• J Gen Intern Med. 2025 Jan 17.

BackgroundGulf War illness (GWI) is characterized by multiple, persistent symptoms (e.g., fatigue, musculoskeletal pain, concentration problems, and gastrointestinal disorders) across more than one body system that are severe enough to interfere with daily functioning. For Veterans in rural areas, the confluence of geographic barriers and GWI may create unique challenges when navigating health care, given the range of specialty care needed to support GWI. However, little is known about how rural Veterans manage their GWI symptoms and navigate health care systems.ObjectiveTo examine how Veterans with GWI perceive rurality to influence their health care experiences.DesignA cross-sectional qualitative study utilizing Health Experiences Research methodology.ParticipantsVeterans with GWI, who served in the active-duty US military, National Guard, or Reserves during the 1990-1991 Gulf War (GW) and who connected rurality to their health care experiences during interviews.ApproachSecondary qualitative analysis and inductive thematic analysis of semi-structured interviews, conducted between November 2018 and August 2021, with Veterans about their military and health experiences over time.Key ResultsFifteen (n = 15) Veterans with GWI connected rurality to their health care experiences and quality of life. Three themes emerged from their interviews: (1) GWI and rural residence amplified problems with care coordination; (2) Managing GWI made distance especially burdensome; and (3) Rural contexts facilitated wellness and support, while creating barriers to accessing care.ConclusionOur findings suggest that rurality intersects with GWI management in ways that compound barriers to health care access for Veterans. VA can address time and distance barriers by continuing to expand specialty telehealth services and telehealth training for providers and patients. VA could also incorporate recommendations from the VA/DoD clinical practice guidelines into point-of-care decision support to enhance recognition of GWI and improve consistency of treatment, which may contribute to trust-building among GW Veterans.© 2025. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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