# Addressing Social Determinants of Health Among Rural Veterans

> **NIH VA I01** · VA BOSTON HEALTH CARE SYSTEM · 2024 · —

## Abstract

Background: Rural Veterans represent over one third of all Veterans served by the Department of Veterans
Affairs and rural America is strikingly different than urban areas with respect to the social and economic
conditions that drive health. Based on research documenting the relationship between social adversity (e.g.,
homelessness, food insecurity) and health, policy makers suggest routine screening and referral (S&R) for
unmet social and economic needs (hereafter: “unmet needs”) in the clinical setting. This call has catalyzed a
small but promising evidence base, indicating that efficacy of S&R. However, the S&R evidence base focuses
on unmet needs in urban settings. This means we lack the knowledge needed to adapt unmet need S&R for
the unique needs of rural VA settings and the rural Veterans they serve.
Significance: Our study addresses the HSR&D priorities to mitigate the unmet needs of Veterans and to
integrate heath care solutions as much as possible into existing care, rather than depending on new personnel
and resources. This study will advance these priorities by adapting the specifications of evidence-based S&R
to align with existing unmet needs and unmet need resources in rural VA settings. This study will also establish
a process for adapting S&R that can be replicated across VISNs and facilities.
Innovation and Impact: This research is highly innovative as we know of no research that is implementing
unmet need interventions for rural Veterans. We will provide novel knowledge about unmet needs among rural
Veterans, the mechanism by which these needs manifest, and the social service infrastructure within the VA
and community that serve rural Veterans. Our research is also innovative in our use of user-centered design
(UCD) methods to adapt the specifications of an S&R intervention. Specifically, throughout the process of
adapting S&R to the target local sites, we will engage and solicit feedback from the eventual end-users,
including Veterans.
Specific Aims: 1) Determine unmet needs among rural Veterans and their associations with health outcomes;
2) Assess existing systems for addressing unmet needs and adapt S&R to fit local conditions and stakeholder
preferences; 3) Pilot test the adapted intervention and develop an Adaptation Playbook.
Methodology: Guided by the Replicating Effective Programs (REP) framework, we propose a 3-year mixed-
methods study. We will survey rural Veterans served by VISN 1 about their unmet needs and merge survey
data with secondary VA data to assess the scope and scale of unmet needs and their associations with health
care outcomes. We will conduct qualitative interviews with key stakeholders (Veterans, VA providers and staff,
representatives of community agencies) to understand how unmet needs manifest among rural Veterans, the
existing infrastructure for identifying unmet needs and referring for services, and opportunities and preferences
for adapting S&R. We will use the information gathered from these ...

## Key facts

- **NIH application ID:** 10926832
- **Project number:** 5I01HX003492-03
- **Recipient organization:** VA BOSTON HEALTH CARE SYSTEM
- **Principal Investigator:** Deborah Gurewich
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2022-09-01 → 2025-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10926832

## Citation

> US National Institutes of Health, RePORTER application 10926832, Addressing Social Determinants of Health Among Rural Veterans (5I01HX003492-03). Retrieved via AI Analytics 2026-05-26 from https://api.ai-analytics.org/grant/nih/10926832. Licensed CC0.

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