Date of Conferral

8-6-2024

Date of Award

August 2024

Degree

Ph.D.

School

Public Policy and Administration

Advisor

Michael Brewer

Abstract

The Department of Veterans Affairs (VA) has faced significant challenges in maintaining the trust of the veterans it aims to serve—especially those veterans most at risk for adverse outcomes. While veterans currently enrolled in VA care report high trust in the quality of their care, nonenrolled veterans report much lower levels of trust, preventing them from seeking the care they need. This study explored the complex dynamics and drivers of low trust among veterans who are not enrolled in VA healthcare, versus higher reported trust among veterans who are. The research leveraged organizational reputation theory and the macro cognitive perspective to analyze the anonymous survey results and purposive sampling of a population of 33 veterans who were not enrolled in VA care. The qualitative data illuminated the themes, stakeholders, and influential third parties that helped shape these veterans’ perceptions of VA. The findings illustrated that the personal experiences of a veteran’s family, close friends, or someone they had served with had a much larger influence on their own perception of VA, versus anything they had observed in the news, across social media, or in popular culture. The findings also illuminated five key themes contributing to negative narratives around VA, with “lack of empathy” and “competence” being cited more often than the other three. The results form the basis for positive social change and future engagement strategies that leverage the most influential stakeholders to counter the most influential negative narratives among this population. These efforts could inspire nonenrolled veterans to enroll in care they might not otherwise seek, directly improving the health outcomes for the nation’s 18.2 million veterans.

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