The Meanings Soldiers Attach to Health and Their Impacts on Primary Health-Care Utilization and Avoidance in an Australian High-Risk Combat Unit

• Published date: 01 April 2021
• DOI: 10.1177/0095327X19852652
• Date: 01 April 2021
• Subject Matter: Articles

Article

The Meanings Soldiers

Attach to Health and

Their Impacts on Primary

Health-Care Utilization

and Avoidance in an

Australian High-Risk

Combat Unit

Paula A. Dabovich

1

, Jaklin A. Eliott

1

and Alexander C. McFarlane

2

Abstract

It is widely accepted many health and mental health conditions experienced by

veterans may be prevented or reduced in severity through early primary health-care

intervention, yet research suggests high levels of health-care avoidance in this

population. The aim of this study was to examine the meanings military personnel

attached to health and how these impacted health-care utilization. To achieve this,

50 hours of primary interview data were obtained from 13 Australian Army combat

personnel undergoing rehabilitation, which were thematically analyzed. Results

support previous findings that engagement with health-care services was perceived

to negatively impact career and deployment opportunities; however, these issues

were marginal to perceptions of losing personal agency when engaging with the

health-care system for physical and psychological concerns, which resulted in

1

School of Public Health, University of Adelaide, Adelaide, South Australia, Australia

2

The Centre for Traumatic Stress Studies, The University of Adelaide, Adelaide, South Australia,

Australia

Corresponding Author:

Paula A. Dabovich, Centre for Traumatic Stress Studies, University of Adelaide, Level 1, 22-30 Frome

Road, Adelaide, South Australia 5000, Australia.

Email: paula.dabovich@adelaide.edu.au

Armed Forces & Society

2021, Vol. 47(2) 227-247

ªThe Author(s) 2019

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DOI: 10.1177/0095327X19852652

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mistrust of it. We argue issues of mistrust underscore health-care avoidance in the

military and recommend primary health-care principles be incorporated into to

garrison health services.

Keywords

health care, military culture, Australia/NZ, Veterans

Military personnel often undertake roles which are physically, psychologically, and

socially demanding, both domestically and internationally. Reflecting the demand-

ing nature of their role, the Australian Departments of Defence and Veterans’ Affairs

have acknowledged that serving members of the Australian Defence Force experi-

ence higher rates of mental health disorders and suicidal ideation compared to

civilians (McFarlane et al., 2011). In transition, almost 50%have been documented

as meeting the criteria for a mental health disorder in the preceding year, and 20%as

experiencing varying degrees of suicidality during the same period (Van Hooff et al.,

2018). In addition, many are discharged from service on medical grounds, after

which they are considered at higher risk of completed suicide (Australian Institute

of Health and Welfare, 2017), along with chronic and complex health conditions

(Centre for Suicide Prevention, 2014; Ministry of Defence, 2015). These conditions

include posttraumatic stress disorder, alcohol use disorders, and chronic inflamma-

tory responses (Capone, McGrath, Reddy, & Shea, 2013; Foa, Keane, Friedman, &

Cohen, 2009; Lang et al., 2012; Pols & Oak, 2007).

It is widely accepted that many of the conditions experienced by veterans may

be prevented or reduced in severity by early primary health-care interventions

normally found within community or garrison settings (i.e., Koes, Van Tulder,

& Thomas, 2006; Valtonen et al., 2015), yet research suggests that military and ex-

military personnel avoid or underutilize the services offered to them (Currier,

Holland, & Allen, 2012; Hoge et al., 2004; Jakupcak et al., 2013; Pols & Oak,

2007; Tsan, Zeber, Stock, Sun, & Copeland, 2012; Vogt, 2011). Various reasons

for this avoidant behavior have been suggested, including personal factors such as

fear of stigma (Ben-Zeev, Corrigan, Britt, & Langford, 2012; Blais & Renshaw,

2013; Blais, Renshaw, & Jakupcak, 2014; Coleman, Stevelink, Hatch, Denny, &

Greenberg, 2017; Gould et al., 2010; Held & Owens, 2013; Kim, Britt, Klocko,

Riviere, & Adler, 2011; Mittal et al., 2013), fear of losing professional and deploy-

ment opportunities (McFarlane et al., 2011), as well as unhelpful/specific persona l

beliefs and attitudes toward illness and care (Kim et al., 2011; Vogt, Fox, & Di

Leone, 2014). There are, however, limitations in the current literature around this

phenomenon. First, investigation into health-care avoidance has almost exclu-

sively examined this in the context of mental health, with relatively little exam-

ination of health-care utilization for physical or social concerns. Accordingly,

most scholarly debate focuses on issues such as the individual’s fear of mental

228 Armed Forces & Society 47(2)