Date

8-20-2026

Department

School of Behavioral Sciences

Degree

Doctor of Education in Community Care and Counseling (EdD)

Chair

Bridgette Hester

Keywords

Remote Care, Rural Veteran, Telemental Health, Veteran Mental Health

Disciplines

Counseling

Abstract

The purpose of this qualitative descriptive study was to explore how rural veterans in northern Florida and southern Alabama described their reasons for not using telemental health services to address their mental health issues and how technology use influenced their decisions. The study was informed by the Unified Theory of Acceptance and Use of Technology (UTAUT), which identifies factors associated with technology acceptance and use, and was grounded in a patient-centered axiological framework. The study included 12 rural veterans who had either never used or had discontinued telemental health services. Data was collected through semi-structured interviews and focus groups and analyzed using reflexive thematic analysis. The four primary themes were: Relational Expectations Shape Telemental Health Acceptability; Structural and Rural Context Constraints Shape Access Decisions; Technology Perceptions and Experiences in Telemental Health Decision-Making; and Autonomous, Socially Situated Mental Health Decisions. Participants described trust, rapport, and emotional safety as important factors in evaluating telemental health. Structural barriers, including provider shortages, travel burden, and limited local services, affected care options, while technology-related factors such as digital confidence, connectivity, and usability influenced perceptions of feasibility. However, technology alone did not explain participants’ decisions. The findings indicated that participants evaluated telemental health according to whether it aligned with their expectations for meaningful and effective counseling. The findings suggest that rural veterans' non-use of telemental health is best understood as a relational, contextual, and patient-centered mental health care decision rather than solely a technology adoption issue.

Download

Included in

Counseling Commons

Share

COinS