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Background Access to healthcare is a poorly defined construct, with insufficient understanding of differences in facilitators and barriers between US urban versus rural specialty care. We summarize recent literature and expand upon a prior conceptual access framework, adapted here specifically to urban and rural specialty care. Methods A systematic review was conducted of literature within the CINAHL, Medline, PubMed, PsycInfo, and ProQuest Social Sciences databases published between January 2013 and August 2018. Search terms targeted peer-reviewed academic publications pertinent to access to US urban or rural specialty healthcare. Exclusion criteria produced 67 articles. Findings were organized into an existing ten-dimension care access conceptual framework where possible, with additional topics grouped thematically into supplemental dimensions. Results Despite geographic and demographic differences, many access facilitators and barriers were common to both populations; only three dimensions did not contain literature addressing both urban and rural populations. The most commonly represented dimensions were availability and accommodation , appropriateness , and ability to perceive. Four new identified dimensions were: government and insurance policy , health organization and operations influence , stigma , and primary care and specialist influence . Conclusions While findings generally align with a preexisting framework, they also suggest several additional themes important to urban versus rural specialty care access.

Military to civilian reintegration challenges affect nearly half of United States (US) veterans returning from post-9/11 conflicts, which includes Operations Enduring Freedom, Iraqi Freedom, New Dawn (OEF, OIF, OND), and current efforts to defeat networks of violent extremists. This has become a national concern. Additionally, traumatic exposure during formative years may influence future reactions to trauma. Holistic, theory-driven perspectives are warranted to explore complex risk and protective factors as well as reintegration outcomes among post-9/11 veterans. Further, evidence-based reintegration guidelines for reintegration clinical practice are lacking. The present dissertation sought to better understand reintegration from theoretical and empirical perspectives. Findings of this dissertation are threefold: 1) theory integration procedures resulted in a System Theory of Stress, Resilience, and Reintegration, 2) recent reintegration literature was synthesized and an accompanying clinical practice guideline is presented, and 3) results of a cross-sectional study of early life trauma, deployment stress, resilience resources, and reintegration are presented.