THE COST OF ACCESS: EXPLORING STRUCTURAL BARRIERS AND BEHAVIORAL DEMAND FOR MATERNAL MENTAL HEALTH CARE AMONG RURAL AND VETERAN WOMEN

Author

• Jacqueline Kaye Nash, Southern Illinois University CarbondaleFollow

Date of Award

5-1-2026

Degree Name

Doctor of Philosophy

Department

Population Health

First Advisor

McDaniel, Justin

Abstract

Despite growing attention toward maternal health and mental health in the United States (US), significant gaps in access to care persist, including at the intersection of maternal mental health. This dissertation examines how rurality and military service influence maternal mental health prevalence, healthcare service utilization, and willingness to pay for alternative care delivery models, including mobile health (mHealth) applications, for increased access. Three complementary studies, reflecting quantitative analysis and behavioral economics methodologies, were developed to evaluate access barriers and care preferences among women of childbearing age in the US. Data were collected from a nationally representative survey and primary data collection techniques. The findings of the studies indicate that rurality and military service are associated with higher prevalence of maternal mental health conditions and a higher likelihood of going without healthcare services when a need is present. While women from all backgrounds expressed value for alternative care models, active-duty servicewomen displayed a higher and more sustained demand compared to civilian and veteran women. Geographic location was not a significant predictor of demand, suggesting that alternative care models may serve as an equitable access solution across populations. Collectively, these findings highlight the importance of flexible, accessible care delivery models and inform policy and practice efforts aimed at improving maternal mental health outcomes among rural and military-affiliated women.