Examining Trust Among Veterans from Camp Lejeune Exposed to Environmental Toxicants: A Qualitative Study

Abstract Background Serving Veterans with military environmental exposures is a top priority of the Veterans Health Administration (VHA). This priority is critical for over 1 million Veterans and civilians who were exposed to contaminated drinking water at United States Marine Corps (USMC) Base Camp Lejeune (CL) between 1953 and 1987. Since 2012, VHA has enacted various legislation to provide healthcare coverage and monetary relief for harm caused by water contamination. Objective To understand the perceived impact of toxicant exposure at CL on Veterans’ trust in the VHA. Design This is a qualitative study based on semi-structured telephone interviews between February 2024 and May 2024 to understand Veteran experiences with toxicant exposure and feelings of trust. Participants Twenty-two Veterans who served at CL during the officially recognized contamination period were interviewed (68.2% male; mean age 63 years; 72.7% White). Approach Recruitment included contacting participants who completed a previous survey and posting an invitation on two private CL Facebook pages. Interviews were audio-recorded and transcribed, then a codebook was developed inductively. During thematic analysis, we synthesized overarching themes, later organized into the Health Systems Trust Content Area Framework. Key Results We developed three key themes. First, reasons for trust included Veterans’ positive experiences with VHA healthcare. Second, reasons for lack of trust in Veterans Affairs included poor experiences with healthcare, lack of transparency, and complicated claims processes. Third, Veterans’ trust in the VHA was complicated by external factors, including the USMC and US government. Conclusions These findings suggest that CL Veterans’ trust in the VHA is shaped by complex factors, including potentially modifiable factors (e.g., healthcare access, transparency). Future efforts to measure and rebuild trust in this vulnerable population should include continued collaboration with Veterans, drawing on their specific experiences and lessons from past contaminations, for improved health policy and greater VHA service use.