{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T17:03:58Z","timestamp":1784653438581,"version":"3.55.0"},"reference-count":31,"publisher":"Oxford University Press (OUP)","license":[{"start":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T00:00:00Z","timestamp":1784592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>During the COVID-19 pandemic, geographic isolation, host-nation healthcare limitations, and broader geopolitical considerations contributed to limited access to care for dependents of active duty service members in Okinawa. This research explored perceived healthcare access barriers among military spouses in Okinawa, Japan, during the COVID-19 Public Health Emergency and identified potential demographic and structural factors associated with perceived access and wellness outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>This study used a cross-sectional online survey from February to May 2023 during the COVID-19 Public Health Emergency. Ethical approval was received from the University of Nebraska Medical Center. The 35-item instrument captured demographics, healthcare utilization, access barriers, and wellness perceptions. Access to emergency, urgent, routine, specialty, and preventive care was assessed against TRICARE standards, with percentages calculated to indicate whether benchmarks were met across demographic groups. Logistic regression evaluated associations between age, sponsor rank, and MTF assignment with access outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Emergency care met TRICARE standards for 90% of respondents, but fewer met urgent (19%), routine (17%), specialty (25%), or preventive care (47%) benchmarks. Only 22% of spouses perceived they could access care when needed. Younger spouses (19-30) and those assigned to Kadena\u2019s 18th Medical Group reported the lowest access. Nearly half reported worsened mental health, and 40% reported food or medical cutbacks. Enlisted spouses were disproportionately affected.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Military spouses in Okinawa perceived significant barriers to healthcare access during the COVID-19 pandemic, with military treatment facility (MTF) enrollment, sponsor rank, and age emerging as the most consistent factors associated with disparity. Policy implications include the need to provide military families with adequate and accurate information on MTF access to care wait times and civilian healthcare availability before arrival at a new duty station. These findings highlight the need for further research examining military spouse healthcare access in overseas and remote locations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag334","type":"journal-article","created":{"date-parts":[[2026,7,9]],"date-time":"2026-07-09T11:56:17Z","timestamp":1783598177000},"source":"Crossref","is-referenced-by-count":0,"title":["Military Spouse Perceptions of Healthcare Access in Okinawa During the COVID-19 Public Health Emergency: A Cross-Sectional Study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-5478-415X","authenticated-orcid":false,"given":"Elayne L","family":"Wilson","sequence":"first","affiliation":[{"name":"University of Alabama at Birmingham Department of Health Policy and Organization, , Birmingham, AL 35209,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matthew","family":"Fifolt","sequence":"additional","affiliation":[{"name":"University of Alabama at Birmingham Department of Health Policy and Organization, , Birmingham, AL 35209,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Medcalf","sequence":"additional","affiliation":[{"name":"University of Nebraska Medical Center Department of Epidemiology, , Omaha, NE 68198,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"2026072112253239800_usag334-B1","doi-asserted-by":"publisher","first-page":"1250","DOI":"10.15585\/mmwr.mm6936a4","article-title":"Delay or avoidance of medical care because of COVID-19-related concerns\u2014United States, June 2020","volume":"69","author":"Czeisler","year":"2020","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"2026072112253239800_usag334-B2","volume-title":"Household Pulse Survey, 2020\u20132021","author":"National Center for Health 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