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101. Toward Gender-Aware VA Health Care: Existing Strengths and Areas for Improvement

DS Vogt, National Center for PTSD; DM Salgado, National Center for PTSD; ER Stone, National Center for PTSD; MG Keehn, National Center for PTSD; LA King, National Center for PTSD

Objectives: During the past two decades, the Veterans Health Administration (VHA) has recognized the importance of improving health care to women veterans by supporting numerous research projects. Many have focused on the efficacy of gender-specific treatments and functional access to services. Yet, interpersonal aspects of care may also contribute to the healthcare environment for women veterans. This environment may be influenced by three overlapping characteristics of VHA staff: (1) gender-role ideology, the extent to which employees make judgments about different facets of care for women patients that are free from gender stereotypes; (2) sensitivity, the degree to which employees are aware of and sympathetic toward the unique needs of female patients; and (3) knowledge, or the extent to which employees possess accurate information regarding women veterans and features of their VHA care. Together, these comprise what we term gender awareness (GA). In the present study, we developed a reliable and valid mechanism to assess GA among VHA staff and identified existing strengths and areas for improvement.

Methods: The design was observational and cross-sectional, relying on proportional stratified random sampling of VHA employees across the VA New England Healthcare System. In the first three waves of data collection, 681 employees completed the GA assessment instrument. These data were used for scale refinement and psychometric (reliability and convergent and discriminant validity) analyses, including computation of descriptive statistics, frequency distributions, item-total correlations, alpha coefficients, interscale correlations, and correlations with other measures. Using a fourth wave of data, with 875 completed surveys, additional descriptive statistics were computed on GA components within specific content areas for the sample as a whole, and ANOVA comparisons were computed for particular subgroups (e.g., males vs. females, healthcare providers vs. administrative support).

Results: Results revealed sufficient internal consistency (alpha coefficients at approximately the .80 - .90 range), convergent validity (acceptably high coefficients in the .32-.65 range), and discriminant validity (acceptably low coefficients in the .03 - .17 range). Correlations among subscale scores for ideology, sensitivity, and knowledge (.15 - .51) supported the expected multidimensionality of GA. Findings from descriptive analyses revealed both strengths and weaknesses in staff GA. For example, while the majority of healthcare workers were receptive to women patients and supportive of programs and services that benefit women veterans, a significant minority of healthcare workers exhibited a lack of sensitivity to women’s privacy needs and to the burden that childcare responsibilities place on women in obtaining health care. Findings also revealed that levels of GA differed across employee subgroups.

Conclusions: The GA assessment instrument is a reliable and valid measure of factors contributing to the quality of VA healthcare for women veterans. While a majority of healthcare workers exhibited satisfactory GA, a significant minority demonstrated deficits in each of the three components of GA.

Impact: The recognition that there is room for improvement in staff GA guides our future plans to extend the present research to develop and evaluate an intervention to enhance GA among VHA staff.