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2009 HSR&D National Meeting Abstract

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National Meeting 2009

3063 — Barriers to DVA Care Access for Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) Reserve and National Guard Servicewomen

Mengeling MA (Center for Research in the Implementation of Innovative Strategies in Practice (CRIISP), Iowa City VAMC and University of Iowa), Booth BM (Center for Mental Healthcare Outcomes and Research, Central Arkansas Veterans Healthcare System, University of Arkansas), Cretzmeyer MT (CRIISP, Iowa City VAMC), Reisinger HS (CRIISP, Iowa City, VAMC), Silander AB (CRIISP, Iowa City VAMC), Torner JC (Iowa City VAMC and Univeristy of Iowa), Franciscus CL (CRIISP, Iowa City VAMC), Sadler AG (CRIISP, Iowa City VAMC)

Objectives:
Although unprecedented numbers of Reserve and National Guard (R/NG) service members have been deployed to combat and are a DVA priority care population, the majority seek their health care elsewhere. The research objective was to determine R/NG servicewomen’s perceived barriers to and perceptions of DVA care.

Methods:
Eight focus groups were held with groups of OEF/OIF era Reserve/National Guard service women in four Midwestern states (N = 39). The purpose of these groups was to facilitate questionnaire development for a study investigating R/NG servicewomen’s deployment experiences, trauma risk, post-deployment health, and barriers to DVA care. Groups were stratified by Officer/Enlisted personnel and deployment status (not deployed, deployed to non-combat region, and deployed once or more than once to combat region). Two focus group transcripts were reviewed by six study researchers to identify themes. Subsequently, the remaining transcripts were independently coded by two researchers and entered into NVivo 8.0 for data management and analysis. Agreement between coders was > 80%.

Results:
Barriers to accessing care was one of the most frequently coded themes in all groups (220 references). The leading barrier to DVA care was lack of knowledge about eligibility and how to access care. Women hospitalized for deployment injuries noted receiving no information about DVA care. Fear about stigmatization if their R/NG leadership or peers found out about mental health care generally, or about rape experiences specifically was notable. Speculation regarding the availability or quality of care specific to the needs of women was consistent among focus groups. Officers were as uninformed about DVA care as enlisted personnel and reported unease about the well-being and unmet mental health needs of deployed R/NG personnel.

Implications:
Lack of knowledge about DVA eligibility and care access was endemic in deployed R/NG servicewomen. Perception about care stigma on career and concern about hassles and quality of DVA care specific to women were notable.

Impacts:
Continued outreach efforts to educate R/NG servicewomen about DVA care eligibility and gender-specific health services is necessary in order to facilitate their access to care.


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