2012 National Meeting

3149 — Beyond Mammograms and Pap Smears: What is Gender-Sensitive Patient-Centered Care?

Oishi SMHamilton ABKlap RCanelo IChow B, and Yano EM, VA Greater Los Angeles Healthcare System;

Objectives:
Women’s healthcare in the Veterans Health Administration (VHA) has progressed in terms of increased availability of gender-specific care such as mammography and pap smears. The concept of “gender-sensitivity,” however, has broader connotations than provision of gender-specific care alone, with relevance to the culture of healthcare delivery across all specialty services providing care for women. Our objective was to investigate perspectives on the meaning of gender-sensitive care in the context of the increasingly gender-mixed population served by VHA.

Methods:
We developed a purposive sample of individuals who provide care to women Veterans at VA sites involved in the HSRandD Women Veterans Practice-Based Research Network (PBRN), including Women Veteran Program Managers and Military Sexual Trauma (MST) coordinators; internists, psychiatrists, psychologists, social workers, case managers, nurses, and clerks for a maximum sample of 60 individuals. We conducted semi-structured qualitative interviews covering numerous topics including elements of gender-sensitive care delivery currently in use or important for future improvements. We analyzed transcripts using the constant comparison method.

Results:
Elements of women-friendly environmental provisions included feminine products and changing tables in bathrooms; child-friendly waiting rooms; child care provision; secluded space in mixed-gender waiting areas; and special women’s quiet rooms near clinics, equipped with crafts, refreshments, and comfortable furniture. Broader elements of gender-sensitivity included differing location and content of MST services for women and men; attention to changing gender roles, e.g., by including changing tables in men’s bathrooms; and safety provisions for trauma survivors in non-clinical areas such as elevators and stairwells. Several participants called for culture change, focusing on paradigmatic concerns, including gender issues around trauma-centered care and the need for a “whole-woman” patient-centered focus in service coordination.

Implications:
As women and men increasingly share environments and providers in VHA, environmental and cultural adjustments should focus on child-friendliness; similarities and differences in trauma experiences for women and men; safety and comfort in clinical and non-clinical areas, and holistic coordination of services.

Impacts:
While the 2010 VHA Handbook for Health Care Services for Women Veterans advances VA policy in gender-sensitive healthcare delivery, our findings may help guide development of local efforts to implement patient-centered care for women Veterans.