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Mengeling MA, CADRE and ORH VRHRC-CR, Iowa City VA Medical Center and the University of Iowa Carver College of Medicine, Iowa City, IA; TRUE G, CHERP and CEPACT, Philadelphia Medical Center and University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Burkitt KH, CHERP Pittsburgh VA Medical Center, Pittsburgh, PA; Ono SS, CIVIC Portland VA Medical Center and Department of Medicine, Oregon Health and Science University, Portland, OR; Bayliss N, CHERP Pittsburgh VA Medical Center, Pittsburgh, PA; Holmes W, CHERP and CEPACT, Philadelphia VA Medical Center and The University of Pennsylvania School of Medicine, Leonard Davis Institute, Philadelphia, PA; Zickmund S, CHERP Pittsburgh VA Medical Center, Qual EASE, and University of Pittsburgh, Medicine and Clinical and Translational Science, Pittsburgh, PA; Sadler AG, CADRE, Iowa City VA Medical Center and University of Iowa Hospitals and Clinics, Iowa City, IA;
Objectives:
The Veterans Health Administration (VHA) defines military sexual trauma (MST) as sexual harassment and sexual assault experienced during military service. VHA MST disclosure rates appear to be low, particularly when compared to military sexual assault prevalence estimates among VA-enrolled Veterans. To provide insight into VHA MST disclosure rates, our study explored how an experientially diverse sample of Veterans defines MST and the VHA MST screening items.
Methods:
Qualitative interviews were conducted with 76 veterans (38 men/38 women) at four geographically diverse VHA Medical Centers. Sample variation was maximized using stratified recruitment by sex, VHA MST-screening results, and Sexual Experiences Questionnaire scores. Participants were asked to generate definitions and examples of both MST and the VHA MST screening items during semi-structured interviews. Qualitative coding was guided by the "editing style" interpretive framework for research conducted in the context of medical care. Thematic coding percentages were computed.
Results:
The majority of Veterans described MST as sexual assault (59%), coercion (24%), resulting in lasting psychological harm (10%), with Veterans' definitions frequently encompassing more than one thematic code. Male and female Veterans' definitions of MST and VHA MST screening items elicited responses emphasizing descriptions of sexual assault (e.g., "rape," "violate your body," "have sex with you against your will"). While emphases on physical contact were anticipated for MST item 2, characterizations of MST item 1 ("uninvited and unwanted sexual attention") included physical containment, physical threats, and sexual assault. Veterans felt the individual experiencing the event subjectively determined whether it was sexual harassment; thus sexual harassment could not be objectively measured. Women veterans noted some forms of sexual harassment, particularly comments about women, were viewed as culturally accepted and therefore did not warrant reporting.
Implications:
Veterans' interpretations of VHA screening items suggest Veterans may more narrowly define MST experiences than intended by the VHA MST screen. Further, many Veterans may not consider sexual harassment as MST when answering the screening questions. MST was commonly exemplified by sexual assault by both male and female Veterans.
Impacts:
These findings suggest a greater range of MST examples are needed to facilitate valid screening.
