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2019 HSR&D/QUERI National Conference Abstract

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1084 — "It's All in Your Head": Women Veterans' Experiences with Gender Bias in VA Specialty Care

Lead/Presenter: Jose Casares,  COIN - West Haven
All Authors: Casares JD (VA Central Western Massachusetts Healthcare System), Mattocks K (VA Central Western Massachusetts Healthcare System), Brown, AN (VA Central Western Massachusetts Healthcare System) Haskell, SG (VA Connecticut Healthcare System; Yale University School of Medicine, Department of Internal Medicine) Bastian, L (VA Connecticut Healthcare System; Yale University School of Medicine, Department of Internal Medicine) Brandt, CA (VA Connecticut Healthcare System; Yale University School of Medicine, Center for Medical Informatics)

Objectives:
In the past decade, VA has responded to a dramatic increase in women Veterans (WV) seeking care by extending Women's Health training to over 5000 women's health primary care providers and changing the culture of VA to be more inclusive of women Veterans. These initiatives have resulted in increased patient satisfaction and quality of care, but have focused mostly on primary care settings. Less is known about women's experiences with specialty care within VA. This qualitative study sought to examine WV's experiences with VA specialty care providers, with a focus on cardiovascular, musculoskeletal, and mental health care settings.

Methods:
Semi-structured interviews were conducted with 80 OEF/OIF/OND WVs at 4 VHA facilities nationwide. Interviews focused on understanding WVs' experiences with VA specialty care providers, including their perceptions of gender bias.

Results:
Three major themes emerged from interviews, including: (1) WVs are frequently told their symptoms were attributable to hormones or mood swings (e.g. "I've been told my traumatic brain injury was due to my period, menopause, or it's all just in my head".; (2) WVs believe they aren't being listened to and that their symptoms aren't taken seriously (e.g. "I don't feel like I'm listened to, and when I have a complaint, especially a female complaint, you know, it's just dismissed"; and (3) WVs recommended provision of gender sensitivity training and more female providers in specialty care (e.g. "Treat us the same as anybody else. We all wore uniforms, and it's not wanting extra treatment or specialty treatment. Our injuries are the same. We just happen to have a female body.").

Implications:
This study is the first to highlight perceived gender bias experienced by women Veterans in VA specialty care. Women felt that their symptoms were disregarded or diminished by their VA specialty care providers. As a result, they felt that they received fewer referrals for diagnostic tests and were not made aware of additional treatment options that may help their symptoms.

Impacts:
While women Veterans report positive experiences within women's health clinics and primary care settings, their negative experiences in VA specialty care suggest that some providers may harbor unintentional or unconscious gender biases. Even if slighted perceptions, findings indicate impoverished communication and satisfaction, and potential poor quality care are likely effects. Thus, local and national initiatives, such as cultural competence training programs and evaluations on specialty care treatment outcomes by gender, are a requirement to address ongoing gender discrimination that create a gender gap in women Veterans' ability to receive quality specialty care. Unpacking Veteran-specialty provider interaction and medical behavior/outcomes will allow VA to demonstrate a key benefit of learning healthcare systems.