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2019 HSR&D/QUERI National Conference Abstract

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4136 — Identifying and Reducing VHA Staff Barriers to Intervening in the Harassment of Women Veterans

Lead/Presenter: Karen Dyer,  Center for the Study of Healthcare Innovation, Implementation & Policy
All Authors: Relyea MR (VA Connecticut Healthcare System; Yale School of Medicine), Sitzer, J (Jesse Brown VA Medical Center), Haskell, SG (VA Connecticut Healthcare System; Yale School of Medicine) Adams, L (VA Connecticut Healthcare System; Yale School of Medicine)

Objectives:
In response to findings that women Veterans frequently experience harassment when coming to VHA for healthcare, VHA began training staff to identify and intervene in harassment. Yet, a recent survey indicated that staff often do not intervene when witnessing harassment of women Veterans. Ensuring that VHA staff intervene in harassment requires understanding and overcoming barriers to intervening. This project aims to identify staff barriers to intervening in harassment and determine whether the current VHA harassment training reduces those barriers.

Methods:
Using a pretest-posttest design, we evaluated harassment trainings at two VHA medical centers. On the evaluation survey, staff indicated whether they had witnessed and intervened in harassment, their barriers to intervening, and intentions to intervene. We conducted bivariate analyses of pretest responses to identify barriers associated with witnessing harassment, intervening, and intentions to intervene. We then conducted logistic and linear regressions to compare the relative strength of barriers. Lastly, we used paired t-tests of pretest and posttest surveys to determine whether the training was successful at reducing barriers.

Results:
Overall, 229 staff participated in the evaluation. Staff reported several common barriers to intervening (e.g., not having the skills to intervene) and some barriers unique to VHA (e.g., reluctance to make Veterans who commit harassment feel less comfortable at VHA). At the bivariate level, almost all barriers were negatively correlated with intervening. In multivariate analyses, we identified specific barriers to witnessing harassment, intervening, and intentions to intervene. Although VHA's harassment training appeared to reduce several key barriers, it did not reduce the barrier regarding concerns about making patients feel uncomfortable.

Implications:
VHA staff report several barriers to intervening in harassment. The robust barrier concerning fears of harming patient engagement is in line with qualitative data indicating staff experience a role conflict when attempting to both engage patients and intervene.

Impacts:
The current VHA harassment training appears promising for reducing barriers to intervening in the harassment of women Veterans. However, it may be strengthened by education or guidelines to help staff determine when and how to intervene when faced with concerns regarding making patients feel uncomfortable at VHA.