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2023 HSR&D/QUERI National Conference Abstract

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4133 — Sexual harassment prevention messaging at VA healthcare facilities: a qualitative analysis of expert recommendations

Lead/Presenter: Karissa Fenwick,  COIN - Los Angeles
All Authors: Fenwick KM (Center for the Study of Healthcare Innovation, Implementation, and Policy, Greater Los Angeles), Dyer KE (Center for the Study of Healthcare Innovation, Implementation, and Policy, Greater Los Angeles) Oishi K (Center for the Study of Healthcare Innovation, Implementation, and Policy, Greater Los Angeles) Yano EM (Center for the Study of Healthcare Innovation, Implementation, and Policy, Greater Los Angeles; University of California Los Angeles David Geffen School of Medicine; University of California Los Angeles Fielding School of Public Health) Klap R (Center for the Study of Healthcare Innovation, Implementation, and Policy, Greater Los Angeles) Hamilton AB (Center for the Study of Healthcare Innovation, Implementation, and Policy, Greater Los Angeles; University of California Los Angeles David Geffen School of Medicine)

Objectives:
A 2015 survey found that one in four women Veteran regular VA users reported experiencing sexual harassment by men Veterans at VA healthcare facilities. Since becoming aware of the prevalence of harassment on its grounds, VA has launched several harassment prevention messaging campaigns via posters, leadership statements, and online platforms. However, culture change requires sustained efforts, and ongoing interventions are needed to create an environment of care that is welcoming toward women. This study’s objective was to identify expert recommendations for sexual harassment prevention messages to guide future VA campaigns.

Methods:
Using snowball sampling, we recruited experts in sexual harassment prevention and intervention from military, academic, non-profit, VA, and other healthcare settings. Experts included researchers, clinicians, administrators, and program developers. We conducted 40 telephone interviews using a semi-structured guide focused on identifying interventions for addressing patient-perpetrated sexual harassment at VA. We analyzed interview data using the constant comparative method.

Results:
We identified four themes related to prevention messaging to address patient-perpetrated sexual harassment of women Veterans at VA. Theme one involved message frame valence. Some participants suggested that negative message frames (e.g., that VA does not tolerate harassment) may deter harassment and support staff in addressing it. However, others stated that positive frames (e.g., that VA is welcoming and inclusive) may be less likely to provoke resistance or backlash. Theme two related to correcting misperceptions about harassment. Participants stated that underscoring the adverse impact of harassment on women Veterans may sensitize the VA community to harassment and reduce perceptions that harassment is innocuous. Further, highlighting discrepancies between perceived norms (e.g., that most men Veterans condone harassment) and actual norms (e.g., that most men Veterans oppose harassment) may improve social norms around harassment. Theme three involved leveraging strengths of the Veteran population. Participants recommended emphasizing the shared military bonds between men and women Veterans and linking harassment prevention messages to military values (e.g., leadership, honor) to increase message resonance. Theme four related to effectiveness of harassment prevention messaging. Some participants stated that messaging is a simple and effective way to influence the VA community, but others expressed that messaging alone is insufficient for changing culture.

Implications:
Results provide guidance for designing harassment prevention messages, including focusing on desired (vs. undesired) behaviors, targeting social norms, and tailoring to the VA context. More work is needed to assess Veteran and VA staff reactions to different messaging approaches prior to campaign implementation. Prospective campaigns should include evaluations of messaging impact.

Impacts:
The 2020 Deborah Sampson Act requires “prominent display” of anti-harassment messages in VA healthcare facilities. Findings offer initial evidence to guide VA administrators in developing effective sexual harassment prevention messages as part of ongoing, multifaceted efforts to reduce harassment at VA.