March is Women’s History Month
In honor of Women’s History Month, HSR&D is highlighting the strong commitment of VA research toward making sure that the VA healthcare system provides equal and optimal care to women Veterans, who now make up 10% of the total Veteran population – and are the fastest growing group among this population. The VA Women’s Health Services provides support to implement positive changes in providing optimal care for all women Veterans. VA also supports important research on women Veterans’ health and healthcare.
HSR&D investigators conduct an array of research on women’s health. For example, a recent Medical Care Supplement, co-sponsored by the VA Women’s Health Research Network, featured HSR&D and QUERI research on suicide prevention for women Veterans (Medical Care. February 2021). In addition, HSR&D supports the:
- Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), which develops and tests innovations that improve the effectiveness and value of VA healthcare, with a focus on primary care, women Veterans’ health, and high-risk/high-need Veterans.
- Charleston Health Equity and Rural Outreach Innovation Center (HEROIC), which aims to improve access and equity in healthcare for all Veterans by eliminating geographic, racial/ethnic, and gender-based disparities.
- QUERI Enhancing Mental and Physical Health of Women through Engagement and Retention
(EMPOWER), which works to expand access to virtual preventive and mental health services for women Veterans with high-priority health conditions residing in rural and urban-isolated areas.
HSR&D Researchers in Women’s Health
Elizabeth Yano, PhD, MPH, is an HSR&D Senior Research Career Scientist and Director of CSHIIP, located within the VA Greater Los Angeles Healthcare System. Dr. Yano is nationally recognized for her leadership in establishing VA’s women’s health research agenda. Along with HSR&D investigators Susan Frayne, MD, MPH, and Alison Hamilton, PhD, MPH, Dr. Yano leads the VA Women’s Health Research Network (WHRN) – one of HSR&D’s initiatives to transform VA’s capacity to examine and reduce gender disparities in health and healthcare. Dr. Yano also co-leads the VA Women’s Health Practice-Based Research Network (PBRN) – a national network of sites that supports women’s health research and facilitates the testing of VA-based women’s health-related interventions.
Melissa Dichter, PhD, MSW, is part of the leadership team for HSR&D’s Center for Health Equity Research and Promotion (CHERP) and has worked to provide insight into how women who have experienced intimate partner violence (IPV) view being part of a research study. Women Veterans face disproportionately high rates of lifetime IPV, making this an important population to include in research. However, due to concerns regarding stigma, emotional distress, and potential for increased violence (i.e., perpetrator retaliation) resulting from disclosure of IPV, research with women who have experienced IPV requires safety and confidentiality measures that can pose challenges. In an article in Women’s Health Issues (Dichter et al., 2019), Dr. Dichter and colleagues discuss recruitment strategies and findings on women Veterans’ motivations for – and experiences with their participation in VA research. Her work also was featured in HSR&D’s Veterans’ Perspectives.
Studies on Women’s Health by HSR&D Researchers
The following are just a few of the HSR&D studies on women’s health.
Study Shows Majority of Women Veterans Feel Welcome at VA
VA has escalated ongoing efforts to ensure that women Veterans experience an environment in which they feel safe, welcome, and respected, and sought women Veterans’ input on these efforts and potential future changes. Thus, investigators in this HSR&D-funded study (PI: A. Hamilton) analyzed patient suggestions on how to make the VA healthcare system more welcoming to women. In August and September 2017, a survey was administered to a convenience sample of women Veterans (n=1,303) at 26 VA primary care and women’s clinics that were part of VA’s Women’s Health Practice-Based Research Network (PBRN).
- Of the study participants, 85% felt welcome within the VA healthcare system.
- Overall, 490 distinct responses were provided to a question asking for suggestions to make VA more welcoming to women Veterans (260 comments and 230 suggestions).
- Comments included praise for VA (67%), as well as stories about feeling uncomfortable or harassed in VA (26%).
- Suggestions included those related to VA staff (31%: e.g., hiring more female staff members), the environment of care (18%: e.g., separate building or entrance for women’s clinics), additional resources for women Veterans (18%: e.g., peer support programs), clinical services for women Veterans (15%; e.g., more women’s providers), changing men Veterans’ behavior toward women Veterans at VA (5%), and making the treatment of women and men the same (5%).
Given that many respondents identified staff gender sensitivity as an area in need of improvement, further attention should be paid to staff training, especially for new staff who may be unfamiliar with the male-dominated VA environment. Policies related to addressing harassment at multiple levels should continue to be developed and implemented.
Moreau J, Dyer K, Hamilton A, et al. Women Veterans’ perspectives on how to make Veterans Affairs Healthcare settings more welcoming to women. Women’s Health Issues. July-August 2020;30(4):299-305.
VA’s Primary Care-Mental Health Integration Affects Access Differently for Women and Men Veterans
Beginning in 2007, VA invested in improving access to mental healthcare through the national Primary Care-Mental Health Integration (PC-MHI) initiative. Through PC-MHI care models, primary care providers, mental health specialists, and/or care managers jointly manage mild-to-moderate psychiatric conditions directly in primary care settings. This retrospective cohort study of 5.4 million Veterans (including 448,455 women) who received care at one of 396 VA primary care clinics between FY2013 and FY2016, set out to answer the following question: Did VA’s national PC-MHI initiative improve access to care equally among men and women Veterans?
- Mental health integration in primary care was associated with greater use of all outpatient services among men, but with lower use of services (except primary care visits) among women.
- Each percentage point increase in the proportion of Veterans who saw an integrated specialist was associated with 38% fewer mental health visits per year for women, but 39% more visits for men.
- Women Veterans had twice the rates of depression and anxiety and used more mental health and primary care services than men.
Enabling mental healthcare through PC-MHI has differing impacts on men and women Veterans and differing health system impacts. In men, addressing unmet mental health needs in PC-MHI may increase the demand for specialty mental healthcare, whereas in women PC-MHI appears to offer an alternative to specialty mental healthcare.
Leung L, Rubenstein L, Post E, et al. Association of Veterans Affairs primary care mental health integration with care access among men and women Veterans. JAMA Network Open. October 20, 2020;3(10):e2020955.
Women Veterans More Likely than Males to Use Any Healthcare Up to One Year Post-Discharge
This study examined gender differences among a national sample of 9,566 Veterans in the use of VA and non-VA health services during the first 15 months of the transition from military to civilian life. In Fall 2016, study participants within approximately 90 days post-military separation provided baseline data and, one year later, completed a web-based survey. In addition to demographics, the survey asked about healthcare use. Questions also targeted housing (stable or unstable), social support, employment, and education, in addition to sleep quality, PTSD, anxiety, depression, and behavioral risk factors (e.g., smoking, drinking).
- Women Veterans were twice as likely as men to use any healthcare (VA or non-VA) immediately post-military and 84% more likely than men to do so a year later– but the use of VA care was comparable between men and women.
- While unstable housing was similar across genders (10% for women and 12% for men), women Veterans with unstable housing at military separation were less likely to use healthcare a year later, especially for the subgroup with mental/behavioral health issues.
- Sleep problems, anxiety, and depression were associated with healthcare use for both men and women following transition.
VA housing assistance services could be gender-tailored for the 10% or 12% of Veterans with unstable housing; this could be implemented via outreach in the first 15 months post-separation. Further sleep problems, depression, and anxiety remain drivers of healthcare use; whether expert treatment is provided in the community is unknown and should be assessed.
Copeland L, Finley E, Vogt D, et al. Gender differences in newly separated Veterans’ use of healthcare. American Journal of Managed Care. March 12, 2020;26(3).
For More Information
Visit HSR&D’s Women’s Health Topics page for current info on projects, publications, and other activities related to Women’s Health.
Visit HSR&D’s Women’s Health Network page for more information on ongoing Women’s Health research and resources.