Health Services Research & Development

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Veterans' Perspectives

How Stranger Harassment of Women Veterans Affects Healthcare

HSR&D’s monthly publication Veterans’ Perspectives highlights research conducted by HSR&D and/or QUERI investigators, showcasing the importance of research for Veterans – and the importance of Veterans for research.

In the April 2019 Issue:

Women Veterans Healthcare CREATE

HSR&D’s Women Veterans Healthcare Collaborative Research to Enhance and Advance Transformation and Excellence (CREATE) initiative conducted research to examine the essential factors that facilitate (or slow) the pace, effectiveness, and outcomes of the delivery of comprehensive care for women Veterans within the VA healthcare system. This CREATE initiative worked closely with several operational partners, including the Office of Women’s Health Services and the Office of Mental Health Services.

Introduction

Stranger harassment or street harassment, also referred to as sexual harassment, includes a range of verbal and non-verbal behaviors such as comments, catcalls, staring, as well as noises and gestures. Approximately two-thirds of women in recent U.S. national surveys reported experiencing sexual harassment in public spaces at some point in their lives; however, only five percent of women respondents in a recent national survey reported that they were sexually harassed in a healthcare setting. Given that sexual harassment is common in the U.S. military, investigators with HSR&D’s Women Veterans Healthcare CREATE initiative sought to examine whether harassment also was prevalent in the settings where many Veterans, including women, receive their healthcare.

Between 2005 and 2015, the number of women Veterans using VA healthcare increased 46%, from 237,952 to 455,875. Nonetheless, women still only comprise 8% of VA patients, and they are still vastly outnumbered by men in almost all VA healthcare environments, including waiting rooms, hallways, and treatment centers. This has posed challenges for the healthcare system, especially since many women Veteran using VA have complex medical and mental health conditions.  At least one-quarter have been exposed to trauma, including military sexual trauma (MST), which includes both sexual harassment and sexual assault.

The Women Veterans Healthcare CREATE Team and members of its Executive Steering Committee.

The Women Veterans Healthcare CREATE Team and members of its Executive Steering Committee.


Inviting Women Veterans to Participate


The key to any study examining Veterans’ perspectives is getting Veterans to participate.

The key to any study examining Veterans’ perspectives is getting Veterans to participate. In this study, investigators sent more than 3,000 eligible women Veterans a pre-notification packet that included an introductory letter, VA leadership endorsements, a small refrigerator magnet depicting women Veterans, and a study brochure that provided the required elements of informed consent. Study interviewers then made up to 12 attempts to contact potential respondents at varying days and times, using a computer-assisted telephone interviewing system.

After excluding non-responders and partial interviews, investigators conducted full interviews with 1,387 women Veterans from January – March 2015. These women had three or more primary care or women’s health encounters at one of 12 diverse urban and rural VA medical centers (VAMCs) across nine states in the prior 12 months. In addition to questions about stranger harassment, investigators also assessed patient socio-demographics, health status, trauma exposure, military sexual trauma (MST), and mental health (anxiety disorder, PTSD, and depression).


Women Reporting Stranger Harassment on VA Grounds More Likely to Delay or Miss Healthcare


One in four women Veterans (25%) reported inappropriate and/or unwanted comments or behavior by male Veterans on VA grounds.

Findings from this study show:

  • One in four women Veterans (25%) reported inappropriate and/or unwanted comments or behavior by male Veterans on VA grounds. Eight percent said that this occurred “usually or always” when they were at VA. Negative interactions included sexual/derogatory comments and questions about the women’s Veteran identity and right to VA care.
  • Women Veterans who reported harassment were less likely to report feeling welcome at VA, and more likely to report feeling unsafe and delaying/missing care.
  • Younger women were more likely to report harassment, as were women Veterans with self-reported fair or poor health status, those with MST and/or other trauma exposures, and those with anxiety.
  • About two-thirds of the women in this study screened positive for probable anxiety (63%) and MST (62%). Also, a majority of women reported combat or lifetime exposure to trauma (80%).


Women Veterans Respond to Questions about Stranger Harassment


Woman Veteran: “You get the feeling that you shouldn’t be there [VAMC], not as much as men, and that your service didn’t matter.”

Of those women reporting an incident on VA grounds, 61% reported harassment, 16% reported that their status as a Veteran was questioned, 7% reported harassment in addition to questions about Veteran status, and 5% reported threatening/criminal behavior. Some of the specific comments offered by women Veterans include:

  • When describing her experience, a 37-year-old, non-White Veteran noted, “In the parking lot, the catcalling starts right away. The women’s clinic is a long way, and I am bombarded by sexual attention. It is very threatening.”
  • A few women described discomfort that affected their ability to obtain care. A 63-year-old White Veteran noted, “I was taking swimming therapy and was the only woman there and it got touchy. I got generalized looks, and stupid comments about women in bathing suits. I quit pool therapy.”
  • Others noted the incongruity of sexualized behavior in a healthcare setting. For example, a 34-year-old non-White Veteran said: “Getting hit on when I’m there just to see a doctor. That’s not what I’m there for. They try to get in my business and it gets old. It’s unwanted.”
  • A 59-year-old White veteran said: “You get the feeling that you shouldn’t be there, not as much as men, and that your service didn’t matter.”
  • A 56-year-old White veteran said: “Not sexual, but they assume that I am not a Veteran, but someone’s spouse, and when I tell them that I am a Veteran, they start talking about how women should not be in the military.


How VA is Working to Fix the Problem

Because this study was part of the Women Veterans’ Healthcare CREATE Initiative, findings were presented to VA healthcare leaders as soon as they were discovered. In response to these findings, VA Women’s Health Services enhanced this work by:

  • Establishing a national workgroup,
  • Gauging effective harassment reduction programs outside VA,
  • Convening an expert panel, and
  • Piloting and evaluating harassment interventions.

This work is ongoing, as is VA Women’s Health Services’ campaign to change the environment and culture of VA to be more inclusive, welcoming, and respectful of women Veterans.

For more information about this study, please contact Ruth Klap, PhD, at Ruth.Klap@va.gov .

For more information about the Women Veterans’ Healthcare CREATE, please contact Elizabeth Yano, PhD, MSPH at elizabeth.yano@va.gov

Klap R, Darling J, Hamilton A, Rose D, Dyer K, Canelo I, Haskell S, and Yano E. Prevalence of Stranger Harassment of Women Veterans at Veterans Affairs Medical Centers and Impacts on Delayed and Missed Care. Women’s Health Issues. March-April 2019;29(2):107-115.