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PPO 18-112 – HSR Study

PPO 18-112
Addressing Gender-Based Harassment of Women Veterans at VA Facilities
Alison B Hamilton, PhD MPH
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
West Los Angeles, CA
Funding Period: October 2018 - December 2020


Project Background: Daily public revelations of sexual harassment, frequent media reports from victims accusing perpetrators, and #metoo in social media highlight decades of harassment by those in more powerful positions across many settings. A recent study conducted by our research team revealed that many women Veterans and staff report sexual harassment by male Veterans at VA facilities. In fact, 25% of women Veterans seen in VA primary care across 12 sites reported experiencing harassment from male Veterans while on VA grounds. Similarly, women staff who took part in VA-based focus groups described experiencing unwelcome advances, sexual comments, and being followed outside work. Exposure to harassment was associated with women Veterans delaying or missing care, and feeling unwelcome at the VA. Among staff, it was associated with negative impacts on employee morale, burnout, and turnover. The goal of this pilot study is to identify strategies for addressing harassment of women Veteran VA patients and VA employees. Because harassment is a contentious issue with varying perspectives on what constitutes acceptable versus unacceptable behavior, achieving this goal requires innovative, stakeholder-engaged methods. After obtaining input from subject matter experts, we propose to engage VA stakeholders through public deliberation methods, which are appropriate for addressing value-laden healthcare policy issues about which different stakeholders have entrenched, and possibly conflicting, views. Project Objectives: The Specific Aims are to: (1) identify strategies for addressing harassment of women Veterans and employees; and (2) engage in public deliberation methods at VA Greater Los Angeles (GLA) to design a stakeholder-informed, locally-tailored strategy for addressing harassment. Project Methods: To achieve Aim 1, we will conduct semi-structured interviews with national subject matter experts (n=20). Informed by Aim 1 results, we will then engage VA clinicians, other VA staff, and Veterans (both men and women; n=20) in a series of four structured deliberation sessions designed to elicit in-depth views, with the goal of reaching common ground on how to address harassment. We will evaluate stakeholders' experiences of engaging in these sessions using an adapted version of the Ways of Engaging- Engagement ACtivity Tool (WE-ENACT), a measure developed by the Patient-Centered Outcomes Research Institute. At the end of the deliberation sessions, our objective is to have a locally tailored strategy to test at VA GLA, with support from a future HSR&D IIR. Significance and Relevance to Veterans' Health: The project is guided by a patient-centered, community- engaged research framework that features partnerships between researchers and stakeholders, and cross- communication among stakeholders. As such, the project is responsive to several HSR&D priorities, including patient-centered care and healthcare systems change, as well as HSR&D's cross-cutting methods domain of engaging Veterans, providers, and other stakeholders. Using novel engagement methods, this pilot represents an important next step in ensuring that our healthcare system achieves VA's policy of health care that ensures the dignity, privacy, sense of security, and safety of every Veteran.

External Links for this Project

NIH Reporter

Grant Number: I21HX002690-01

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Journal Articles

  1. Fenwick KM, Luger TM, Dyer KE, Chrystal JG, Hamilton AB, Yano EM, Klap R. Challenges to Addressing Patient-Perpetrated Sexual Harassment in Veterans Affairs Healthcare Settings. Journal of general internal medicine. 2021 Aug 1; 36(8):2332-2338. [view]
  2. Fenwick KM, Dyer KE, Klap R, Oishi K, Moreau JL, Yano EM, Bean-Mayberry B, Sadler AG, Hamilton AB. Expert Recommendations for Designing Reporting Systems to Address Patient-Perpetrated Sexual Harassment in Healthcare Settings. Journal of general internal medicine. 2022 Nov 1; 37(14):3723-3730. [view]
  3. Dyer KE, Potter SJ, Hamilton AB, Luger TM, Bergman AA, Yano EM, Klap R. Gender Differences in Veterans' Perceptions of Harassment on Veterans Health Administration Grounds. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2019 Jun 25; 29 Suppl 1:S83-S93. [view]
  4. Dyer KE, Hamilton AB, Yano EM, Moreau JL, Frayne SM, Carney DV, Golden RE, Klap R. Mobilizing embedded research and operations partnerships to address harassment of women Veterans at VA medical facilities. Healthcare (Amsterdam, Netherlands). 2021 Jun 1; 8 Suppl 1:100513. [view]
  5. Klap R, Darling JE, Hamilton AB, Rose DE, Dyer K, Canelo I, Haskell S, Yano EM. Prevalence of Stranger Harassment of Women Veterans at Veterans Affairs Medical Centers and Impacts on Delayed and Missed Care. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2019 Mar 1; 29(2):107-115. [view]
  6. Fenwick KM, Potter SJ, Klap R, Dyer KE, Relyea MR, Yano EM, Luger TM, Bergman AA, Chrystal JG, Hamilton AB. Staff and Patient Perspectives on Bystander Intervention Training to Address Patient-Initiated Sexual Harassment in Veterans Affairs Healthcare Settings. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2021 Nov 1; 31(6):576-585. [view]
  7. Moreau JL, Dyer KE, Hamilton AB, Golden RE, Combs AS, Carney DV, Frayne SM, Yano EM, Klap R, VA Women's Health Practice-Based Research Network. Women Veterans' Perspectives on How to Make Veterans Affairs Healthcare Settings More Welcoming to Women. Women's health issues : official publication of the Jacobs Institute of Women's Health. 2020 Jul 1; 30(4):299-305. [view]
Government Briefings

  1. Hayes P, Yano EM. Resilience and Coping: Mental Health of Women Veterans: Briefing before the US House of Representatives Veteran Affairs Subcommittee on Health and Women Veterans Task Force Virtual Round Table; 2020 May 19; Washington, DC. [view]

DRA: Health Systems
DRE: Technology Development and Assessment, TRL - Development
Keywords: Patient Preferences
MeSH Terms: None at this time.

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