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.
NIH Reporter Project Information
- 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.
- 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.
Technology Development and Assessment, TRL - Development
None at this time.