Project Background: Harassment is a recognized problem in VA facilities. Recent national studies of women Veterans receiving Veterans Health Administration (VHA) health services found that 25% reported experiencing harassment at the VA in the past year. Most often, these incidents involved sexual harassment (e.g., catcalls, being stared at/watched, or sexual/derogatory comments) or sexist harassment (e.g., someone questioning their identity as a Veteran or their right to care). Women Veterans who experience harassment are significantly more likely to feel unsafe and unwelcome at the VA; and to delay or underutilize care, which may place them at risk for poorer health outcomes. Significance/Impact: Harassment has the potential to negatively impact the dignity, privacy, sense of security, safety, and health of women Veterans. Recognizing this, VA has launched several initiatives: Women’s Health Services’ “End Harassment” campaign and, most recently, VHA Executive in Charge, Dr. Stone’s “Stand Up to Harassment Now!” campaign. However, to date, there are no evidence-based interventions to address harassment of service users in healthcare setting such as the VA. The current study attempts to expand the VA’s efforts to address harassment by developing and evaluating a bystander activation intervention that can be used to increase awareness of gender-based harassment (GBH) and confidence in and willingness to help/intervene among a range of individuals within the system (e.g. Veterans, VA staff and leadership). By addressing harassment and the discomfort it creates, this intervention may reduce disparities in access to and the quality of care of women Veterans. Innovation: The lack of evidence-based interventions to address harassment in healthcare settings represents a significant gap in VHA’s ability to provide high-quality, gender-sensitive, comprehensive health care to women Veterans. The project attempts to address this gap by actively partnering and collaborating with Veterans and other stakeholders to develop and evaluate a novel, Veteran-informed bystander harassment intervention that, if effective, has the potential to make VA settings more comfortable, safe and welcoming for women Veterans. Specific Aims: The specific aims of this study are 1) to develop a Veteran-informed harassment bystander activation intervention. 2) to conduct a pilot trial to examine the feasibility, acceptability, potential efficacy, and information regarding implementation of the intervention with Veterans and VA staff. Methodology: We will create a bystander activation harassment intervention using participatory action research (PAR) methods. First, 20 women who have experienced harassment and are receiving services at the VAMHCS will develop photonarratives using Photovoice PAR methods that convey experiences of harassment at VA and its impacts. We will also conduct focus groups with male Veterans, female Veterans, and VA staff to inform the adaptation of existing bystander behavior materials for use in a VA setting. The intervention will be developed using these materials and refined over several meetings with Veterans and VA staff/leadership input. Once developed, we will conduct a pilot trial of the intervention with Veterans receiving VAMHCS services (n=35) and VA staff (n=15). All participants will complete a baseline assessment, a qualitative interview at immediate post-intervention, and a 2-week post-intervention assessment. Feasibility and acceptability will be assessed via rates of recruitment, retention, participant reported acceptability. Outcomes that will be explored include awareness of harassment; recognition of the need to intervene; and responsibility for, knowledge regarding how, and intent to intervene; and input on implementation collected. Implementation/Next Steps: Next steps will include using the results of this study to inform a larger randomized trial to examine the efficacy of the harassment bystander activation intervention.
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Grant Number: I21HX003187-01
None at this time.
TRL - Applied/Translational
Attitudes/Beliefs, Sexual Trauma/Assault
None at this time.