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True JG, Ono S, Zickmund SL, Mengeling M, Burkitt KH, Sadler A. A Veteran-centered approach to military sexual trauma screening: learning from Veterans' experiences and perspectives. Paper presented at: VA HSR&D / QUERI National Meeting; 2015 Jul 9; Philadelphia, PA.
Objectives: The Veterans Health Administration (VHA) proactively instituted universal screening for Military Sexual Trauma (MST) in 2002; however, MST disclosure at VHA is low compared with rates reported in the literature. We elicited Veterans' experiences and perspectives on being asked about MST, including perceptions of VHA's screening questions and the context and manner in which they are asked, with the goal of identifying Veteran-generated suggestions for examining and improving processes around MST detection and referral to care. Methods: We conducted semi-structured, in-person qualitative interviews with 76 Veterans (38 men, 38 women) at four geographically diverse VHA facilities. We sought to ensure maximum sample variation through stratifying recruitment by sex, results of MST screening as indicated in the electronic medical record, and individual responses to the Sexual Experiences Questionnaire. We coded qualitative interviews using the editing style interpretive framework for research conducted in the context of medical care; we examined coded text to identify themes around Veterans' experiences of being asked screening questions and suggestions for improving the screening process. Results: Veterans identified key barriers to disclosing MST in clinical settings including lack of trust or rapport with the person asking the questions, concerns about confidentiality, and being asked about MST in ways that felt insensitive. Many Veterans, especially those who had experienced MST, expressed concerns that poor screening processes would lead to lack of disclosure and/or lack of engagement in treatment for those who were most in need of care for MST-related conditions. Veterans' insights about how to improve VHA's MST screening process focused on framing and timing, as well as attention to the knowledge, training, and attitudes of persons asking the screening questions. Implications: Military sexual trauma ""sexual assault or repeated, threatening sexual harassment that occurs while in the military""is linked with a range of physical, mental, and psychosocial sequelae. Encouraging accurate disclosure of MST experiences and follow-up to care for Veterans who have MST-related conditions requires a Veteran-centered approach to screening. Impacts: Veterans' suggestions for improving sexual trauma screening processes can inform provision of patient-centered MST screening and care for Veterans who seek care within and outside VHA.