Abstract
Background
One in four women Veterans who use the Veterans Health Administration (VA) screen
positive for military sexual trauma and may need trauma-sensitive care and coordination.
VA primary care providers (PCPs), women veterans' main source of care, need to be
well-versed in trauma-sensitive approaches to care. Women veterans' numerical minority
in the VA can make provider exposure to female patients inconsistent, which may impede
PCP experience in providing appropriate care. To inform strategies for improving trauma-sensitive
primary care, we sought to better understand PCPs’ current approaches to providing
care to women veterans with sexual trauma histories.
Methods
We conducted semistructured telephone interviews with PCPs (n = 28) practicing in VA primary care clinics. Participants were asked about their
experiences delivering trauma-sensitive care as well as best practices. Interviews
were recorded, transcribed, and analyzed for major themes regarding barriers to and
facilitators of trauma-sensitive care.
Results
Participants expressed challenges delivering care to women with sexual trauma histories,
including 1) insufficient time, 2) lack of perceived proficiency and/or personal comfort
(with general physical examinations as well as gender-specific care such as Pap, breast,
and pelvic examinations), and 3) difficulties with fostering positive patient–provider
relationships. Access to mental health resources was noted as a key facilitator of
providing trauma-sensitive care. Participants also shared existing (and potential)
best practices and recommendations, such as paying special attention to patient behavioral
cues related to comfort.
Conclusions
PCPs delivering care to women in VA facilities may benefit from an increased awareness
of best practices to facilitate the delivery of trauma-sensitive care.
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Biography
Alicia A. Bergman, PhD, is a social scientist and health services researcher at the VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy. Her research focuses on improving primary care services for women veterans.
Biography
Alison B. Hamilton, PhD, MPH, is a medical anthropologist and implementation scientist with the VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, and a Research Anthropologist at UCLA. Dr. Hamilton's work focuses on women veterans' health.
Biography
Joya G. Chrystal, LCSW, is a licensed clinical social worker and health science specialist at the VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy. Her research focuses on women veterans' mental health and healthcare utilization.
Biography
Bevanne A. Bean-Mayberry, MD, is a general internist, women's health primary care provider, and health services researcher, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, and Clinical Associate Professor, UCLA David Geffen School of Medicine.
Biography
Elizabeth M. Yano, Ph.D., MSPH, is Director, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, and Adjunct Professor, Health Policy and Management, UCLA Fielding School of Public Health. Her research focuses on research implementation into evidence-based practice and policy.
Article info
Publication history
Published online: April 23, 2019
Accepted:
March 6,
2019
Received in revised form:
March 2,
2019
Received:
September 24,
2018
Footnotes
Funded by VA Women's Health Services, Veterans Health Administration, as part of a multi-project evaluation (XVA 65-062). Dr. Yano's time was covered through a VA HSR&D Senior Research Career Scientist Award (RCS 05-195). The effort was also supported by VA HSR&D CRE 12-026. The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs or the United States Government.
Identification
Copyright
Published by Elsevier Inc. on behalf of Jacobs Institute of Women's Health.
