Advertisement

What Drives Women Veterans’ Trust in VA Healthcare Providers?

  • Gwendolyn C. Carlson
    Correspondence
    Correspondence to: Gwendolyn C. Carlson, PhD, Department of Mental Health, VA Greater Los Angeles Healthcare System, 16111 Plummer St (Mailcode 116B), Sepulveda, North Hills, CA 91343; Phone: (818) 891-7711x32611; fax: (818) 895-5838.
    Affiliations
    Department of Mental Health, VA Greater Los Angeles Healthcare System, North Hills, California

    VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California

    Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, California
    Search for articles by this author
  • Claire T. Than
    Affiliations
    VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California
    Search for articles by this author
  • Danielle Rose
    Affiliations
    VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California
    Search for articles by this author
  • Julian Brunner
    Affiliations
    VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California
    Search for articles by this author
  • Catherine Chanfreau-Coffinier
    Affiliations
    VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California

    VA Informatics and Computing Infrastructure (VINCI), Salt Lake City VA Healthcare System, Salt Lake City, Utah
    Search for articles by this author
  • Ismelda A. Canelo
    Affiliations
    VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California
    Search for articles by this author
  • Ruth Klap
    Affiliations
    VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California

    Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, California
    Search for articles by this author
  • Bevanne Bean-Mayberry
    Affiliations
    VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California

    Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California
    Search for articles by this author
  • Alpna Agrawal
    Affiliations
    Department of Mental Health, VA Greater Los Angeles Healthcare System, North Hills, California

    VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California

    Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, California
    Search for articles by this author
  • Alison B. Hamilton
    Affiliations
    VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California

    Department of Psychiatry and Biobehavioral Sciences, UCLA Geffen School of Medicine, Los Angeles, California
    Search for articles by this author
  • Megan R. Gerber
    Affiliations
    Albany Medical College, Albany Stratton VA Medical Center, Albany, New York
    Search for articles by this author
  • Elizabeth M. Yano
    Affiliations
    VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, North Hills, California

    Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California

    Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California
    Search for articles by this author
Published:March 30, 2022DOI:https://doi.org/10.1016/j.whi.2022.02.004

      Abstract

      Introduction

      Little is known about women veterans’ trust in Veterans Affairs (VA) health care and what factors promote trust in VA providers. We examined provider behaviors and characteristics of women veterans associated with trust in their VA providers.

      Methods

      We used a 2015 survey of women veterans who were routine users of primary care at 12 VA medical centers (n = 1,395). Patient trust in their VA provider was measured on a seven-item scale. We used multiple logistic regression to examine associations of patient-provider communication and gender appropriateness with complete trust in VA provider (100 [complete trust] vs. <100 [less than complete trust]), controlling for patient characteristics.

      Results

      On average, 39.7% of women veterans reported complete trust in their VA providers. Those with complete trust reported greater patient-provider communication and gender appropriateness of VA services than those with less-than-complete trust (all ps ≤ .001). In multiple logistic regression models, higher ratings of provider communication (adjusted odds ratio, 2.37), gender-appropriate care (adjusted odds ratio, 1.93), and trauma-sensitive communication (adjusted odds ratios, 1.79–6.08) were associated with a higher likelihood of reporting complete trust in their VA provider.

      Conclusions

      Women veterans reported high levels of trust in their VA providers. Provider communication, gender-appropriate care, and trauma-sensitive communication were associated with greater patient trust. Although it is important to highlight the steps already taken by VA to increase the quality of care for women veterans, current findings suggest that women veterans’ trust may be further increased by interventions to improve trauma-informed care by VA providers.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Women's Health Issues
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Agency for Health Research and Quality
        AHPS Patient-Centered Medical Home (PCMH) Item Set.
        (Available:)
        • Andersen R.
        A behavioral model of families' use of health services. Chicago: Center for Health Administration Studies.
        University of Chicago, Chicago1968
        • Anderson L.A.
        • Dedrick R.F.
        Development of the Trust in Physician scale: A measure to assess interpersonal trust in patient-physician relationships.
        Psychological Reports. 1990; 67: 1091-1100
        • Babitsch B.
        • Gohl D.
        • Von Lengerke T.
        Re-revisiting Andersen’s Behavioral Model of Health Services Use: A systematic review of studies from 1998–2011.
        GMS Psycho-Social-Medicine. 2012; 9: 1-20
        • Bean-Mayberry
        • Yano E.M.
        • Washington D.L.
        • Goldzweig C.
        • Batuman F.
        • Huang C.
        • Shekelle P.G.
        Systematic review of women veterans’ health: Update on successes and gaps.
        Women's Health Issues. 2011; 21: S84-S97
        • Bean-Mayberry B.A.
        • Chang C.-C.H.
        • McNeil M.A.
        • Whittle J.
        • Hayes P.M.
        • Scholle S.H.
        Patient satisfaction in women’s clinics versus traditional primary care clinics in the Veterans Administration.
        Journal of General Internal Medicine. 2003; 18: 175-181
        • Birkhäuer J.
        • Gaab J.
        • Kossowsky J.
        • Hasler S.
        • Krummenacher P.
        • Werner C.
        • Gerger H.
        Trust in the health care professional and health outcome: A meta-analysis.
        PloS one. 2017; 12: 1-13
        • Brown T.
        • Berman S.
        • McDaniel K.
        • Radford C.
        • Mehta P.
        • Potter J.
        • Hirsh D.A.
        Trauma-informed medical education (TIME): Advancing curricular content and educational context.
        Academic Medicine. 2020; 96: 661-667
        • Chanfreau-Coffinier C.
        • Gordon H.S.
        • Schweizer C.A.
        • Bean-Mayberry B.A.
        • Darling J.E.
        • Canelo I.
        • Yano E.M.
        Mental health screening results associated with women veterans' ratings of provider communication, trust, and care quality.
        Women's Health Issues. 2018; 28: 430-438
        • Chang C.-S.
        • Chen S.-Y.
        • Lan Y.-T.
        Service quality, trust, and patient satisfaction in interpersonal-based medical service encounters.
        BMC Health Services Research. 2013; 13: 22
        • Department of Veterans Affairs
        National center for Veteran’s analysis and statistics.
        (Available:)
        www.va.gov/vetdata/veteran_population.asp
        Date: 2018
        Date accessed: March 2, 2021
        • Department of Veterans Affiars Department of Defesnse (VA/DoD)
        VA/DOD clinical practice guideline for the management of posttraumatic stress disorder and acute stress disorder.
        (Available:)
        • DeSalvo K.B.
        • Fan V.S.
        • McDonell M.B.
        • Fihn S.D.
        Predicting mortality and healthcare utilization with a single question.
        Health Services Research. 2005; 40: 1234-1246
        • Diehle J.
        • Schmitt K.
        • Daams J.G.
        • Boer F.
        • Lindauer R.J.
        Effects of psychotherapy on trauma-related cognitions in posttraumatic stress disorder: A meta-analysis.
        Journal of Traumatic Stress. 2014; 27: 257-264
        • Dong Y.
        • Peng C.-Y.J.
        Principled missing data methods for researchers.
        SpringerPlus. 2013; 2: 1-17
        • Evans E.A.
        • Tennenbaum D.L.
        • Washington D.L.
        • Hamilton A.B.
        Why women veterans do not use VA-provided health and social services: Implications for health care design and delivery.
        Journal of Humanistic Psychology. 2019; : 1-30
        • Fan V.S.
        • Au D.
        • Heagerty P.
        • Deyo R.A.
        • McDonell M.B.
        • Fihn S.D.
        Validation of case-mix measures derived from self-reports of diagnoses and health.
        Journal of Clinical Epidemiology. 2002; 55: 371-380
        • Foynes M.M.
        • Makin-Byrd K.
        • Skidmore W.C.
        • King M.W.
        • Bell M.E.
        • Karpenko J.
        Developing systems that promote veterans’ recovery from military sexual trauma: Recommendations from the Veterans Health Administration national program implementation.
        Military Psychology. 2018; 30: 270-281
        • Gobin R.L.
        • Freyd J.J.
        The impact of betrayal trauma on the tendency to trust.
        Psychological Trauma: Theory, Research, Practice, and Policy. 2014; 6: 505-511
        • Hall M.A.
        • Dugan E.
        • Zheng B.
        • Mishra A.K.
        Trust in physicians and medical institutions: What is it, can it be measured, and does it matter?.
        Milbank Quarterly. 2001; 79: 613-639
        • Hall M.A.
        • Zheng B.
        • Dugan E.
        • Camacho F.
        • Kidd K.E.
        • Mishra A.
        • Balkrishnan R.
        Measuring patients’ trust in their primary care providers.
        Medical Care Research and Review. 2002; 59: 293-318
        • Hamilton A.B.
        • Frayne S.M.
        • Cordasco K.M.
        • Washington D.L.
        Factors related to attrition from VA healthcare use: Findings from the National Survey of Women Veterans.
        Journal of General Internal Medicine. 2013; 28: 510-516
        • Hughes T.M.
        • Merath K.
        • Chen Q.
        • Sun S.
        • Palmer E.
        • Idrees J.J.
        • Pawlik T.M.
        Association of shared decision-making on patient-reported health outcomes and healthcare utilization.
        American Journal of Surgery. 2018; 216: 7-12
        • Isobel S.
        • Wilson A.
        • Gill K.
        • Howe D.
        ‘What would a trauma-informed mental health service look like?’Perspectives of people who access services.
        International Journal of Mental Health Nursing. 2021; 30: 495-505
        • Jacobs E.A.
        • Rolle I.
        • Ferrans C.E.
        • Whitaker E.E.
        • Warnecke R.B.
        Understanding African Americans’ views of the trustworthiness of physicians.
        Journal of General Internal Medicine. 2006; 21: 642-647
        • Karlin B.E.
        • Ruzek J.I.
        • Chard K.M.
        • Eftekhari A.
        • Monson C.M.
        • Hembree E.A.
        • Foa E.B.
        Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration.
        Journal of Traumatic Stress. 2010; 23: 663-673
        • Kelly U.
        • Boyd M.A.
        • Valente S.M.
        • Czekanski E.
        Trauma-informed care: Keeping mental health settings safe for veterans.
        Issues in Mental Health Nursing. 2014; 35: 413-419
        • Kimerling R.
        • Gima K.
        • Smith M.W.
        • Street A.
        • Frayne S.
        The Veterans Health Administration and military sexual trauma.
        American Journal of Public Health. 2007; 97: 2160-2166
        • Kimerling R.
        • Street A.E.
        • Pavao J.
        • Smith M.W.
        • Cronkite R.C.
        • Holmes T.H.
        • Frayne S.M.
        Military-related sexual trauma among Veterans Health Administration patients returning from Afghanistan and Iraq.
        American Journal of Public Health. 2010; 100: 1409-1412
        • Klap R.
        • Darling J.E.
        • Hamilton A.B.
        • Rose D.E.
        • Dyer K.
        • Canelo I.
        • Yano E.M.
        Prevalence of stranger harassment of women veterans at Veterans Affairs medical centers and impacts on delayed and missed care.
        Women's Health Issues. 2019; 29: 107-115
        • Klest B.
        • Tamaian A.
        • Boughner E.
        A model exploring the relationship between betrayal trauma and health: The roles of mental health, attachment, trust in healthcare systems, and nonadherence to treatment.
        Psychological Trauma: Theory, Research, Practice, and Policy. 2019; 11: 656-662
        • Kroenke K.
        • Spitzer R.L.
        • Williams J.B.
        The Patient Health Questionnaire-2: Validity of a two-item depression screener.
        Medical Care. 2003; 41: 1284-1292
        • Lang A.J.
        • Stein M.B.
        An abbreviated PTSD checklist for use as a screening instrument in primary care.
        Behaviour Research and Therapy. 2005; 43: 585-594
        • Lehavot K.
        • Goldberg S.B.
        • Chen J.A.
        • Katon J.G.
        • Glass J.E.
        • Fortney J.C.
        • Schnurr P.P.
        Do trauma type, stressful life events, and social support explain women veterans’ high prevalence of PTSD?.
        Social Psychiatry and Psychiatric Epidemiology. 2018; 53: 943-953
        • Lutwak N.
        • Dill C.
        Military sexual trauma increases risk of post-traumatic stress disorder and depression thereby amplifying the possibility of suicidal ideation and cardiovascular disease.
        Military Medicine. 2013; 178: 359-361
        • Massarweh N.N.
        • Itani K.M.
        • Morris M.S.
        The VA MISSION act and the future of veterans’ access to quality health care.
        JAMA. 2020; 324: 343-344
        • Monteith L.L.
        • Holliday R.
        • Schneider A.L.
        • Miller C.N.
        • Bahraini N.H.
        • Forster J.E.
        Institutional betrayal and help-seeking among women survivors of military sexual trauma.
        Psychological Trauma: Theory, Research, Practice, and Policy. 2021; 13: 8104-8823
        • Morral A.R.
        • Gore K.L.
        • Schell T.L.
        Sexual assault and sexual harassment in the US military. Volume 2. Estimates for Department of Defense service members from the 2014 RAND military workplace study.
        Rand National Defense Research Institute: Santa Monica, Ca. 2015;
        • Pearson S.D.
        • Raeke L.H.
        Patients’ trust in physicians: Many theories, few measures, and little data.
        Journal of General Internal Medicine. 2000; 15: 509-513
        • Racine N.
        • Killam T.
        • Madigan S.
        Trauma-informed care as a universal precaution: Beyond the adverse childhood experiences questionnaire.
        JAMA Pediatrics. 2020; 174: 5-6
        • Rossiter A.G.
        • Smith S.
        The invisible wounds of war: Caring for women veterans who have experienced military sexual trauma.
        Journal of the American Association of Nurse Practitioners. 2014; 26: 364-369
        • SAMHSA
        SAMHSA’s concept of trauma and guidance for a trauma-informed approach.
        (Available:)
        • Shan L.
        • Li Y.
        • Ding D.
        • Wu Q.
        • Liu C.
        • Jiao M.
        • Hao J.
        Patient satisfaction with hospital inpatient care: Effects of trust, medical insurance and perceived quality of care.
        PloS One. 2016; 11: 1-18
        • StataCorp, L.
        Author, College Station, TX2015
        • Street Jr., R.L.
        • Makoul G.
        • Arora N.K.
        • Epstein R.M.
        How does communication heal? Pathways linking clinician–patient communication to health outcomes.
        Patient Education and Counseling. 2009; 74: 295-301
        • Stroupe K.T.
        • Martinez R.
        • Hogan T.P.
        • Gordon E.J.
        • Gonzalez B.
        • Kale I.
        • Hynes D.M.
        Experiences with the veterans’ choice program.
        Journal of General Internal Medicine. 2019; 34: 2141-2149
        • Suris A.
        • Lind L.
        Military sexual trauma: A review of prevalence and associated health consequences in veterans.
        Trauma, Violence, & Abuse. 2008; 9: 250-269
        • Vogt D.S.
        • Barry A.A.
        • King L.A.
        Toward gender-aware health care: evaluation of an intervention to enhance care for female patients in the VA setting.
        Journal of Health Psychology. 2008; 13: 624-628
        • Washington D.L.
        • Bean-Mayberry B.
        • Hamilton A.B.
        • Cordasco K.M.
        • Yano E.M.
        Women veterans’ healthcare delivery preferences and use by military service era: Findings from the National Survey of Women Veterans.
        Journal of General Internal Medicine. 2013; 28: 571-576
        • Washington D.L.
        • Caffrey C.
        • Goldzweig C.
        • Simon B.
        • Yano E.M.
        Availability of comprehensive women’s health care through Department of Veterans Affairs Medical Center.
        Women's Health Issues. 2003; 13: 50-54
        • Wilson L.C.
        The prevalence of military sexual trauma: A meta-analysis.
        Trauma, Violence, & Abuse. 2018; 19: 584-597
        • Yano E.M.
        A partnered research initiative to accelerate implementation of comprehensive care for women veterans: The VA women’s health CREATE.
        Medical Care. 2015; 53: S10-S14
        • Yano E.M.
        • Darling J.E.
        • Hamilton A.B.
        • Canelo I.
        • Chuang E.
        • Meredith L.S.
        • Rubenstein L.V.
        Cluster randomized trial of a multilevel evidence-based quality improvement approach to tailoring VA Patient Aligned Care Teams to the needs of women Veterans.
        Implementation Science. 2015; 11: 1-14
        • Yano E.M.
        • Hamilton A.B.
        Accelerating delivery of trauma-sensitive care: Using multilevel stakeholder engagement to improve care for women veterans.
        Families, Systems, & Health. 2017; 35: 373-375
        • Yano E.M.
        • Haskell S.
        • Hayes P.
        Delivery of gender-sensitive comprehensive primary care to women veterans: implications for VA patient aligned care teams.
        Journal of General Internal Medicine. 2014; 29: 703-707

      Biography

      Gwendolyn C. Carlson, PhD, is a clinical psychologist and COIN Investigator, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System and a clinical instructor in the David Geffen School of Medicine at UCLA.

      Biography

      Claire T. Than, PhD, MPH, is a Health Science Specialist and Statistician, VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System.

      Biography

      Danielle Rose, PhD, is a COIN Investigator, VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System.

      Biography

      Julian Brunner, PhD, MPH, is a COIN Investigator, VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System.

      Biography

      Catherine Chanfreau-Coffinier, PhD, has affiliations that include include VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, and VA Informatics and Computing Infrastructure (VINCI), Salt Lake City VA Healthcare System.

      Biography

      Ismelda A. Canelo, MPA, is a Health Science Specialist and Project Manager, VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System.

      Biography

      Ruth Klap, PhD, is a former investigator at the HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, and has an appointment at the Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA.

      Biography

      Bevanne Bean-Mayberry, MD, MHS, is a COIN Investigator, VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, and a Clinical Professor in the Department of Medicine, David Geffen School of Medicine at UCLA.

      Biography

      Alpna Agrawal, MD, PhD, is a COIN Investigator, VA Los Angeles HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System; Health Sciences Assistant Clinical Professor, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA.

      Biography

      Alison B. Hamilton, PhD, MPH, is Chief Officer of Implementation and Policy, VA HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy, and Professor-in-Residence in the David Geffen School of Medicine at UCLA. Her research interests include implementation science and qualitative research methods.

      Biography

      Megan R. Gerber, MD, MPH, Affiliations include the Albany Medical College, Albany New York and the Albany Stratton VA.

      Biography

      Elizabeth M. Yano, PhD, MSPH, is Director, VA HSR&D Center for the Study of Healthcare Innovation, Implementation, Director, VA Women's Health Research Network (Consortium) and Policy, and UCLA Adjunct Professor of Public Health and Medicine.