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Women Veterans’ Experiences with Perceived Gender Bias in U.S. Department of Veterans Affairs Specialty Care
Institution:1. VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts;2. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts;3. VA Greater Los Angeles Healthcare System, Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), Los Angeles, California;4. Division of General Internal Medicine, UCLA David Geffen School of Medicine, Los Angeles, California;5. Durham VA Health Care System – Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), Durham, North Carolina;6. Division of General Internal Medicine, Duke University School of Medicine, Durham, North Carolina;7. VA Connecticut Healthcare System—Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center, West Haven, Connecticut;8. Yale University School of Medicine, New Haven, Connecticut;1. VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California;2. University of California, Los Angeles School of Medicine, Division of Psychiatry and Behavioral Sciences-Semel Institute, Los Angeles, California;3. University of Montana, Department of Psychology, Missoula, Montana;4. VA HSR&D Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Healthcare System, & Geriatric Research, Education and Clinical Center (GRECC), Seattle, Washington;5. University of Washington, Department of Psychiatry & Behavioral Sciences, Seattle, Washington;6. Washington State University Vancouver, Department of Human Development, Vancouver, Washington;7. Department of Psychology, Eastern Michigan University, Ypsilanti, Michigan;8. Center for Clinical Management Research, Health Services Research and Development Service, VA Ann Arbor Health Care System, Ann Arbor, Michigan;9. Center for Clinical Management Research (CCMR), VA Ann Arbor Medical Center, Ann Arbor, Michigan;10. University of Michigan Medical School, Department of Psychiatry, Ann Arbor, Michigan;11. University of California, Los Angeles School of Public Health, Department of Health Services, Los Angeles, California;12. University of California, Los Angeles School of Medicine, Division of General Internal Medicine and Health Services Research, Los Angeles, California;13. RAND Health Program, RAND Corporation, Santa Monica, California;1. Ann Arbor VA Healthcare System, Ann Arbor, Michigan;2. Department of Psychiatry, University of Michigan Medical School, Ann Arbor, Michigan;3. Department of Veterans Affairs, Center for Clinical Management Research, Ann Arbor, Michigan;4. Department of Learning Health Sciences, University of Michigan Medical School, Ann Arbor, Michigan;5. VA Central Western Massachusetts Healthcare System, Leeds, Massachusetts;6. Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts;1. Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California;2. Department of Health Promotion and Policy, School of Public Health and Health Sciences, University of Massachusetts, Amherst, Massachusetts;3. RAND Corporation, Santa Monica, California;4. Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California;5. Center for Innovation to Implementation (ci2i), VA Palo Alto Health Care System, Palo Alto, California;6. Stanford School of Medicine, Stanford, California;7. Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, California;8. UCLA Department of Psychiatry and Biobehavioral Sciences, Los Angeles, California;9. Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California;1. VA HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, North Hills, California;2. Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California;3. Department of Medicine, Geffen School of Medicine, University of California Los Angeles, Los Angeles, California;4. Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles, Los Angeles, California;1. VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California;2. Department of Health Policy and Management, Fielding School of Public Health, University of California Los Angeles (UCLA), Los Angeles, California;3. Department of Medicine, Geffen School of Medicine, UCLA, Los Angeles, California;4. RAND Corporation, Santa Monica, California
Abstract:BackgroundIn the past decade, the U.S. Department of Veterans Affairs (VA) has responded to a dramatic increase in women veterans seeking care by expanding Women's Health training to more than 5,000 women's health primary care providers and changing the culture of the VA to be more inclusive of women veterans. These initiatives have resulted in increased patient satisfaction and quality of care, but have focused mostly on primary care settings. Less is known about women's experiences in specialty care within VA. This qualitative study sought to examine women veterans' experiences with VA specialty care providers, with a focus on cardiovascular, musculoskeletal, and mental health care settings.MethodsSemistructured interviews were conducted with 80 women veterans who served during the Iraq and Afghanistan conflicts at four VA facilities nationwide. Interviews focused on understanding women veterans’ experiences with VA specialty care providers, including their perceptions of gender bias.ResultsFour major themes emerged from interviews, including that 1) women did not feel that VA specialty care providers listened to them or took their symptoms seriously, 2) women were told their health conditions or symptoms were attributable to hormonal fluctuations, 3) women noted differences in care based on whether the VA specialty provider was male or female, and 4) women provided recommendations for how gender-sensitive specialty care might be improved.ConclusionsThis study is the first to highlight the perceived gender bias experienced by women veterans in VA specialty care. Women felt that their symptoms were disregarded or diminished by their specialty care providers. Although women veterans report positive experiences within women's health clinics and the primary care setting, their negative experiences in VA specialty care suggest that some providers may harbor unintentional or unconscious gender biases.
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