Health Care For Women Veterans Research Articles

Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System.

Research Priorities to Support Women Veterans' Reproductive Health and Health Care Within a Learning Health Care System.

Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) 2.0 QUERI: study protocol for a cluster-randomized hybrid type 3 effectiveness-implementation trial

BackgroundWomen Veterans are the fastest-growing segment of Veterans Health Administration (VA) users. The VA has invested heavily in delivering care for women Veterans that is effective, comprehensive, and gender-tailored. However, gender disparities persist in cardiovascular (CV) and diabetes risk factor control, and the rate of perinatal depression among women Veterans is higher than that among civilian women. Challenges such as distance, rurality, negative perception of VA, discrimination (e.g., toward sexual and/or gender minority individuals), and harassment on VA grounds can further impede women’s regular use of VA care. Enhancing Mental and Physical Health of Women through Engagement and Retention (EMPOWER) 2.0 builds on work to date by expanding access to evidence-based, telehealth preventive and mental health services for women Veterans with high-priority health conditions in rural and urban-isolation areas.MethodsEMPOWER 2.0 will evaluate two implementation strategies, Replicating Effective Practices (REP) and Evidence-Based Quality Improvement (EBQI), in supporting the implementation and sustainment of three evidence-based interventions (Virtual Diabetes Prevention Program; Telephone Lifestyle Coaching Program; and Reach Out, Stay Strong Essentials) focused on preventive and mental health care for women Veterans. We will conduct a mixed-methods implementation evaluation using a cluster-randomized hybrid type 3 effectiveness-implementation trial design to compare the effectiveness of REP and EBQI on improved access to and rates of engagement in telehealth preventive lifestyle and mental health services. Other outcomes of interest include (a) VA performance metrics for telehealth care delivery and related clinical outcomes; (b) progression along the Stages of Implementation Completion; (c) adaptation, sensemaking, and experiences of implementation among multilevel stakeholders; and (d) cost and return on investment. We will also generate implementation playbooks for program partners to support scale-up and spread of these and future evidence-based women’s health programs and policies.DiscussionEMPOWER 2.0 provides a model for mixed-methods hybrid type 3 effectiveness-implementation trial design incorporating evaluation of performance metrics, implementation progress, stakeholder experience, and cost and return on investment, with the ultimate goal of improving access to evidence-based preventive and mental telehealth services for women Veterans with high-priority health conditions.Trial registrationClinicalTrials.gov, NCT05050266. Registered on 20 September 2021.

30 Years of Women's Health Issues

30 Years of Women's Health Issues

Quality of life among women veterans.

Of 23 million US veterans, 2 million are women. Female veterans often have physical and mental health disorders, but only 6.5% use the Veterans Health Administration (VA) system. Health care for women veterans is challenging in a health care system unfamiliar with this population. The purpose of this study was to investigate how receipt of treatment by female veterans at a VA women's health specialty clinic affected levels of distress, quality of life (QOL), and depression. A retrospective record review was completed on 51 female veterans between the ages of 40 and 60 years attending a VA clinic. The clinic provides comprehensive women's health services to female veterans. Multiple linear regression models were fit to explore QOL and depression levels with socioeconomic status, parity, years of service, and military sexual trauma (MST). Female veterans had significantly lower baseline scores for QOL than did a comparison group. The only significant predictor associated with higher health-related symptom scores at baseline was a history of MST (β = 0.363; t = 2.44; p = .02). Means and standard deviations for total scores were significantly higher than those of the comparison group. Higher symptom scores indicated lower QOL among female veterans. Study findings suggested that timely, comprehensive, gender-specific health care can significantly improve overall QOL and depression levels. Nurse practitioners play a leading role in providing primary care to this population with significant potential to impact QOL, depression levels, and overall health of female veterans.

Finding a Medical Home for Perinatal Depression: How Can We Bridge the Postpartum Gap?

Finding a Medical Home for Perinatal Depression: How Can We Bridge the Postpartum Gap?

Accelerating the Growth of Evidence-Based Care for Women and Men Veterans.

Accelerating the Growth of Evidence-Based Care for Women and Men Veterans.

Reproductive Health of Women Veterans: A Systematic Review of the Literature from 2008 to 2017.

The literature on the reproductive health and healthcare of women Veterans has increased dramatically, though there are important gaps. This article aims to synthesize recent literature on reproductive health and healthcare of women Veterans. We updated a literature search to identify manuscripts published between 2008 and July 1, 2017. We excluded studies that were not original research, only included active-duty women, or had few women Veterans in their sample. Manuscripts were reviewed using a standardized abstraction form. We identified 52 manuscripts. Nearly half (48%) of the new manuscripts addressed contraception and preconception care (n = 15) or pregnancy (n = 10). The pregnancy and family planning literature showed that (1) contraceptive use and unintended pregnancy among women Veterans using VA healthcare is similar to that of the general population; (2) demand for VA maternity care is increasing; and (3) women Veterans using VA maternity care are a high-risk population for adverse pregnancy outcomes. A recurrent finding across topics was that history of lifetime sexual assault and mental health conditions were highly prevalent among women Veterans and associated with a wide variety of adverse reproductive health outcomes across the life course. The literature on women Veterans' reproductive health is rapidly expanding, but remains largely observational. Knowledge gaps persist in the areas of sexually transmitted infections, infertility, and menopause.

"I Think It's Pretty Much the Same, as It Should Be": Perspectives of Inpatient Care Among Women Veterans.

The purpose of this study was to gain a deeper understanding of the inpatient hospitalization experience for women veterans through in-depth interviews. Women veterans who were admitted for inpatient care on medical units within a university-affiliated VA hospital were invited to participate in a semistructured interview that inquired about their hospital experience, interactions with medical providers, and how being a woman veteran might affect this experience. Interviews were transcribed verbatim and analyzed using constant comparative method until thematic saturation was achieved ( n = 25). Three themes, (a) Being a woman and a veteran: Intersecting identities, (b) Expecting equality and equity, and (c) Defining woman-centered inpatient care described the unique perspective and context for Veterans Health Administration (VHA) health care of women veterans. These findings provide insight and guidance to clinical practice and care delivery for women veterans, including training and interpersonal approaches medical providers can take to improve the hospital experience for women.

Improving Perinatal Mental Health Care for Women Veterans: Description of a Quality Improvement Program.

Purpose We describe results from a quality improvement project undertaken to address perinatal mental healthcare for women veterans. Description This quality improvement project was conducted in a single VA healthcare system between 2012 and 2015 and included screening for depressive symptoms with the Edinburgh Postnatal Depression Scale (EPDS) three times during the perinatal period, a dedicated maternity care coordinator (MCC), an on-site clinical social worker, and an on-site obstetrician/gynecologist (Ob/gyn). Information on prior mental health diagnosis was collected by the MCC or Ob/gyn. The prevalence of perinatal depressive symptoms and receipt of mental healthcare among those with such symptoms are reported by presence of a pre-pregnancy mental health diagnosis. Assessment Of the 199 women who used VA maternity benefits between 2012 and 2015, 56% (n = 111) had at least one pre-pregnancy mental health diagnosis. Compared to those without a pre-pregnancy mental health diagnosis, those with such a diagnosis were more likely to be screened for perinatal depressive symptoms at least once (61.5% vs. 46.8%, p = 0.04). Prevalence of depressive symptoms was 46.7% among those with a pre-pregnancy mental health diagnosis and 19.2% among those without. Among those with a pre-pregnancy mental health diagnosis and depressive symptoms (n = 35), 88% received outpatient mental healthcare and 77% met with the clinical social worker. Among those without a pre-pregnancy mental health diagnosis and depressive symptoms (n = 8), none received outpatient mental healthcare, but 77.8% met with the clinical social worker. Conclusion Improving perinatal mental healthcare for women veterans requires a multidisciplinary approach, including on-site integrated mental healthcare.

Lessons from Initiating the First Veterans Health Administration (VA) Women's Health Practice-based Research Network (WH-PBRN) Study.

The Veterans Health Administration (VA) Women's Health Practice-Based Research Network (WH-PBRN) was created to foster innovations for the health care of women veterans. The inaugural study by the WH-PBRN was designed to identify women veterans' own priorities and preferences for mental health services and to inform refinements to WH-PBRN operational procedures. Addressing the latter, this article reports lessons learned from the inaugural study. WH-PBRN site coordinators at the 4 participating sites convened weekly with the study coordinator and the WH-PBRN program manager to address logistical issues and identify lessons learned. Findings were categorized into a matrix of challenges and facilitators related to key study elements. Challenges to the conduct of PBRN-based research included tracking of regulatory documents; cross-site variability in some regulatory processes; and troubleshooting logistics of clinic-based recruitment. Facilitators included a central institutional review board, strong relationships between WH-PBRN research teams and women's health clinic teams, and the perception that women want to help other women veterans. Our experience with the inaugural WH-PBRN study demonstrated the feasibility of establishing productive relationships between local clinicians and researchers, and of recruiting a special population (women veterans) in diverse sites within an integrated health care system. This identified strengths of a PBRN approach.

The VA Women’s Health Practice-Based Research Network: Amplifying Women Veterans’ Voices in VA Research

The VA Women’s Health Practice-Based Research Network: Amplifying Women Veterans’ Voices in VA Research

Leading the Nation in Women’s Health: The Important Role of Research

Article history: Received 20 April 2011; Accepted 20 April 2011 Over the past two decades, the Veterans Health Administration (VHA) has supported numerous initiatives to remedy gaps in services available to women veterans. Finding deficits in the VHA’ sw omen’s health care delivery in the early 1990s, reports from the U.S. Government Accounting Office spurred the initial move to upgrade the care provided to women veterans. Unfortunately, much of the country continued to marginalize women’s services in VHA, providing only a “pap” clinic and part-time (and often “collateral duty”) Women Veteran Coordinators to meet all of the needs of women veterans. Nonetheless, there were pockets of true excellence, facilities that engaged in a process of intensive development of comprehensive women’ sh ealth centers (BeanMayberry et al., 2007; Yano, Goldzeig, 2006). In 2008, my office, which oversees delivery of VA health care to women veterans nationally, launched an initiative to take this early work to the next level, transforming VA’s women’s health delivery system into an ational leader in women’s health. Our goal is to provide “the best care anywhere” for women veterans (Longman, 2005). A solid foundation of research is essential to this vision. The U.S. Department of Veterans Affairs has already produced an impressive body of work that has helped to guide changes in strategies for the provision of care for women veterans (BeanMayberry, et al., 2010; Goldzweig, Balekian, Rolon, Tano, & Shekelle, 2006). However, still more research is needed; this current Special Issue of Women’s Health Issues takes another important step forward in filling remaining gaps, while also identifying new areas of research needing attention. As more and more women are entering and serving in military roles, many of which of which expose them to combat, we are challenged to understand and treat the effects of military service on women’s lives. Examining all of the possible effects of military service includes, of course, not only careful assessment of negative effects and vulnerabilities, but also of positive outcomes based on hard-won opportunities to serve their country, strengths, and resilience, and other factors that may have had less attention overall. Nationally, our population of women veterans is rapidly expanding, from the group of pioneering womenwho comprised only 3.5% of the military during World War II, to 4% during the Vietnam Era, and to approximately 11% in 1991, during Gulf War I. Today, women comprise 15% of active duty military and 17% of the National Guard and Reserve forces (Women’s Research and Education Institute, 2008). Thus, we need to plan for the many women “in the pipeline” who will be seeking health care from the VA in the next few years and beyond. The characteristics of the women veteran population and subpopulations (e.g., by period of service or era, among racial-ethnic minorities, education, marital status) are changing as well, requiring ongoing research to support our strategic planning and readiness in the face of their long-term preventive, reproductive, chronic

A Five-Step Guide for Moving from Observational Studies to Interventional Research for Women Veterans

A Five-Step Guide for Moving from Observational Studies to Interventional Research for Women Veterans

Health and Health Care of Women Veterans and Women in the Military: Research Informing Evidence-Based Practice and Policy

VA Greater Los Angeles HSR&D Center of Excellence for the Study of Healthcare Provider Behavior, Sepulveda, California VA Women’s Health Research Network, Los Angeles, California and Palo Alto, California Department of Health Services, UCLA School of Public Health, Los Angeles, California Center for Health Care Evaluation, VA Palo Alto Health Care System, Palo Alto, California Division of General Medical Disciplines, Stanford University, Stanford, California

VA Research: Committed to Women Who Have “Borne the Battle” and Beyond

In increasing numbers, women have been serving in the military and playing critical roles in our Nation’s recent wars in Iraq and Afghanistan. The U.S. Department of Veterans Affairs (VA) stands ready to fulfill President Lincoln’s promise “To care for him [and her] who shall have borne the battle” and serve and honor America’s women veterans. The VA has proudly cared for women veterans from all eras, but their recent surge in numbers demands changes in the VA’s health care system. Throughout its history, the VA has demonstrated its ability to innovate to meet evolving needs. Under the leadership of Secretary Eric K. Shinseki, the VA has set forth an ambitious agenda to transform the VA and its health care system, including expanding health care access and improving the culture of VA care for women veterans. Research is one of the keys to the success of this transformation. Improving the health and health care of women veterans has been a research priority within VA since the 1990s. However, in anticipationof thegrowingnumbersofwomenveterans, research to improve their health and health care has assumed heightened urgency. In 2004, the VA Office of Research and Development established the first comprehensive VAwomen’s health research agenda directed toward positioning VA as a national leader in women’s health care (Yano et al., 2006). Subsequently, there has been dramatic growth in research aimed at understanding the needs of women veterans, and their access to and use of care (Bean-Mayberry, et al., 2010; Washington, Yano, Simon, Canning, & Sun, 2006). Importantly, VA research has promoted implementation of new effective treatments (e.g., of posttraumatic stress disorder amongwomen veterans; Schnurr et al., 2007) and policy and program changes in the organization and delivery of care (Veterans Health Administration, 2008; Yano,Washington & Bean-Mayberry, 2008; Yano, Rose, et. al., 2010) in a health care system eager to translate research into more effective practice to meet women veterans’ needs and preferences. The value of the VA’s research agenda-setting and planning effort is evident in the growth of the women’s health research

National Variations in VA Mental Health Care for Women Veterans

Objectives Although the Veterans Health Administration (VA) has recently adopted new policies encouraging gender-specific mental health (MH) care delivery to women veterans, little is known about the potential difficulties local facilities may face in achieving compliance. We assessed variations in women’s mental health care delivery arrangements in VA facilities nationwide. Methods We used results from the VA Survey of Women Veterans Health Programs, a key informant survey of senior women’s health clinicians representing all VA facilities serving more than 300 women veterans, to assess the array of gender-sensitive mental health care arrangements (response rate, 86%; n = 195). We also examined organizational and area factors related to availability of women’s specialty mental health arrangements using multivariable logistic regression. Results Nationally, over half (53%) of VA facilities had some form of gender-sensitive mental health care arrangements. Overall, 34% of sites reported having designated women’s mental health providers in general outpatient mental health clinics (MHCs). Almost half (48%) had therapy groups for women in their MHCs. VAs with women’s primary care clinics also delivered mental health services (24%), and 12% of VAs reported having a separate women’s MHC, most of which (88%) offered sexual trauma group counseling. Assignment to same-gender mental health providers is not routine. VAs with comprehensive women’s primary care clinics were more likely to integrate mental health care for women as well. Conclusion Local implementation of gender-sensitive mental health care in VA settings is highly variable. Although this variation may reflect diverse local needs and resources, women veterans may also sometimes face challenges in accessing needed services.

The health and health care of women veterans

The health and health care of women veterans

Improving health care for women veterans

Improving health care for women veterans

Toward a VA women’s health research agenda: Setting evidence-based priorities to improve the health and health care of women veterans

The expansion of women in the military is reshaping the veteran population, with women now constituting the fastest growing segment of eligible VA health care users. In recognition of the changing demographics and special health care needs of women, the VA Office of Research & Development recently sponsored the first national VA Women's Health Research Agenda-setting conference to map research priorities to the needs of women veterans and position VA as a national leader in Women's Health Research. This paper summarizes the process and outcomes of this effort, outlining VA's research priorities for biomedical, clinical, rehabilitation, and health services research.

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