1121 — A Veteran-Centered Approach to Military Sexual Trauma Screening: Learning from Veterans' Experiences and Perspectives

TRUE G, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center; Unversity of Pennsylvania School of Medicine; Ono S, CIVIC Portland VA Medical Center and Department of Medicine, Oregon Health and Science University, Portland, OR; Zickmund S, CHERP Pittsburgh VA Medical Center, Qual EASE, and University of Pittsburgh, Medicine and Clinical and Translational Science, Pittsburgh, PA; Mengeling M, CADRE and ORH VRHRC-CR, Iowa City VA Medical Center and the University of Iowa Carver College of Medicine, Iowa City, IA; Burkitt K, CHERP Pittsburgh VA Medical Center, Pittsburgh, PA; Sadler A, CADRE, Iowa City VA Medical Center and University of Iowa Hospitals and Clinics, Iowa City, IA;

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.