Eliminating Barriers, Elevating Care for LGBTQ+ Veterans
August 2024
“All Veterans, all people, have a basic right to be identified as they define themselves. This is essential for their general well-being and overall health. Knowing the gender identity of our patients helps us better understand the population we serve.” —VA Secretary Denis McDonough
VHA recently launched a national campaign to emphasize its dedication to providing respectful, excellent healthcare for all Veterans. Health Systems Research (HSR) and the Quality Enhancement Research Initiative (QUERI) support VHA’s mission by identifying, evaluating, and implementing evidence-based practices that promote the health and well-being of all Veterans—including those who identify as lesbian, gay, bisexual, transgender, or queer, as well as others in the LGBTQ community (LGBTQ+).
Compared to heterosexual and non-transgender Veterans, LGBTQ+ Veterans face a higher risk of depression, posttraumatic stress disorder, suicide ideation and attempt, and health risk behaviors such as alcohol misuse and smoking.[1]
Examples of recently completed and ongoing HSR and QUERI LGBTQ+ research:
- Examining VHA initiation of gender-affirming hormone therapy in concordance with clinical guidelines. Gender-affirming hormone therapy (GAHT) is a common medical intervention sought by transgender and gender diverse (TGD) individuals. Initiating GAHT in accordance with clinical guideline recommendations ensures delivery of high-quality care. However, no prior studies examined how current GAHT initiation in VHA compares to recommended GAHT initiation. This study assessed guideline concordance around feminizing and masculinizing GAHT initiation in VHA. Researchers observed high concordance between current GAHT initiation practices in VHA and guidelines, particularly for feminizing GAHT.
- Implementation of LGBTQ+ affirming care policies in the VHA: Barriers and facilitators. Through interviews with providers and LGBTQ+ Veterans, this project examined barriers and facilitators to LGBTQ+ affirming care (healthcare that is inclusive, validating, and understanding of the LGBTQ+ population). Findings indicate that strategies to ultimately improve care access and reduce healthcare disparities for LGBTQ+ Veterans might include engaging LGBTQ+ Veterans in determining how to improve their healthcare, and creating collaborative structures that enable Veterans, staff, providers, leaders, and policymakers to work together to implement LGBTQ+ affirming care policies.
- Clinical care needs and experiences for Veterans with spinal cord injury identifying as LGBT. Healthcare providers often lack experience in dealing with the physical, mental health, and sociocultural issues related to LGBT identity, especially in the context of delivering spinal cord injury and disorders (SCI/D) specialty care. This ongoing project aims to provide novel information from provider and Veteran perspectives to identify barriers, attitudes, and experiences of Veterans and clinicians and design VA clinical programs that address the LGBT population’s complex healthcare needs.
- Narrative-based cultural humility training to ensure affirming care for transgender and gender diverse Veterans. Implementation of Veteran-informed, evidence-based cultural competence trainings for VA providers is lacking. This study is evaluating Identity Development Evolution and Sharing (IDEAS), an innovative and effective stigma reduction training for healthcare providers that involves showing a film rooted in transgender and gender diverse (TGD) Veteran narratives, then engaging providers in a post-film, moderated conversation with a panel of TGD Veterans.
In June 2024, VA’s LGBTQ+ Health Program collaborated with the Office of Research and Development (ORD) to host a first-ever field meeting aimed at forging a new path for LGBQ+ Veteran health research. This event brought together VA investigators from across the nation to craft a research agenda that aims to identify and address the unique health needs of LGBQ+ Veterans.
Honoring Research on LGBTQ+ Veteran Health
In spring of 2024, HSR staff and researchers were the inaugural recipients of VA’s new LGBTQ+ Health Program Research Paper Awards:
- Taylor L. Boyer, MPH, and John R. Blosnich, PhD, MPH, of HSR’s Center for Health Equity Research and Promotion (CHERP) received the 2024 Monica Helms and Angela B. Sheedy TGD Research Paper of the Year Award for “Patient Experiences and Provider Perspectives on Accessing Gender-Affirming Surgical Services in the Veterans Health Administration,” which explores transgender and gender diverse (TGD) patients’ and VA providers’ perspectives on Veterans’ access to gender-affirming surgery and other gender-affirming medical interventions not offered at VA.
- Sarah Wilson, PhD, of HSR’s Durham Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT), and Michelle Hilgeman, PhD, of the Tuscaloosa VA Medical Center, received the 2024 Leonard Matlovich LGBQ+ Research Paper of the Year Award for “Rolling out PRIDE in All Who Served: Barriers and Facilitators for Sites Implementing an LGBTQ+ Health Education Group for Military Veterans,” which clarifies determinants of implementation and sustainment of VA’s PRIDE program. The PRIDE program was developed to improve health equity and access to care for LGBTQ+ Veterans and has led to improved outcomes among participating Veterans.
[1] IIR 17-089 – HSR Study (va.gov)
