The report is a product of the VA/HSR Evidence Synthesis Program.

An Evidence Map of the Women Veterans' Health Literature (2016-2023)

Takeaway: This evidence map identified 933 articles that address issues related to women Veterans' health published from 2016-2023. The number of articles more than doubled compared to the prior 8 years. The three largest areas in this literature were general mental health, chronic medical conditions, and interpersonal violence. The areas that saw the most growth since 2008-2015 were physical and mental reproductive health, suicide and self-injury, and chronic pain. There was relatively little focus on long-term care and aging, and rural-dwelling women Veterans, and few evaluations of interventions or programs to address specific conditions that impact women Veterans. Emerging evidence areas included military exposures, harassment and discrimination, cancer care, and health issues that impact transgender and nonbinary Veterans.

Women Veterans are the fastest growing population served by VA. The number of women using VA healthcare has increased nearly 3-fold since 2000, with women Veterans (WVs) using outpatient care at a higher frequency than their male counterparts. Compared to Veteran men, WVs tend to be younger, more racially and ethnically diverse, and are more likely to be service connected.

The last WVs' health evidence map covered literature from 2008 to 2015. In response to a request from VA's Office of Women's Health, and with technical support from the VA Women's Health Research Network, the ESP Center at the Durham VA Health Care System created an updated evidence map that describes the literature on WVs' health published from 2016 to 2023. This evidence map focuses on assessing areas of growth, evaluating progress made within the future directions identified in the previous evidence map, and identifying areas that need further research.

Investigators identified 933 relevant articles from January 2016 to October 2023 in MEDLINE, Embase, and CINAHL. Eligible articles had to include more than 75% WVs, report results separately for WVs as a subgroup, and/or include analyses with stratified results for WVs, or focus on providers or staff caring for WVs.

Summary of Findings

• The number of articles published during 2016-2023 relevant to WVs' health more than doubled compared to 2008-2015.
• Most of the studies (82%) used an observational design. While there was a 3-fold increase in the number of clinical trials since the 2008-2015 map, the total number remained low (k = 27).
• Nearly half (45%) of the studies sought to specifically include a prioritized Veteran population, such as Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn Veterans or Veterans with a history of trauma.
• The three largest focus areas were general mental health, chronic medical conditions, and interpersonal violence.
• Research areas that experienced the greatest growth since the last evidence map included reproductive physical and mental health, interpersonal violence, and VA-identified priority research areas such as chronic pain/opioid use and suicide/non-suicidal self-injury.
• Gaps in the literature included long-term care and aging, rural-dwelling WVs or WVs from racial and ethnic minoritized populations, menopause, medical conditions commonly experienced by women such as hypertension, migraines, or back pain, and intervention and implementation studies.
• There was a substantial increase in articles that sought to address health issues for transgender and/or nonbinary Veterans, although overall numbers remain small.
• Emerging research areas include harassment and discrimination experienced within VA care, cancer care, and toxic exposures.

Implications

A robust evidence base is critical to promote the health, quality of life, and overall well-being of WVs. The pace of growth in WVs' health research has doubled and expanded in important areas that align with VA research priorities. Further advancement of this field is needed, with greater use of rigorous but pragmatic research and program evaluation approaches.

Limitations

• Identified articles could have been categorized in multiple ways.
• Approaches to organizing the literature were not identical to prior WVs' health evidence maps, limiting a direct comparison.

Future Research

Future research should include studies related to the conditions that affect the aging women Veteran population, including chronic conditions and issues related to aging and long-term care needs. There is also a need to explore the intersection of exposures and conditions among WVs (e.g., mental health and violence) as they co-occur with chronic conditions and the reproductive lifespan (e.g., including post-menopausal). Additionally, future work should continue to leverage mixed-sex and gender study populations to explore how and when care for chronic conditions should be tailored for women. Finally, research areas with rich descriptive evidence bases should shift to focus on the conduct of intervention evaluations, implementation studies, or robust program evaluations.

Citation: Pace R, Dancu C, Raman SR, et al. An Evidence Map of the Women Veterans' Health Literature (2016-2023). Washington, DC: Evidence Synthesis Program, Health Systems Research, Office of Research and Development, Department of Veterans Affairs. VA ESP Project #09-010; 2024.

To view the full report, go to vaww.hsrd.research.va.gov/publications/esp/WVHM.cfm (intranet only).

An HSR Cyberseminar will be presented on this report November 19, 2024 at 2:00 p.m.

ESP is currently soliciting review topics from the broader VA community. Nominations will be accepted electronically using the online Topic Submission Form. If your topic is selected for a synthesis, you will be contacted by an ESP Center to refine the questions and determine a timeline for the report.

This Management Brief is provided to inform you about recent HSR findings that may be of interest. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs. If you have any questions or comments about this Brief, please email CIDER. The Center for Information Dissemination and Education Resources (CIDER) is a VA HSR Resource Center charged with disseminating important HSR findings and information to policy makers, managers, clinicians, and researchers working to improve the health and care of Veterans.

This report is a product of VA/HSR's Evidence Synthesis Program (ESP), which was established to provide timely and accurate synthesis of targeted healthcare topics of particular importance to VA managers and policymakers; and to disseminate these reports throughout VA.

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