Women Veterans Who Report Stranger Harassment on VA Grounds Are More Likely to Delay or Miss Healthcare
BACKGROUND:
Also referred to as sexual harassment, street harassment or stranger harassment, public harassment includes a range of verbal and non-verbal behaviors such as comments, catcalls, staring, as well as noises and gestures. Approximately two-thirds of women in recent U.S. national surveys reported ever experiencing sexual harassment in public spaces; however, only five percent of women respondents in a recent U.S national survey reported that they were sexually harassed in a healthcare setting. This study examined the prevalence of self-reported harassment among women Veterans who use VA healthcare. From January – March 2015, investigators conducted computer-assisted telephone interviews with randomly sampled women Veterans (n=1,387) who had three or more primary care or women's health encounters at one of 12 diverse urban and rural VAMCs across nine states in the prior 12 months. Investigators also assessed patient sociodemographics, health status, trauma exposure, military sexual trauma (MST), and mental health (anxiety disorder, PTSD, and depression).
FINDINGS:
- One in four women Veterans (25%) reported inappropriate and/or unwanted comments or behavior by male Veterans on VA grounds. Eight percent said that this usually or always took place at VA. Negative interactions included sexual/derogatory comments and questions about the women's Veteran identity and right to VA care. Those who reported harassment were less likely to report feeling welcome at VA, and more likely to report feeling unsafe and delaying/missing care.
- Younger women were more likely to report harassment, as were women Veterans with self-reported fair or poor health status, those with MST and/or other trauma exposures, and those with anxiety.
- The majority of respondents were 45 or older (65%); 56% identified as non-Hispanic White and 28% identified as non-Hispanic Black. About two-thirds screened positive for probable anxiety (63%) and MST (62%). A majority of women reported combat or lifetime exposure to trauma (80%).
IMPLICATIONS:
- Because this study was part of a larger partnered research initiative – the Women Veterans' Healthcare CREATE Initiative, funded by HSR&D – these findings were presented to VA healthcare leaders as soon as they were discovered. VA Women's Health Services responded by establishing a national workgroup, gauging effective harassment reduction programs outside VA, convening an expert panel, piloting interventions, and launching a national culture campaign. Work is ongoing.
LIMITATIONS:
- Findings are from a cross sectional study of 12 VAs and may not be generalizable to other VAs.
- Trauma histories may increase incident recall as negative and likelihood of reporting the incident.
AUTHOR/FUNDING INFORMATION:
This study was funded by HSR&D (CRE 12-026). All authors, except Dr. Haskell, are part of HSR&D's Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP). Dr. Yano is Director of CSHIIP and is supported by an HSR&D Senior Research Career Scientist Award. Dr. Haskell is part of HSR&D's Pain Research, Informatics, Multi-morbidities, and Education (PRIME) Center.
Klap R, Darling J, Hamilton A, Rose D, Dyer K, Canelo I, Haskell S, and Yano E. Prevalence of Stranger Harassment of Women Veterans at VA Medical Centers and Impacts on Delayed and Missed Care. Women’s Health Issues. January 25, 2019; Epub ahead of print.
