“You want people to listen to you”: Patient experiences of women's healthcare within the Veterans Health Administration

IF 3.1 2区医学 Q2 HEALTH CARE SCIENCES & SERVICES

Health Services Research Pub Date : 2024-05-28 DOI:10.1111/1475-6773.14324

Ashley C. Mog PhD, MSc, Samantha K. Benson MPH, Vyshnika Sriskantharajah BS, P. Adam Kelly PhD, MBA, Kristen E. Gray PhD, MS, Lisa S. Callegari MD, MPH, Ernest M. Moy MD, MPH, Jodie G. Katon PhD, MS

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引用次数: 0

Abstract

Objective

To identify constructs that are critical in shaping Veterans' experiences with Veterans Health Administration (VA) women's healthcare, including any which have been underexplored or are not included in current VA surveys of patient experience.

Data Sources and Study Setting

From June 2022 to January 2023, we conducted 28 semi-structured interviews with a diverse, national sample of Veterans who use VA women's healthcare.

Study Design

Using VA data, we divided Veteran VA-users identified as female into four groups stratified by age (dichotomized at age 45) and race/ethnicity (non-Hispanic White vs. all other). We enrolled Veterans continuously from each recruitment strata until thematic saturation was reached.

Data Collection/Extraction Methods

For this qualitative study, we asked Veterans about past VA healthcare experiences. Interview questions were guided by a priori domains identified from review of the literature, including trust, safety, respect, privacy, communication and discrimination. Analysis occurred concurrently with interviews, using inductive and deductive content analysis.

Principal Findings

We identified five themes influencing Veterans' experiences of VA women's healthcare: feeling valued and supported, bodily autonomy, discrimination, past military experiences and trauma, and accessible care. Each emergent theme was associated with multiple of the a priori domains we asked about in the interview guide.

Conclusions

Our findings underscore the need for a measure of patient experience tailored to VA women's healthcare. Existing patient experience measures used within VA fail to address several aspects of experience highlighted by our study, including bodily autonomy, the influence of past military experiences and trauma on healthcare, and discrimination. Understanding distinct factors that influence women and gender-diverse Veterans' experiences with VA care is critical to advance efforts by VA to measure and improve the quality and equity of care for all Veterans.

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"你希望人们倾听你的心声"：退伍军人健康管理局内妇女医疗保健的患者体验。

目标：确定对塑造退伍军人在退伍军人健康管理局（VA）女性医疗保健方面的体验至关重要的构建因素，包括尚未得到充分探索或未被纳入当前退伍军人健康管理局患者体验调查中的构建因素：从 2022 年 6 月到 2023 年 1 月，我们对使用退伍军人管理局女性医疗保健服务的退伍军人进行了 28 次半结构化访谈，访谈样本来自全国各地：利用退伍军人事务部的数据，我们将退伍军人事务部的女性用户按年龄（以 45 岁为二分法）和种族/族裔（非西班牙裔白人与所有其他族裔）分为四组。我们从每个招募分层中不断招募退伍军人，直到达到主题饱和为止：在这项定性研究中，我们向退伍军人询问了他们过去的退伍军人医疗保健经历。访谈问题以文献综述中确定的先验领域为指导，包括信任、安全、尊重、隐私、沟通和歧视。分析与访谈同时进行，采用归纳和演绎内容分析：我们确定了影响退伍军人对退伍军人妇女医疗保健体验的五个主题：感觉被重视和支持、身体自主、歧视、过去的从军经历和创伤以及可获得的护理。每个新出现的主题都与我们在访谈指南中询问的多个先验领域相关：我们的研究结果表明，有必要为退伍军人事务部的妇女医疗保健量身定制患者体验测量方法。退伍军人事务部内使用的现有患者体验测量方法未能解决我们的研究中强调的体验的几个方面，包括身体自主性、过去的从军经历和创伤对医疗保健的影响以及歧视。了解影响女性和不同性别退伍军人在退伍军人医疗保健方面体验的独特因素，对于推动退伍军人事务部衡量和改善所有退伍军人的医疗保健质量和公平性至关重要。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Health Services Research 医学-卫生保健

CiteScore

4.80

自引率

5.90%

发文量

193

审稿时长

4-8 weeks

期刊介绍： Health Services Research (HSR) is a peer-reviewed scholarly journal that provides researchers and public and private policymakers with the latest research findings, methods, and concepts related to the financing, organization, delivery, evaluation, and outcomes of health services. Rated as one of the top journals in the fields of health policy and services and health care administration, HSR publishes outstanding articles reporting the findings of original investigations that expand knowledge and understanding of the wide-ranging field of health care and that will help to improve the health of individuals and communities.