Five-year trend in healthcare access and patient-reported health outcomes among women veterans

Barriers and facilitators to mental healthcare for women veterans: a scoping review

BACKGROUND

Traditionally, veteran research and support have centred on the requirements of a predominantly male population. However, as female participation in the Armed Forces increases and their roles diversify, consideration of women's unique mental health needs is imperative. Women veterans are at greater risk of post-service mental health challenges than their male counterparts, and female mental health outcomes have deteriorated in recent years.

AIMS

To determine the provenance of these outcomes, a scoping review considering both barriers and facilitators to female veteran participation in mental health services was conducted.

METHODS

A review was carried out following the 2020 Joanna Briggs Institute Scoping Review framework. Twenty-four papers were identified, with all but one originating from the US.

RESULTS

This research indicated that whilst women experience barriers common to male veterans (e.g. help-seeking stigma), they also experience unique gender-specific barriers to accessing mental healthcare services (e.g. lack of gender-sensitive treatment options, feeling uncomfortable) and such barriers result in under-utilization of services.

CONCLUSIONS

Literature indicates that consideration and mitigation of these barriers might improve access and health outcomes for women veterans. Further research is required outside the US to understand the barriers to mental healthcare experienced by women veterans internationally.

Nursing leadership and influence in practice domains at a Veterans Affairs Health Care System

BACKGROUND

Studies in Veteran populations have examined disparities in health service use, care quality, outcomes and increased demands for behavioral health.

PURPOSE

The purpose is to describe the development of nursing leadership roles that influenced practice improvements and demonstrated outcomes related to health disparities in a Veterans Affairs (VA) population over a 12-year period.

METHODS

The Sundean and colleagues' concept analysis of nurse leadership influence was applied to frame the initiative process and impacts.

DISCUSSION

Antecedents and processes that facilitated leadership development included mentorship, disparities expertise, partnerships, consultation, scholarship, dissemination, advocacy, education, and strong coauthor collaboration. Improvements and outcomes included access to services, improved health indicators, tools, workforce, funding, innovations, and nurse investigator studies, consistent with VA priorities and policy related to disparities and equity. Limitations and barriers were addressed.

CONCLUSION

This initiative models' strategies to increase nurse leadership in health equity and care transformation in health systems and community practices.

Women Veterans' Descriptions of Interactions With Civilian Health Care Providers: A Qualitative Inquiry

Women veterans often obtain care for unique gender- and military-related health issues from civilian health care settings. There is a gap in the literature surrounding woman veterans' perspectives about the care they receive. The purpose of this study was to apply the Interaction Model of Client Health Behavior framework to study the patient-provider interaction described by women veterans. A qualitative descriptive methodology, using directed content analysis, was employed. Six themes were identified. Consistent screening, provider knowledge about service roles and experiences of women veterans, and familiarity with military-related health conditions support holistic care. Further research in this area is warranted.

'Treat everyone like they're a man': Stakeholder perspectives on the provision of health and social care support for female veterans in the UK

International research suggests that female veterans may experience gender-specific barriers to accessing veteran-specific care. This is the first UK study to report an exploratory qualitative investigation of the provision of health and social care support for female veterans and whether this support meets their needs. The research team carried out 13 virtual semi-structured interviews between October and November 2020, with representatives from statutory and third sector organisations that provide support to UK female veterans. Ethical approval was obtained from the Anglia Ruskin University School of Education and Social Care Research Ethics Committee. The authors identified four overarching themes and nine sub-themes in a thematic analysis following the framework outlined by Braun and Clarke (2006). The findings of this study suggest that practitioners from statutory and third sector organisations perceive the UK veteran support sector as male-dominated and male-targeted, with a lack of consideration for female veterans' needs. Participants reported a lack of engagement with veteran-specific services by female veterans and suggested that women either do not identify with the 'veteran' label or do not feel comfortable accessing male-dominated veteran-specific services. The need for specific services for female veterans split participant opinion, with most of those who were female veterans themselves highlighting the importance of 'safe spaces' for women, particularly those who had experienced gender-based violence during military service. Others felt that the veteran support sector currently lacked evidence of women's unique support needs, and an examination of current provision was required. The authors recommend a thorough assessment of UK female veterans' health and social care needs, alongside development of training and guidance for health and social care professionals, to ensure that veteran services are adequately developed, tailored and targeted with women's needs in mind.

Gender differences in barriers to mental healthcare for UK military veterans: a preliminary investigation

INTRODUCTION

Limited UK research focuses on female military veterans' gender-related experiences and issues when accessing civilian mental healthcare support. This study sought to illuminate a preliminary understanding of any gender differences in barriers that may discourage them accessing mental healthcare support.

METHODS

A total of 100 participants completed an open online survey of UK triservice veterans who identified as having experienced postmilitary mental health problems. They completed a 30-item Barriers to Access to Care Evaluation scale and were asked to elaborate using free-text questions. Resulting quantitative data were analysed for gender-related differences, while the qualitative text was thematically explored.

RESULTS

While stigma, previous poor experience of mental healthcare and a lack of trust in civilian providers were found to act as barriers to postmilitary support for both men and women, significantly more women reported that their gender had also impacted on their intention to seek help. Women also commented on the impact of gender-related discrimination during service on their help-seeking experiences.

CONCLUSIONS

While efforts are being made by the UK Ministry of Defence to reduce barriers to mental healthcare for those still serving in the Armed Forces, it has been more difficult to provide a similar level of support to the veteran population. With little veteran research focusing on the specific experiences of women, this study suggests that female veterans encounter specific access barriers and issues related to their gender. Further research is therefore needed to ensure these findings are addressed.