Stigma, Gender, and Other Barriers to VHA Use for OEF/OIF Veterans
Dawne S Vogt PhD BA
VA Boston Health Care System, Jamaica Plain
Boston, MA
Funding Period: September 2008 - August 2011

BACKGROUND/RATIONALE:
Findings indicate that many OEF/OIF veterans are not receiving the health care they need. Although previously funded HSR&D studies have examined individual factors (e.g., background characteristics) and structural factors (e.g., ease of using VA facilities) as potential barriers to care, few studies have addressed the effects of negative beliefs related to health-care seeking, or stigma, as a potential barrier to VA use. Moreover, studies of barriers to care within prior cohorts are likely to fall short because the current generation of veterans is very different from the VA's typical clientele, and thus, barriers to care may differ for this population. Finally, although a number of studies have addressed barriers to VA care in female- and male-only samples, no study has explored gender differences in wide array of barriers to care, including stigma-related factors, within a national sample of male and female OEF/OIF veterans. Therefore, a study of the prevalence and multidimensional nature of barriers to VA care in a population-based sample would fill a critical gap in the literature and complement other HSR&D funded research.

OBJECTIVE(S):
The primary objective of this project is to examine the contribution of individual, institutional, and most importantly, stigma-related barriers, to VA health care. A secondary objective is to document unique barriers to VA care for women and men. The achievement of these overriding objectives will be expressed through two immediate objectives. Immediate Objective 1 is to conduct focus groups with OEF/OIF veterans to explore the relevance of proposed stigma-related barrier categories and uncover any additional factors that are not addressed within the proposed framework, and to use this information to inform the measurement of barriers to care. Immediate Objective 2 is to administer measures of barriers to care and assess health-care use within a national sample of female and male OEF/OIF veterans and use these data to address study hypotheses.

METHODS:
Phase I will involve focus groups with OEF/OIF veterans. Six focus groups (48 participants) will be conducted with users and non-users of VA care. Analyses of focus group data will involve identifying barriers to care that are salient for this population and using this information to inform the measurement of stigma-related barriers to care. In Phase II, mail surveys incorporating barrier measures and addressing health-care use will be administered to a nationally representative sample of OEF/OIF veterans (N=1000). Psychometric analyses will be conducted to examine the reliability and validity of newly developed and updated barrier measures. Hypotheses regarding associations between potential barriers and health-care use, and gender differences in these relationships, will be tested using multiple regression analyses.

FINDINGS/RESULTS:
None to date.

IMPACT:
Health problems that are not addressed initially often go on to become chronic health conditions that require more extensive and expensive care. The primary product of this project will be information regarding barriers to care for female and male OEF/OIF veterans that can be used to inform clinical care, outreach efforts, and staff education. Efforts to reduce barriers to care can result in better health outcomes for this cohort of recently returned veterans.


PUBLICATIONS:
None at this time.

DRA: Health Services and Systems, Military and Environmental Exposures, Special (Underserved, High Risk) Populations
DRE: none
Keywords: Access, Operation Enduring Freedom, Operation Iraqi Freedom
MeSH Terms: none