Why Women Veterans Do Not Use VA-Provided Health and Social Services: Implications for Health Care Design and Delivery

Abstract

Background: The Veterans Administration (VA) is transforming its historically male-dominated health care system to better serve women veterans, few of whom, nevertheless, use VA health care. We describe the factors affecting women veterans' use of VA-provided health care. Methods: We conducted in-person interviews with 22 women veterans in Los Angeles, California, from 2013 to 2015 who received some non-VA health care. Using grounded theory, we inductively identified the major themes and selected illustrative quotations. Results: Why women veterans do not use VA health care is shaped by factors related to the safety, quality, and value of health care, including poor linkage to VA services during and after military service, limited knowledge and inaccurate beliefs regarding

Healthcare Access among Older Rural Women Veterans in Utah*

“…This study confirms barriers to healthcare access identified in recent studies of rural and veterans' healthcare (e.g., Author; CAMH 2015; Evans et al 2019; NCVAS 2015; 2017; Sanders et al 2015). For example, our findings support the need for more information about the VA health services, particularly among older, rural women veterans who need to establish eligibility for VA services.…”

“…Nevertheless, an important limitation to this study concerns its generalizability. Specifically, while this case study supports the findings of Evans et al (2019) for urban women veterans and their recommendations to address persistent barriers, the relevance of our findings to veterans in other rural and urban locations cannot be addressed with these case study data. To this end, additional research is needed that allows for a comparison of veterans' experiences in other locales that would help assess the applicability of our findings in different contexts and identify other contextual barriers.…”

“…In the wake of this mandate, research has indicated that healthcare programming and access has improved for many marginalized groups (DAV 2014; Frayne et al 2014; Hamilton et al 2013; NCVAS 2015; 2017; Washington et al 2013). Nevertheless, recent studies have highlighted on‐going institutional barriers to women veterans' access to, and satisfaction with, VA services (e.g., CAMH 2015; Evans et al 2019; NCVAS 2015; 2017). In 2017, a smaller percentage of female veterans (32%) compared to males (36%) used VA health care, but a larger percentage of female veterans (19%) than male Veterans (11%) used only VA health care (NCVAS 2020).…”

“…Without assistance from support networks first‐generation veterans often face difficulties navigating the VA system and obtaining necessary care (Wurster et al 2013). This may be especially the case in rural areas where veterans have been found to face obstacles in accessing healthcare (CAMH 2015; Evans et al 2019; NCVAS 2015; 2019). Additionally, women veterans' reported experiences with being overlooked, forgotten or feeling “invisible” (Shane 2019) has had implications for their healthcare and health outcomes (Garrick 2015:329; Strong, Crowe, and Lawson 2018).…”

“…Importantly, the system's healthcare providers remain predominately male, and females cannot access a full range of gender‐specific benefits/services consistently (DAV 2014; Ross et al 2015). In a recent case study of urban women veterans (Evans et al 2019:25) which explored why women veterans do not use VA healthcare, reasons identified were related to women's perceptions of the accessibility, appropriateness, and acceptability of the VA environment and services. Research by Chanfreau‐Coffinier et al (2019), which also examined perceptions of healthcare among women veterans, found that women's views of the quality of care was affected by their use of different healthcare sources—VA and non‐VA.…”