Military sexual trauma (MST), the experience of sexual assault or repeated, threatening sexual harassment during military service, is a far-too-common experience among veterans, particularly given that these experiences are associated with significant, long-term negative mental and physical health consequences. In response to concerns about the healthcare needs of veterans who have experienced MST, VHA has implemented a universal MST Screening Program and extensive treatment resources targeting MST-related health conditions. The long-term objective of this program of research is to shape the implementation of an improved MST Screening Program influenced by veteran perspectives, leading to higher quality healthcare services and more satisfied consumers. Existing research has evaluated VHA's MST Screening Program from an organizational perspective, but there have been few efforts to examine patient perspectives on this experience. Veterans with histories of MST have typically experienced traumatic events that are disempowering, and are likely to have experienced negative and invalidating interactions with medical systems. Accordingly, the MST screening process is likely to be critically important, not only because it serves to identify impacted veterans so that they may be referred to appropriate care resources, but also because it sets the tone for how VHA, as an institution, and specific healthcare providers, in particular, will approach their MST-relate healthcare needs. Given the sensitivity of the topic, the MST screening process is also likely to be important for veterans who have not experienced MST, conveying information about how VHA and specific healthcare providers will respond to discussions of potentially difficult topics. Given that the quality of screening for sensitive topics in the absence of a patient- centered implementation framework is likely to be of variable quality, significant efforts must be made to gather data on patient perspectives on this process, and to implement changes to the program that integrate patient perspectives with our existing knowledge of best practices for trauma-related screening. The immediate objective of this health services research pilot proposal is to gather information aimed at better understanding veterans' experiences with the MST screening process (including veterans' satisfaction with the process and veterans' willingness to disclose experiences of MST) and characteristics of the screening process that are associated with greater veteran satisfaction. Such information can be used to refine the questions used to assess veteran's experiences with the MST screening process as well as providing answers to critical methodological questions that will influence data collection procedures in future studies. Given that patient perspectives on the MST Screening Program is a new area of inquiry, the design for this pilot application takes a mixed methods approach. We propose a two-phase design in which our primary questions of interest are explored using both qualitative and quantitative methodologies, wherein early qualitative work will inform the constructs to be measured in subsequent qualitative work. Participants will be drawn from the eight VA facilities in VISN 1, VA New England Veterans Integrated Service Network and will be balanced across (1) male and female veterans and (2) those who endorse experiences of MST and those who deny experiences of MST.
The immediate objective of this health services research project is to conduct the first evaluation of the current Military Sexual Trauma (MST) Screening Program from a perspective that incorporates veterans? preferences. This project will gather information aimed at better understanding veterans? experiences with the MST screening process, including veterans? satisfaction with the process and veterans? willingness to disclosure MST experiences. The long-term objective is the implementation of an improved MST Screening Program influenced by veteran preferences and veteran perspectives, leading to higher quality healthcare services and more satisfied consumers.
