Spotlight on VA Research

Women's gender-specific health care needs, including some that are combat-related, have been an important part of VA's research agenda for more than a decade. Research in this area is greatly enhanced by VA's partnerships with other organizations that share its strong commitment to promoting women's health and advancing gender equity in health care.

Research into Women's Health Conditions

Research priorities cover a broad range of conditions particularly relevant to women Veterans-among them, chronic diseases, cancer, mental health issues, military occupational hazards, and reproductive health.

Important areas of VA research focusing on women Veterans' health conditions include:

• Posttraumatic stress disorder (PTSD)—In the largest randomized clinical trial to date involving women Veterans with PTSD, VA researchers and their colleagues found that prolonged-exposure therapy-a type of cognitive behavioral therapy in which therapists help patients recall their traumas under safe, controlled conditions-was more effective in reducing PTSD symptoms than counseling focused on current problems. Partly as a result of this study, VA launched a nationwide effort to train more clinicians in prolonged-exposure therapy.
• Violence against servicewomen—To identify risk factors for sexual assault and physical violence against women in the military, a VA research team is interviewing about 500 active-duty women Veterans, all currently or formerly with the Reserves or National Guard. The researchers will also look at health care use, health outcomes, and any barriers to VA care.
• Mammography recommendations—An American College of Physicians committee chaired by VA and Stanford University researcher Douglas Owens, M.D., recently published a new set of mammogram guidelines for women in their 40s. The guidelines, based on a rigorous review of the medical literature, call for periodically performing individual assessments of breast cancer risk; informing women of the potential benefits and harms of the procedure; and incorporating women's preferences and risk profiles into screening decisions.
• Other gender-specific health issues—Additional VA research is examining the cellular mechanisms underlying breast and cervical cancers, the role of hormones in stroke and aging, the basic neurobiological changes in women who have gone through severe trauma, and tailored prosthetic designs for women.

Research into Care, Quality, and Access

Current studies are examining the health care usage of women Veterans and assessing delivery of care to this population to identify effective approaches, barriers to care, and opportunities for care improvement.

VA Research focusing on women's health care satisfaction and the delivery of equitable, high-quality care to women Veterans has yielded valuable findings:

• Quality and sensitivity as top-ranked issues—Researchers have found that among the health care issues that matter most to women Veterans are overall quality of care, access to gender-appropriate services, and a gender-sensitive environment that respects privacy.
• Gynecologic services as key to satisfaction—Availability of routine gynecologic care within primary care settings, which reduces fragmentation of women's health care, has been found to directly influence whether women choose VA or non-VA care. Integrated gynecologic care-along with access to female providers-earns VA primary care clinics extremely high satisfaction ratings among women Veterans.
• Dedicated women's clinic as important factor—Women Veterans are more satisfied with women's clinics than traditional primary care clinics, and the availability of such clinics is cited by many women as a major factor in choosing VA care.
• Lack of knowledge as barrier to use—Educational campaigns could be useful in improving women Veterans' knowledge about VA eligibility and available services, research has shown. Many women Veterans not enrolled in the VA health system are unaware that VA provides women's health care, according to a recent VA study, and even female Veterans who use VA care are not fully informed about the types and quality of care available.

Evolving Research Initiatives

In structuring its research agenda, VA continually evaluates the unique health-related needs of women, as well as disparities in care between male and female Veterans. Ongoing research initiatives aim to contribute to:

• Development of improved therapeutic strategies for health issues important to women, such as breast cancer, cardiac conditions, colorectal cancer, and mental health.
• Skills enhancement for primary care providers who treat women Veterans.
• Improvement of health strategies for family and reproductive issues.

To ensure that VA stays on the leading edge of women's health care, the Department conducts and participates in conferences focusing on women Veterans' health issues, including:

• "Trauma Spectrum Disorders: The Role of Gender, Race, and Other Socioeconomic Factors"—This two-day conference held in October 2008 was hosted by VA, the National Institutes of Health, and the Department of Defense.
• Fourth National Summit on Women Veterans' Issues—This June 2008 event focused on advancing issues relating to women Veterans, including military sexual trauma and readjustment.

Expansive Women-Focused Health Services

To respond to the unique needs of women Veterans, VA offers comprehensive high-quality primary health care services for women, including Pap smears, mammography, and reproductive health care, as well as mental health services such as substance abuse counseling and treatment of military sexual trauma. Every VA medical center has a women Veterans program manager; every community-based outpatient clinic has a liaison for women Veterans; and every regional office has a women Veterans coordinator. In addition to the services provided at each VA medical center, some 50 Women's Health Centers serve women Veterans specifically. These centers-whose numbers have increased eightfold in the past decade in response to increasing need-develop enhanced programs for women, and some also conduct research in medical and psychosocial issues.