From the Department of Obstetrics and Gynecology, Division of Family Planning, University of Utah, Salt Lake City.
the Department of Internal Medicine, Division of Epidemiology, University of Utah, Salt Lake City.
South Med J. 2023 Feb;116(2):181-187. doi: 10.14423/SMJ.0000000000001513.
Women veterans are a fast-growing population in the Veterans Health Administration (VHA), and ensuring reproductive service availability is a VHA priority. As such, we sought to explore barriers and facilitators to VHA reproductive service provision across a catchment area from women's health providers' perspectives.
We performed a mixed-methods study, including semistructured, qualitative provider interviews with a quantitative survey on training, comfort, and knowledge of reproductive services. All women's health providers and their support staff from the Salt Lake City Veterans Affairs Medical Center and nine VHA community-based outpatient clinics were asked to participate. We conducted qualitative interviews and knowledge surveys with providers and staff to explore training, care processes, and improvement opportunities in reproductive service provision. We completed descriptive analyses of all of the quantitative data and used an open, iterative process to analyze provider interviews for emergent themes.
We interviewed 15 providers (7 advanced practice nurses, 4 registered nurses, and 4 physicians) across nine sites (50% response rate). The commonly identified barriers included provider training and staffing, scheduling/referral processes, inconsistent services/supplies, and lack of veteran awareness of reproductive services. Facilitators included prior non-VHA reproductive health experience among providers, invested support staff, and the integrated VHA health system.
Addressing barriers to VHA reproductive healthcare provision may overcome reproductive service variations related to clinic location and improve reproductive health outcomes for women veterans.
女性退伍军人是退伍军人健康管理局（VHA）中增长迅速的人群，确保生殖服务的可及性是 VHA 的优先事项。因此，我们试图从女性健康提供者的角度探讨 VHA 生殖服务提供的障碍和促进因素。
我们进行了一项混合方法研究，包括对盐湖城退伍军人事务医疗中心和九个 VHA 社区门诊的女性健康提供者及其支持人员进行半结构化、定性的提供者访谈，并进行了生殖服务培训、舒适度和知识的定量调查。我们对提供者和工作人员进行了定性访谈和知识调查，以探讨生殖服务提供方面的培训、护理流程和改进机会。我们对所有定量数据进行了描述性分析，并使用开放、迭代的过程对提供者访谈进行了主题分析。
我们在九个地点采访了 15 名提供者（7 名高级执业护士、4 名注册护士和 4 名医生）（50%的回应率）。常见的障碍包括提供者培训和人员配备、预约/转介流程、服务/供应不一致以及退伍军人对生殖服务的意识不足。促进因素包括提供者的非 VHA 生殖健康经验、投入的支持人员以及综合的 VHA 健康系统。
解决 VHA 生殖保健服务提供的障碍可能会克服与诊所位置相关的生殖服务差异，并改善女性退伍军人的生殖健康结果。
