title: Assessment of the healthcare needs and barriers to VA use experienced by women veterans: findings from the national survey of women Veterans.
abstract: BACKGROUND
  Prior regional studies of women Veterans identified barriers to Veterans Affairs (VA) healthcare use. However, these studies do not reflect the demographic profile of women Veterans nationally, recent advances in VA women's healthcare, and the national context of expanded healthcare alternatives.
  
  
  OBJECTIVE
  To characterize health, VA perceptions, barriers, healthcare delivery preferences, and reasons for VA or non-VA healthcare use in a national women Veteran sample.
  
  
  METHODS
  Cross-sectional, population-based 2008-2009 National Survey of Women Veterans (n=3611).
  
  
  RESULTS
  VA users had worse physical and mental health than non-VA-only users and healthcare nonusers. Older women Veterans had worse physical health, whereas younger groups had worse mental health. Healthcare use was highest for dual users, followed by VA-only users, but did not differ by age group. Healthcare nonusers were most likely to lack a regular source for healthcare. Perceptions of VA care quality and sex-appropriateness were highest for VA-only, followed by dual, then non-VA-only users. VA perceptions were guided by personal experience for 90% of VA users, versus media or other secondhand sources for 70% of other groups. Non-VA-only users and healthcare nonusers had more knowledge gaps about VA and misperceptions about VA eligibility and services; non-VA-only users more likely encountered VA enrollment barriers.
  
  
  CONCLUSIONS
  Many nonusers had healthcare needs that were not met. Positive VA perceptions by women with first-hand VA experience, contrasted with VA knowledge gaps by those without such exposure, suggests the need for more education about available VA healthcare services. VA planning should account for mental health needs and healthcare use by younger women Veterans.
authors.affiliation: *VA Greater Los Angeles Health Services Research and Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda and Los Angeles †Department of Medicine, University of California Los Angeles (UCLA) Geffen School of Medicine ‡Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, CA.
authors.forename: Donna L
authors.initials: DL
authors.lastname: Washington
authors.forename: Melissa M
authors.initials: MM
authors.lastname: Farmer
authors.forename: Su Sun
authors.initials: SS
authors.lastname: Mor
authors.forename: Mark
authors.initials: M
authors.lastname: Canning
authors.forename: Elizabeth M
authors.initials: EM
authors.lastname: Yano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D003710:Demography; D005260:Female; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006305:Health Status Indicators; D006801:Humans; D008875:Middle Aged; D014481:United States; D014493:United States Department of Veterans Affairs; D058014:Veterans Health; D016387:Women's Health