Factors Affecting Women's Disclosure of Alcohol Misuse in Primary Care: A Qualitative Study with U.S. Military Veterans.
BACKGROUND
One in five women veterans screens positive for alcohol misuse. Women may be less likely than men to disclose alcohol use to a primary care provider (PCP), resulting in women being less likely to receive effective interventions. We sought to qualitatively examine factors that may affect women veterans' willingness to disclose alcohol use to a PCP.


METHODS
Between October 2012 and May 2013, in-depth interviews were conducted with 30 women veterans at two Department of Veterans Affairs (VA) medical facilities. Qualitative data analyses identified common themes representing factors that influence women's decision to disclose alcohol use to a PCP.


RESULTS
Nine themes were endorsed by women veterans as influencing their willingness to disclose alcohol use to their PCP. Themes included provider behaviors perceived as encouraging or discouraging disclosure of alcohol misuse, perceived positive relationship with provider, negative emotions such as concerns about being judged or labeled an "alcoholic," health concerns about drinking, non-health-related concerns about drinking, self-appraisal of drinking behavior, social support, and clinic factors.


CONCLUSIONS
Our findings demonstrate the importance of social relationships, comfort with one's provider, and education on the potential harms (especially health related) associated with alcohol in encouraging disclosure of alcohol use in women veterans. Our results also support VA national health care efforts, including the provision of brief alcohol counseling and the use of primary care clinics specializing in the care of women veterans.
Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Affairs Healthcare System, North Little Rock, Arkansas; VA South Central (VISN 16) Mental Illness Research, Education, and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Electronic address: macucciare@uams.edu.
Michael A
MA
Cucciare
Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, California.
Eleanor T
ET
Lewis
Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, California.
Katherine J
KJ
Hoggatt
Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Sepulveda, California; Department of Medicine, UCLA David Geffen School of Medicine, Los Angeles, California.
Bevanne
B
Bean-Mayberry
Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, California; Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California.
Christine
C
Timko
Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, California.
Eva M
EM
Durazo
Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, California.
Andrea L
AL
Jamison
Center for Innovation to Implementation, VA Palo Alto Healthcare System, Menlo Park, California; Women's Health Service, VA Palo Alto Health Care System, Palo Alto, California; Division of General Medical Disciplines, Stanford University School of Medicine, Stanford, California.
Susan M
SM
Frayne
D000328:Adult; D000428:Alcohol Drinking; D000437:Alcoholism / Q000453:epidemiology* / Q000523:psychology; D001291:Attitude of Health Personnel; D030881:Disclosure; D005260:Female; D019538:Health Care Surveys; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008875:Middle Aged; D008889:Military Personnel; D011320:Primary Health Care; D036301:Qualitative Research; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000523:psychology* / Q000706:statistics & numerical data; D016387:Women's Health