Providers' perceptions of barriers and facilitators to disclosure of alcohol use by women veterans.
Aim To better understand barriers and facilitators that hinder or help women veterans discuss their alcohol use with providers in primary care in order to better identify problematic drinking and enhance provider-patient communication about harmful drinking.



Women presenting to primary care may be less likely than men to disclose potentially harmful alcohol use. No studies have qualitatively examined the perspectives of primary care providers about factors that affect accurate disclosure of alcohol use by women veterans during routine clinic visits.



Providers (n=14) were recruited from primary care at two veterans Administration Women's Health Clinics in California, United States. An open-ended interview guide was developed from domains of the consolidated framework for implementation science. Interviews elicited primary care providers' perspectives on barriers and facilitators to women veterans' (who may or may not be using alcohol in harmful ways) disclosure of alcohol use during routine clinic visits. Interview data were analyzed deductively using a combination of template analysis and matrix analysis. Findings Participants reported six barriers and five facilitators that they perceived affect women veteran's decision to accurately disclose alcohol use during screenings and openness to discussing harmful drinking with a primary care provider. The most commonly described barriers to disclosure were stigma, shame, and discomfort, and co-occuring mental health concerns, while building strong therapeutic relationships and using probes to 'dig deeper' were most often described as facilitators. Findings from this study may enhance provider-patient discussions about alcohol use and help primary care providers to better identify problematic drinking among women veterans, ultimately improving patient outcomes.
1Center for Mental Healthcare and Outcomes Research,Central Arkansas Veterans Affairs Healthcare System,North Little Rock,AR,USA.
Traci H
TH
Abraham
3Center for Innovation to Implementation,VA Palo Alto Health Care System,Menlo Park,CA,USA.
Eleanor T
ET
Lewis
1Center for Mental Healthcare and Outcomes Research,Central Arkansas Veterans Affairs Healthcare System,North Little Rock,AR,USA.
Karen L
KL
Drummond
3Center for Innovation to Implementation,VA Palo Alto Health Care System,Menlo Park,CA,USA.
Christine
C
Timko
1Center for Mental Healthcare and Outcomes Research,Central Arkansas Veterans Affairs Healthcare System,North Little Rock,AR,USA.
Michael A
MA
Cucciare
D000428:Alcohol Drinking / Q000453:epidemiology / Q000523:psychology*; D019973:Alcohol-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D001291:Attitude of Health Personnel; D002140:California / Q000453:epidemiology; D030881:Disclosure; D005260:Female; D006801:Humans; D010817:Physician-Patient Relations; D036301:Qualitative Research; D057545:Social Stigma; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D058014:Veterans Health / Q000706:statistics & numerical data*; D016387:Women's Health / Q000706:statistics & numerical data*
alcohol use; barriers and facilitators; harmful drinking; screening; veterans; women