Intimate Partner Violence, Health, and Health Care Among Female Veterans

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DESCRIPTION (provided by applicant): This is the third submission of a HSR&D CDA-2 proposal to provide five years of salary support to Katherine Iverson, Ph.D. toward her goal of developing an independent VA health services research career. Dr. Iverson is a Clinical Research Psychologist at the Women's Health Sciences Division of the National Center for Posttraumatic Stress Disorder (WHSD-NCPTSD) and investigator at the HSR&D Center of Excellence (Center for Organization, Leadership, and Management Research; COLMR) at the VA Boston Healthcare System. This proposal outlines research and training plans that will result in Dr. Iverson's efficient and successful transition fom clinical research elucidating health outcomes from intimate partner violence (IPV) among civilian women to health services research to develop, evaluate, and implement effective IPV-related health services for women Veterans. Although her clinical research has benefited many individual women, Dr. Iverson has not yet had the opportunity to conduct health services research that can result in large-scale improvements in women's health care and health. Knowledge of health services research methods and theories are critical to her development as a health services researcher specializing in IPV and women's health. Therefore, Dr. Iverson proposes a comprehensive training program in these methods, including qualitative/mixed-methods and survey research, VA administrative databases, and implementation theory and processes. This training will give her a strong foundation from which to achieve independence as a health services researcher. Additionally, Dr. Iverson has carefully chosen a mentorship team of top women's health and health services researchers (Drs. Patricia Resick, Ann Hendricks, Dawn Vogt and Rachel Kimerling). This mentorship, along with the rich resources available at the WHSD-NCPTSD and COLMR, will ensure that Dr. Iverson has all the support necessary to meet her research and training aims. Both WHSD-NCPTSD and COLMR are committed to her career development and protected research time, as described in the attached letters. She will have access to facilities, resources, and collaborations with HSR&D-funded investigators at both centers. This proposal will provide the necessary foundation for the development, evaluation and implementation of IPV-related health services within VA to improve women's health and health care. Dr. Iverson uses an implementation research framework to guide three proposed studies. First, starting in Year 1, she will conduct a mail survey of women patients in VISN 1 to evaluate the reliability and validity of previously developed IPV screening tool in female VA patients. Second, in Years 1 and 2, she will adapt an existing, but lengthy, evidence-based IPV screening and response training program for Primary Care providers (PCPs) for implementation with VA staff, using information derived from consultation with screening and education experts and interviews with VA PCPs. Finally, in Years 2 and 3, she will conduct a preliminary evaluation of the newly adapted IPV screening and response training with VA PCPs to assess provider knowledge, self-efficacy, and IPV screening practices. Findings from these studies will result in feasible, efficient, and cost-effective methods and protocols for intervening with women Veterans affected by IPV. The proposed research will also lead to future HSR&D research proposals, resulting in significant improvements in women's health care quality, health, and satisfaction with VA care. PUBLIC HEALTH RELEVANCE: Intimate partner violence (IPV) is a substantial women's health issue, affecting large numbers of women and resulting in complex and costly public health problems. Rates of lifetime IPV exceeding 70%1 among women VA patients, along with adverse mental and physical health effects, makes research concerning IPV one of the most critical directions for VA health services research at this time. Research is needed to determine best practices for caring for women Veterans who experience IPV. The proposed research will address this gap in VA research by evaluating specific methods for identifying and responding to IPV among VA patients. The findings from this study will lead to improvements in women's health care quality and health.