Health Services PhD candidate Zoe Pleasure recently received the F31 predoctoral fellowship for her research in Veteran health care.
Zoe Pleasure, a Health Services PhD candidate, has been working in the field of reproductive health research for more than seven years. In her years as a researcher at the Guttmacher Institute, she worked on research projects and publications about maternal near-misses in Kenya, adolescent sexual behavior and contraceptive use, and how changes in state-level policy affect reproductive health. More recently, she co-authored a study analyzing abortion-related TikToks in the wake of the Dobbs decision.
“My research interests coalesce around understanding how people make decisions about reproductive health care: what providers they’re seeing, what contraceptive methods they’re interested in, and whether they decide to use contraception or not,” she explained.
For the past three years, Pleasure has served as a research assistant to faculty members Kristen Gray and Lisa Callegari, who specialize in female Veterans’ health care. When Pleasure was diagnosed with a chronic condition, Crohn’s disease, in 2018, she began connecting the dots between her personal experience and her research.
“As a result of my experiences navigating both the disease and its treatment, I gained personal understanding of how chronic disease and the necessary medication management and medical visits fundamentally change people’s everyday lives,” she reflected.
Pleasure’s PhD will explore the intersection of chronic disease and reproductive decision-making within the Veteran population. Despite a conservative estimate of almost 5% of Veterans having been diagnosed with an autoimmune condition, “there was little research exploring the unique needs for this particular Veteran population,” she explained.
“Veterans who receive VA care are usually navigating a health care system that was originally created for men.”
– Zoe Pleasure, UW Health Services PhD candidate
This summer, Pleasure was awarded the prestigious F31 predoctoral fellowship from the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health for her study in Veteran health care. She will collaborate with Drs. Kristen Gray, Lisa Callegari, Edwin Wong and Emily Williams of the UW Department of Health Systems and Population Health as well as others affiliated with UW Medicine, VA Puget Sound and University of Pittsburgh.
Navigating reproductive care in a system built for men
Veterans with autoimmune conditions face many of the same barriers to contraception access as civilians, only compounded by a host of Veteran-specific challenges. Around 10% of Veterans are women, and the Veterans Administration has acknowledged persistent gaps in their care.
“Veterans who receive VA care are usually navigating a Veteran health care system that was originally created for men,” Pleasure explained. “The availability of sex-specific care, like contraception, gynecological care, and cervical cancer screening, is really variable across sites.”
For this population in particular, receiving quality reproductive health care is key. Autoimmune conditions can simultaneously complicate pregnancy and exacerbate side-effects of certain contraception methods, and those with chronic conditions often don’t know where to turn for informed reproductive health care advice. Primary care doctors and specialists may provide conflicting information about contraception, leading to gaps in care.
“People with autoimmune conditions often rely on sub-specialist providers for some of their primary or reproductive care, which a lot of these providers don’t see as within their scope of practice. Or, maybe these providers don’t have the knowledge base to provide this care in the most patient-centered, equitable, and high-quality way,” Pleasure explained.
The last piece of the puzzle is the structure of the VA’s bureaucratic apparatus itself. To ensure comprehensive care, the VA often outsources care to community care providers, but communication between the VA and these disparate health systems can be uneven, especially if a patient has a complicated medical history.
Understanding gaps in care from the patient and provider perspectives
Pleasure’s study will explore these nuances using mixed methods incorporating a variety of rich data sources. Each source–electronic health records, medical record text notes, and qualitative interviews–is meant to illuminate a different facet of the issue. Health records, which reflect billable procedures and prescriptions, reveal patterns in contraception usage. Providers’ text notes indicate how they chart interactions, and what Veterans tell them about their contraception needs. Lastly, the qualitative interviews will help Pleasure understand Veterans’ everyday, lived experiences. Pleasure seeks to understand this issue holistically: at the Veteran level, provider level, and system level.
“I really wanted to incorporate the perspective of Veterans themselves. So that’s why qualitative interviews are the last step to help me triangulate and expand upon what I’m finding in the first two sources,” Pleasure explained.
Once her study is complete, Pleasure hopes to disseminate her findings within the VA, perhaps by giving a brief or presentation to the VA’s Office of Women’s Health, or talking with primary care or gynecological providers. Indeed, she was drawn to the Health Services PhD program for the opportunity to inhabit dual roles: as an academic, and also a change-maker working within health systems to improve the delivery of care.
“I would love to gain skills in communicating with health system leaders or operational partners that work at the VA about how to improve care for this particular population, and ways that the delivery of care in the VA could be improved to better suit and be more patient-centered for this population,” she reflected.
Collaborators:
- Drs. Kristen Gray, Lisa Callegari, Edwin Wong, Emily Williams – all affiliated with HSPop, SPH, VA Puget Sound COIN https://www.seattledenvercoin.research.va.gov/
- Dr. Susan Wong – UW Medicine and VA Puget Sound COIN
- Dr. Mehret Birru Talabi – University of Pittsburgh and CONVERGE@Pitt https://www.converge.pitt.edu/
- Dr. Elizabeth Wahl – UW Medicine, VA Puget Sound