Award Date

5-15-2026

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Nursing

First Committee Member

Andrew Reyes

Second Committee Member

Nirmala Lekhak

Third Committee Member

Cheryl Maes

Fourth Committee Member

Joseph Morgan

Number of Pages

166

Abstract

Background: Older adults remain sexually active, yet sexual health is frequently under-discussed in healthcare settings, particularly within veteran populations. Sexual health is essential to overall quality of life, and prior studies have shown that older patients value these conversations. However, veterans often face unique factors such as military-related trauma, including military combat exposure and post-traumatic stress disorder, in addition to compounded stigma from these topics in regards to open discussions about sensitive health issues to their healthcare providers. This study is significant in its potential to uncover systemic, cultural, and interpersonal influences that shape these dynamics, with a particular emphasis on Department of Veterans Affairs (VA) healthcare providers.

Methods: A convergent parallel mixed-methods design was used, with quantitative and qualitative data collected simultaneously. Quantitative data were gathered using two validated instruments: Aging Sexual Knowledge and Attitudes Scale (ASKAS) and the Hypergender Ideology Scale (HGIS), to assess healthcare providers’ knowledge, attitudes, and gender-role ideology. Descriptive statistics, correlations, and multiple linear regression analyses were conducted in SPSS. Qualitative data were obtained through semi-structured Zoom interviews and analyzed using Braun and Clarke’s six-phase thematic analysis, incorporating open and in vivo coding. The two data strands were then integrated through triangulation to identify areas of convergence and divergence in how quantitative patterns aligned with qualitative experiences.

Results: Quantitatively, VA healthcare providers demonstrated moderate knowledge and held attitudes that ranged from moderate to somewhat restrictive. Knowledge was associated with more restrictive attitudes (r = .27, p = .017), while hypergender ideology showed the strongest relationship with attitudes (r = .41, p < .001) and remained the strongest predictor. Younger, more educated, and urban-raised providers reported more permissive attitudes. Qualitatively, five themes emerged: time constraints in primary care; patient reluctance and disclosure barriers; trauma-informed approaches; provider-led normalization; and institutional strengths and gaps. Providers described limited appointment time, older veterans’ generational beliefs and discomfort, and histories of MST or PTSD as shaping these conversations. Integrated findings showed that moderate knowledge aligned with reports of limited training and competing demands. The unexpected link between higher knowledge and more restrictive attitudes reflected cautious communication in response to patient discomfort, mistrust, and privacy concerns. Overall, gender-role beliefs, patient-related barriers, and institutional factors influenced practice more than knowledge alone.

Implications: This study on VA HCPs found that gender ideology, trauma-informed considerations, and institutional constraints played a greater role than knowledge in shaping providers’ attitudes and communication about the topic of sexual health with older veterans. Hypergender ideology was the strongest predictor of attitudes, reflecting how deeply gendered beliefs influence clinical decision-making. Providers described using cautious, rapport-building communication approaches to maintain comfort in these sensitive discussions. These findings underscore opportunities to strengthen training, policy, and clinical structures to deliver more consistent, patient-centered sexual health care.

Keywords

gender ideology; healthcare providers; older adults; sexual health; sexual script theory; veterans

Disciplines

Defense and Security Studies | Feminist, Gender, and Sexuality Studies | Gender and Sexuality | Health and Medical Administration

File Format

PDF

File Size

2300 KB

Degree Grantor

University of Nevada, Las Vegas

Language

English

Rights

IN COPYRIGHT. For more information about this rights statement, please visit http://rightsstatements.org/vocab/InC/1.0/

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