Background:
The engagement of veterans in health research is essential to better understand how care is provided and what implementation strategies are necessary to improve care for our nation’s 22 million veterans. Veteran participation in research is vital to the development of effective and culturally congruent treatments for conditions such as post-traumatic stress disorder, chronic pain, insomnia, and other maladies. However, veterans participating as full partners in the research process is lacking. Through a funded engagement award, the Veterans’ Action League (VAL) was created to provide a platform for veterans’ voices to be heard and mobilize veterans in a dynamic unit, connect with other veterans and key stakeholders. VAL Units provide a venue to increase our understanding on what veterans need to make better-informed healthcare decisions and how they want to participate in patient-centered outcomes research (PCOR) and receive comparative effectiveness research (CER) findings. Despite knowing that veterans have distinct healthcare concerns and may require different healthcare delivery, little research has been done from the veterans’ perspectives on how clinicians can accomplish this lofty goal.
Theoretical Framework:
This community engagement project was guided by military service members and veterans reintegration theory positing that those who successfully navigate the challenges of reintegration—establishing and maintain reliable relationships, housing, and employment—will have better healthcare outcomes secondary to stronger social networks that enable resilience and self-empowerment during times of stress. Yet, many returning veterans report challenges in reestablishing themselves within their families and communities after deployment, raising concerns about how family stress and fractured relationships will impact future health outcomes Integrating the unique challenges facing veterans into the healthcare they receive is essential for providing the best possible care.
Methods:
This project was reviewed by institutional review boards and determined exempt. VAL Units were formed in the six states with the largest veteran populations: California, Texas, Florida, Pennsylvania, New York, and Ohio. VAL Units were led by a local veteran leader with strong ties to the veteran community. The VAL Unit leaders were assisted by a Collaborative Academic Research Member (CARM) from the University of San Diego, Florida Atlantic University, University of Rochester, Ohio State University, Pennsylvania State University, and University of Texas San Antonio. VAL leaders engaged their unit in conversation through in-person and virtual “Think Tank Meetings” (TTM) and activities about what veterans critically need to make informed healthcare decisions, how they want to and can be involved, specific factors that can inhibit their involvement in research, and ways to engage veterans in PCOR. Using a field note template, the CARMs recorded, validated, and submitted the dialogue information. The project team analyzed the information using open and axial coding. The knowledge generated provided the basis for the development of the PCOR Community Capacity Building Toolkit for Veterans.
Results: From November 2016 through May 2018 a series of nine TTM were held in each state, a total of 54. Over 384 participants including veterans (n=283) and stakeholders (n=101) attended at least one dialogue session, creating 257 unduplicated participants. The initial TTM discussions regarding strategies to engage veterans as partners in clinical research were met with skepticism. However, the project’s platform allowed open and honest dialogue to occur by engaging veterans with other veterans and key community stakeholders with an interest in improving veteran healthcare. Themes uncovered specified veteran-based engagement strategies and way to engage veteran partnerships in the areas of design, subject recruitment, and dissemination of findings. Through collaborative efforts, the PCOR Community Capacity Building Toolkit for Veterans was created as a resource for veterans, researchers, and stakeholders to engage in meaningful PCOR and CER activities. The Toolkit includes effective, partnership-assessed communication strategies and organized stakeholder-driven suggestions for effective ways for veterans and stakeholders to participate in PCOR initiatives and how they want to receive CER findings.
Conclusion/Implications:
The multi-state interprofessional partnerships developed with veterans, community stakeholders, clinicians, and researchers supported a community engagement framework that yielded a high probability of improving the rates of veteran participation as full partners in the research process and enhancing sustainability over time. Our project empowered veterans to have an active voice in improving the research and outcomes that matter most to them. Veterans’ Action Leagues worked dynamically and cooperatively to bridge the gap between how care is currently delivered and how veterans themselves would like to receive information about their care. Sound healthcare decision-making requires having accurate, up-to-date, understandable, evidence-based information, along with the decision-making tools and capacities to utilize that information. Ultimately, VAL served as a national platform to help veterans live the healthiest lives they can, aid us in better understanding what obstacles veterans face when seeking healthcare treatments, and serve as the foundation for a robust, veteran-driven PCOR community.