Action Ethnography of Community Reintegration for Veterans with TBI

患有 TBI 的退伍军人重返社区的行动民族志

• 批准号: 10021442
• 负责人: Karen Besterman-Dahan
• 金额: --
• 依托单位: JAMES A. HALEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-07-01 至 2019-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10021442
• 关键词: Adoption; Affect; Caring; Characteristics; Communities; Employment; Environment; Environmental Risk Factor; Ethnography; Family; Family Caregiver; Goals; Health; Healthcare; Healthcare Systems; Home environment; Independent Living; Inpatients; Intervention; Interview; Knowledge; Measurement; Mediation; Methods; Participant; Perception; Persons; Policies; Population; Questionnaires; Rehabilitation therapy; Research; Research Personnel; Sampling; Services; Social Network; Specialist; Testing; Time; Translating; Traumatic Brain Injury; Veterans; acute care; community based care; community based participatory research; community based service; community reintegration; cultural competence; design; expectation; experience; holistic approach; improved; interest; preference; prevent; social organization; social relationships

DESCRIPTION (provided by applicant): Background/Rationale: Numerous studies of community reintegration (CR) in traumatic brain injury (TBI) have been conducted in the civilian population but not in Veteran populations. Little is known about how knowledge from civilian studies translates into Veterans experiences and needs. The VA recognizes the distinctive healthcare needs of OEF/OIF Veterans, particularly with TBI, including the need to bridge health and rehabilitation-related services from acute care and inpatient settings to Veterans' homes and communities to facilitate CR. Research is needed to identify barriers and facilitators to CR for Veterans to inform the design of supportive community-based services. Sanders, a well-known CR researcher identified three main needs for researchers and rehabilitation professionals: (1) a comprehensive meaning of CR, which includes the perspectives of persons with TBI; (2) cultural competence in measurement and intervention; and (3) incorporation of a thorough understanding of environmental factors that affect CR into research and treatment. Objectives: The goal of the proposed study is to better understand the experiences of Veterans with moderate to severe TBI, families and CR workers as they transition to and sustain living in communities. Of interest is both Veteran's experiences and the context in which they occur including local, state, regional and VA environments that both facilitate and impede the ability of Veterans and families to negotiate services to achieve salutary levels of CR. The objectives and research questions of this 4-year longitudinal ethnography of Veterans with moderate to severe TBI, using a Community-Based Participatory Research approach are to: O1:Describe the community reintegration experiences as perceived by Veterans; O2:Compare and contrast barriers and facilitators to community reintegration from multiple perspectives (Veterans, families, and CR workers, e.g., Case Mangers, Care Coordinators, VA/DOD/community contacts, etc.); O3:Describe how personal social networks change over time and influence CR; O4: In partnership with Veterans, families and CR specialists, identify strategies to improve CR experiences. Methods: A four-year longitudinal ethnography will use mixed methods (interviews, questionnaires, participant observation) from a Community-Based Participatory Research perspective The inductive, participant-perceived and holistic approach of ethnography is ideal for studying CR in Veterans with TBI because little is known regarding their definitions and perceptions of CR and a thorough understanding of environmental and cultural factors that influence CR. The primary sample will include 25 Veterans with moderate to severe TBI. The secondary sample will include 25 of their primary family caregivers and 25 CR specialists. The tertiary sample will include up to 15 key stakeholders. Impact: Anticipated impact on the VA healthcare system is a comprehensive understanding of Veteran-perceived and environmental factors affecting CR to identify targets for interventions that can decrease barriers and strengthen facilitators for Veterans with moderate to severe TBI. This study will give voice to Veterans and families by actively engaging them in removing barriers to CR directly for themselves and indirectly for others. Results will provide a roadmap for designing and testing interventions to maximize CR in employment, independent living, and social relationships that are grounded in the perceptions of multiple perspectives.

描述(由申请人提供)： 背景/理论基础：许多关于创伤性脑损伤(TBI)的社区重新融入(CR)的研究已在平民人群中进行，但在退伍军人人群中尚未进行。一点儿 了解从民间研究中获得的知识如何转化为退伍军人的经验和需求。退伍军人管理局认识到OEF/OIF退伍军人的独特医疗需求，特别是脑外伤，包括需要将与健康和康复相关的服务从急性护理和住院环境连接到退伍军人之家和社区，以促进CR。需要研究来确定退伍军人CR的障碍和促进者，以便为基于社区的支持性服务的设计提供信息。著名认知康复研究者桑德斯提出了研究人员和康复专业人员的三个主要需求：(1)认知障碍的全面含义，包括脑外伤患者的视角；(2)测量和干预方面的文化能力；(3)将对影响认知障碍的环境因素的透彻理解纳入研究和治疗中。目的：本研究的目的是为了更好地了解中重度脑外伤退伍军人、家属和CR工作者在过渡到社区并维持其生活时的经历。有趣的是老兵的经历 以及它们发生的背景，包括地方、州、区域和退伍军人环境，这些环境既促进也阻碍退伍军人和家属谈判服务以实现有益的CR水平。使用基于社区的参与式研究方法，这项为期4年的中重度脑外伤退伍军人人种学研究的目标和研究问题是：O1：描述退伍军人感知的社区重新融入经历；O2：从多个角度比较和对比社区重新融入社区的障碍和促进者(退伍军人、家庭和CR工作人员，例如病例经理、护理协调员、退伍军人/国防部/社区联系人等)；O：描述个人社会网络如何随着时间和CR的影响而变化；O4：与退伍军人、家庭和CR专家合作，确定改善CR体验的策略。方法：一项为期四年的纵向人种志研究将采用基于社区的参与式研究视角的混合方法(访谈、问卷、参与者观察)。归纳的、参与者感知的和整体的人种志方法是研究脑外伤退伍军人CR的理想方法，因为人们对他们对CR的定义和认知以及对影响CR的环境和文化因素的透彻理解知之甚少。主要样本将包括25名患有中度至重度脑外伤的退伍军人。第二次抽样将包括25名主要家庭照顾者和25名CR专家。第三次抽样将包括最多15个关键利益攸关方。影响：对退伍军人医疗保健系统的预期影响是对影响CR的退伍军人感知和环境因素的全面了解，以确定干预目标，以减少障碍并加强对中度至重度脑外伤退伍军人的促进作用。这项研究将让退伍军人和家属发出声音，让他们积极参与消除直接为他们自己和间接为他人消除CR的障碍。结果将为设计和测试干预措施提供路线图，以最大限度地提高基于多视角感知的就业、独立生活和社会关系的认知能力。