Designing veteran-centered strategies to reduce and prevent food insecurity: A veteran and community-partnered approach

背景：粮食不安全的定义是，由于家庭经济原因，获得粮食的机会有限或不确定 限制和影响每4名9/11后退伍军人中的1人。食物不安全的退伍军人患精神疾病的风险增加 健康状况，如抑郁和自杀念头。目前减少粮食不安全的方法主要集中在 直接获得食物，但对解决诸如失业、贫穷等潜在贡献者几乎无济于事 获得医疗保健和社会孤立。幸运的是，退伍军人管理局有解决这些潜在问题的服务 贡献者。不幸的是，超过一半的9/11后退伍军人还没有注册或使用退伍军人管理局的计划 因为他们缺乏对服务的认识和/或获得服务的机会。基于社区的VSO是关键的切入点 针对尚未满足社会需求、尚未与退伍军人管理局建立联系的退伍军人。然而，我们对此知之甚少 他们的筛查实践。就像在医疗保健环境中一样，社区中有强大的筛查和转诊流程 环境势在必行；否则，很大一部分退伍军人可能会继续没有食物。重要意义： 拟议的CDA直接回应了VHA HSR&D的呼吁，即进行研究，以缓解未得到满足的 退伍军人。越来越多的证据表明，单靠粮食供应并不能改善粮食安全。我们需要一个 考虑粮食不安全的根本原因的综合办法。53%的邮递员中的许多人- 9/11没有参加退伍军人服务的退伍军人与征兵级别较低的分开和/或是女性。这些 这些特点使他们面临更大的粮食不安全风险。因此，我们还需要集成健壮性 筛选过程以识别在社区中存在食物不安全的退伍军人；否则， 很大一部分退伍军人可能会继续满足未得到满足的社会需求。创新：需要合作伙伴 与基于社区的组织、VHA和VBA一起设计干预措施，以解决潜在的 贡献者通过同行支持来减少孤立和导航现有资源是 这项CDA中提出的研究。据我所知，我们的研究也将是第一次尝试检查 志愿人员组织正在对粮食不安全和其他与健康有关的社会需求进行筛查。具体目标：我的长期目标 职业目标是成为一名以退伍军人事务部为基础的独立调查员，因实施创新的、社区的 解决粮食不安全和其他健康社会决定因素的参与式解决方案。在我的指导下 导师团队，我的目标是提高参与性研究的熟练程度，扩大干预知识 设计和评估，并建立将证据转化为实践的实施技能。为了支持这些 职业目标，在CDA期间，我建议：目标1.设计一个利益相关者知情的、全面的 干预措施，帮助9·11事件后的退伍军人，他们的食物没有保障。目标2.进行可行性试验 利益相关者知情的全方位干预，旨在为食品不安全的退伍军人提供同伴 支持并连接现有的服务，以解决粮食不安全的根本原因。目标3. 审查以社区为基础的粮食不安全和其他与健康有关的社会需求的筛查做法 退伍军人。方法：我们将使用以人为中心的设计框架来设计一个环绕式 与关键利益相关者(例如，退伍军人、社区合作伙伴、VHA社会工作和VBA外联)进行干预 专家)。然后，我们将进行为期12周的干预可行性和可接受性试验。在第四年和 5、我们将对德克萨斯州VSO的筛查做法进行景观调查，并1：1深入 与选定的VSO进行访谈，以进一步探讨促进和阻止VSO进行筛查的因素。发现 将包括利益相关者知情的流程图进行筛选。下一步：由此产生的研究 CDA将支持IIR提交，以对利益相关者知情的综合报告进行混合类型1研究 采取干预措施，并提议在社区环境中启动和/或扩大对社会需求的筛选。作为退伍军人- 以护士科学家为基础，我将利用从CDA获得的技能、指导和经验来产生 研究将为实践和政策提供信息，以解决影响退伍军人的复杂社会需求。

Background: Food insecurity is defined as limited or uncertain access to food due to household economic restrictions and affects 1 in 4 post-9/11 Veterans. Food insecure Veterans have increased risk for mental health conditions like depression and suicidal ideation. Current methods to reduce food insecurity focus on immediate food access but do little to address underlying contributors such as such as unemployment, poor access to healthcare, and social isolation. Fortunately, the VA has services that address these underlying contributors. Unfortunately, more than half of post-9/11 Veterans have yet to enroll in, or use, VA programs because they lack awareness of, and/or access to, services. Community-based VSOs are critical entry points for Veterans with unmet social needs who have yet to connect with VA services. However, we know little about their screening practices. Like in healthcare settings, robust screening and referral processes in community settings are imperative; otherwise, a large portion of Veterans may continue to go without food. Significance: The proposed CDA directly responds to the VHA HSR&D’s call for research to mitigate unmet social needs of Veterans. Mounting evidence indicates that food provision alone does not improve food security. We need a comprehensive approach that considers underlying contributors to food insecurity. Many of the 53% of post- 9/11 Veterans not enrolled in VA services separated with low enlistment ranks and/or are women. These characteristics place them at increased risk for food insecurity. Thus, we also need to integrate robust screening processes to identify Veterans who are food insecure where they are—in the community; otherwise, a significant portion of Veterans may continue to go with unmet social needs. Innovation: The need to partner with community-based organizations, VHA, and VBA to design an intervention that will address underlying contributors through peer-support to reduce isolation and navigate existing resources is the basis for the research proposed in this CDA. Our study will also, to my knowledge, be the first attempt to examine how VSOs are screening for food insecurity and other health-related social needs. Specific Aims: My long-term career goal is to be a VA-based independent investigator recognized for implementing innovative, community- engaged solutions that tackle food insecurity and other social determinants of health. With guidance from my mentorship team, I aim to increase proficiency with participatory research, expand knowledge on intervention design and evaluation, and build implementation skills to translate evidence to practice. To support these career objectives, during the CDA I propose to: Aim 1. Design a stakeholder-informed, wrap-around intervention to help post-9/11 Veterans who are food insecure. Aim 2. Conduct a feasibility trial of a stakeholder-informed, wrap-around intervention designed to provide Veterans who are food insecure with peer support and connect to existing services that address underlying contributors to food insecurity. Aim 3. Examine community-based screening practices for food insecurity and other health-related social needs in Veterans. Methodology: We will use the human-centered design framework to design a wrap-around intervention with key stakeholders (e.g., Veterans, community partner, VHA social work, and VBA outreach specialists). We will then conduct a 12-week feasibility and acceptability trial of the intervention. In Year 4 and 5, we will conduct a landscape survey of screening practices among VSOs in Texas and 1:1 in-depth interviews with select VSOs to further explore factors that facilitate and prevent screening in VSOs. Findings will include stakeholder-informed process maps for screening. Next steps: The research generated from this CDA will support an IIR submission to conduct a hybrid type 1 study of the stakeholder-informed, wrap-around intervention and a proposal to initiate and/or expand screening of social needs in community settings. As a VA- based nurse scientist, I will use the skills, mentorship, and experience gained from my CDA to generate research that will inform practice and policy to address complex social needs affecting Veterans.