Photovoice as an Educational Intervention to Improve Care of OEF/OIF Veterans

描述（由申请人提供）： 对退伍军人医疗保健的预期影响：Photovoice是一种创新的参与式研究工具，使个人能够通过视觉图像和第一人称叙述来传达他们的经验，观点和需求。与OEF/OIF退伍军人建立Photovoice的可行性将提供一种新的方法，使退伍军人参与自己的护理，改善患者与提供者的沟通，并使VA提供者和工作人员对退伍军人的经验更加敏感。我们的长期目标是开发一个可扩展版本的Photovoice，作为一种教育干预措施，以加强为OEF/OIF退伍军人提供以患者为中心的护理。项目背景：作为持久自由行动（OEF）和伊拉克自由行动（OIF）的一部分，从战斗部署返回的退伍军人在过渡到部署后生活方面面临复杂的挑战。退伍军人事务部具有独特的地位，以满足作战退伍军人的需求，并支持成功的重返社会。然而，只有不到一半的退伍军人回到退伍军人管理局接受护理，许多人没有参加后续预约。许多OEF/OIF退伍军人缺乏与VA的联系感，作为回报，VA领导层，供应商和工作人员可能难以与战斗退伍军人的部署和部署后经验有关。需要创新的方法来帮助弥合这些知识和理解的差距，并促进以病人为中心的护理环境OEF/OIF退伍军人在VA。在利益相关者（VA领导层/供应商/工作人员和退伍军人）之间建立联系，融洽和信任感，同时使临床医生能够通过患者的眼睛看到疾病和健康，这是以患者为中心的护理模式的关键要素，这是提高VA为返回的退伍军人提供的公平和护理质量的重要一步。项目目标：拟议试点项目的主要目的是确定与OEF/OIF退伍军人一起使用Photovoice的可行性。我们的次要目标是探索Photovoice作为教育干预的初步有效性：1。增加健康沟通自我效能感，降低退伍军人参与者社交焦虑;积极影响退伍军人管理局领导层、提供者和工作人员对“持久自由行动”/“伊拉克自由行动”退伍军人的经验和需求的态度和知识。试点研究的结果将为设计Photovoice作为退伍军人和VA提供者/工作人员的教育干预的多中心研究提供信息，包括确定适当的结果变量和数据收集工具。这项工作的广泛、长期目标是提高对“持久自由行动”/“法语国家组织”退伍军人的护理质量和公平性。项目方法：在这项混合方法研究中，40名持久自由行动/伊法组织退伍军人将参加一个“照片之声”项目，制作由图片和文字组成的声明，传达他们与战斗部署和部署后重返社会有关的经验和观点。样本将包括正在VA医疗中心接受治疗的退伍军人（例如慢性疼痛、创伤性脑损伤、多发性创伤和/或PTSD）。样本还将包括没有获得VA护理的OEF/OIF退伍军人;这些参与者将通过当地大学，国民警卫队和预备役部队以及兽医中心招募。照片之声项目的调查结果将通过医疗中心现场的照片之声展览、大圆桌会议以及医疗中心和相关CBOC的其他教育和培训活动传播给VA领导层、提供者和工作人员。参与Photovoice作为提高OEF/OIF退伍军人自我效能和减少社交焦虑的干预措施的初步有效性将通过参与Photovoice之前和之后对问卷调查的回答变化来衡量。将通过书面评论和小组讨论来评估参加Photovoice展览或演讲对VA提供者和工作人员的影响。

DESCRIPTION (provided by applicant): Anticipated Impacts on Veteran's Healthcare: Photovoice is an innovative participatory research tool that empowers individuals to convey their experiences, perspectives, and needs through visual images and first- person narratives. Establishing feasibility of Photovoice with OEF/OIF Veterans will provide a novel approach to engaging Veterans in their own care, improving patient-provider communication, and sensitizing VA providers and staff to the experiences of returning Veterans. Our long-term goal is to develop a scalable version of Photovoice as an educational intervention to enhance the provision of patient-centered care to OEF/OIF Veterans. Project Background: Veterans returning from combat deployments as part of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF) face complex challenges in making the transition to post-deployment life. The VA is uniquely positioned to meet the needs of combat Veterans and support successful reintegration. However, less than half of returning Veterans come to the VA for care, and many of those who do fail to attend follow-up appointments. Many OEF/OIF Veterans lack a sense of connection with the VA, and in return, VA leadership, providers and staff may have difficulty relating to the deployment and post-deployment experiences of combat Veterans. Innovative approaches are needed to help bridge these gaps in knowledge and understanding and to promote an environment of patient-centered care for OEF/OIF Veterans at the VA. Building a sense of connection, rapport, and trust among stakeholders (VA leadership/providers/staff and Veterans) while enabling clinicians to see illness and health through the patient's eyes are key elements of a patient-centered care model, an essential step to improving the equity and quality of care provided by the VA to returning Veterans. Project Objectives: The primary aim of the proposed pilot project is to establish feasibility of Photovoice with OEF/OIF Veterans. Our secondary aims are to explore preliminary effectiveness of Photovoice as an educational intervention to: 1. increase health communication self-efficacy and decrease social anxiety for Veteran participants and 2. positively impact attitudes and knowledge of VA leadership, providers, and staff as relates to the experiences and needs of OEF/OIF Veterans. Findings from the pilot study will inform the design of a multi-site study of Photovoice as an educational intervention for Veterans and VA providers/staff, including identification of appropriate outcome variables and data collection tools. The broad, long-term objective of the work is to improve the quality and equity of care for OEF/OIF Veterans. Project Methods: In this mixed methods study, 40 OEF/OIF Veterans will participate in a Photovoice project to produce statements made up of pictures and words that communicate their experiences and perspectives related to combat deployment(s) and post-deployment reintegration. The sample will include Veterans who are being treated at a VA Medical Center (e.g. for chronic pain, Traumatic Brain Injury, polytrauma and/or PTSD). The sample will also include OEF/OIF Veterans who have not accessed VA care; these participants will be recruited through local universities, National Guard and Reserve units, and Vet Centers. Findings from the Photovoice project will be disseminated to VA leadership, providers and staff through a Photovoice exhibit on- site at the Medical Center, Grand Rounds presentations, and other educational and training events at the Medical Center and associated CBOCs. Preliminary effectiveness of Photovoice participation as an intervention to increase self-efficacy and decrease social anxiety among OEF/OIF Veterans will be measured by change in responses to questionnaires administered before and after Photovoice participation. The impact of attending a Photovoice exhibit or presentation on VA providers and staff will be assessed through written comments and small-group discussions.