Action Ethnography of Community Reintegration for Veterans with TBI

描述（由申请人提供）： 背景/依据：创伤性脑损伤（TBI）的社区重返社会（CR）的许多研究已经在平民人群中进行，但没有在退伍军人人群中进行。 小 众所周知，平民研究的知识如何转化为退伍军人的经验和需求。 VA认识到OEF/OIF退伍军人的独特医疗保健需求，特别是TBI，包括需要将健康和康复相关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。 需要进行研究，以确定退伍军人CR的障碍和促进因素，为支持性社区服务的设计提供信息。 Sanders是一位著名的CR研究者，他指出了研究人员和康复专业人员的三个主要需求：（1）CR的全面含义，包括TBI患者的观点;（2）测量和干预的文化能力;（3）将对影响CR的环境因素的透彻理解纳入研究和治疗。 目的：拟议研究的目标是更好地了解中度至重度TBI的退伍军人，家庭和CR工作人员在过渡到社区并维持社区生活时的经历。 有趣的是， 以及它们发生的背景，包括地方，州，区域和VA环境，这些环境既促进又阻碍退伍军人和家庭谈判服务以实现有益的CR水平的能力。 这项为期4年的中重度TBI退伍军人纵向民族志的目标和研究问题，使用基于社区的前瞻性研究方法是：O 1：描述退伍军人所感知的社区重返社会经验; O2：从多个角度比较和对比社区重返社会的障碍和促进因素（退伍军人，家庭和CR工作人员，例如，个案管理员、护理协调员、退伍军人事务部/国防部/社区联系人等）; O3：描述个人社交网络如何随时间变化并影响CR; O 4：与退伍军人、家庭和CR专家合作，确定改善CR体验的策略。 研究方法：一个为期四年的纵向民族志将使用混合的方法（访谈，问卷调查，参与观察）从社区为基础的前瞻性研究的角度归纳，参与者感知和整体的民族志方法是理想的研究CR退伍军人TBI，因为很少有人知道他们的定义和认知CR和彻底了解影响CR的环境和文化因素。 主要样本将包括25名患有中度至重度TBI的退伍军人。 次要样本将包括25名主要家庭照顾者和25名CR专家。 第三级样本将包括多达15个关键利益攸关方。 影响：对VA医疗保健系统的预期影响是全面了解影响CR的退伍军人感知和环境因素，以确定干预措施的目标，这些干预措施可以减少障碍并加强中度至重度TBI退伍军人的促进者。 这项研究将通过积极参与消除直接为自己和间接为他人的CR障碍，为退伍军人和家庭发声。 研究结果将提供一个路线图，设计和测试干预措施，以最大限度地提高就业，独立生活和社会关系中的CR，这些都是基于多个角度的看法。

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.