Communicating the Impact of mTBI on Post-Deployment Reintegration using Photovoice

 描述(由申请人提供)： 背景：在后9/11服役时代服役的退伍军人中，高达23%的人可能经历过创伤性脑损伤(TBI)。流行病学研究记录了脑损伤在持久自由(OEF)、伊拉克自由(OIF)和新黎明(OND)作战退伍军人中的持久影响，包括高比例的共病精神障碍。人们对患有脑外伤的退伍军人的生活经历知之甚少，包括对家庭和其他社会关系的影响、社区互动、治疗偏好和康复目标、支持来源、获得护理的机会和参与护理的障碍以及重返社会的挑战。鉴于许多患有脑外伤的退伍军人面临的认知和情感挑战，以及对支持他们的家人和朋友(以下称为“护理伙伴”)的要求和压力，以患者和社区为导向的研究探索这些生活经验和它们揭示的护理系统中的差距，对于制定有效的战略来改善这些差距至关重要。目的：将使用基于社区的参与性研究(CBPR)的PhotoVoice方法来吸引患有脑外伤的OEF/OIF/OND退伍军人及其护理伙伴开发照片叙事，以阐明和传达脑外伤后重新融入社区的经验，包括康复目标、支持来源、治疗偏好和未得到满足的需求。这些照片叙事将被用作吸引关键利益相关者--退伍军人和护理合作伙伴、为退伍军人服务的社区组织(CBO)、退伍军人和非退伍军人临床医生、项目经理、研究人员和政策制定者--的基础，以确定目标领域和战略，以改善退伍军人和护理合作伙伴获得和参与护理的机会，加强(退伍军人、退伍军人、护理合作伙伴和CBO之间的关系)，并促进退伍军人重新融入社区。将为退伍军人事务部的CBPR/合作研究制定蓝图，包括确定发展和维持合作的最佳做法， 让退伍军人和护理合作伙伴参与解释和传播调查结果，探索参与对利益攸关方的影响，并利用基于视觉和叙事的调查结果的力量，以实现退伍军人管理局和社区合作伙伴的战略目标。方法45名患有颅脑损伤的OEF/OIF/OND退伍军人和45名护理伙伴(总计N=90)将创建和分享照片叙事，交流他们关于重新融入社区的需求、挑战和资源的经验和观点。这项两点研究将包括主要使用退伍军人护理的退伍军人，以及那些不使用退伍军人护理或双重护理的退伍军人。方法将主要是定性的，包括对退伍军人和护理伙伴的个人照片启发访谈，对退伍军人护理伙伴对的后续二元访谈，以及小组讨论。根据CBPR模式，对调查结果的解释和传播将通过强调宣传、社区建设和教育的活动，使主要利益攸关方成为合作伙伴。混合方法、过程和影响评估的结果将被用于指导退伍军人管理局将CBPR/以人为中心的方法纳入卫生服务研究和质量改进工作的努力。通过PhotoVoice方法产生的对退伍军人医疗数据的预期影响，以强大的照片叙述的形式，将使退伍军人和护理合作伙伴能够积极参与描述和描述TBI对家庭和社区关系、康复目标、治疗偏好以及获取和参与护理的挑战的影响。涉及退伍军人、他们的护理合作伙伴、退伍军人管理局和社区利益相关者的合作研究将导致目标、战略和资源的协调，以改善对患有脑外伤的退伍军人的护理系统和支持来源。一个长期目标是建设退伍军人管理局进行社区参与研究的能力，以便为旨在改善退伍军人及其家人生活的以患者为中心的护理实践、政策和计划的实施提供信息。

 DESCRIPTION (provided by applicant): Background Up to 23% of Veterans serving in the post-9/11 service era may have experienced a traumatic brain injury (TBI). Epidemiological studies have documented lasting effects of TBI among Veterans of Operations Enduring Freedom (OEF), Iraqi Freedom (OIF), and New Dawn (OND), including high rates of comorbid psychiatric disorders. Little is known about the lived-experiences of Veterans with TBI- including impact on family and other social relationships, community interactions, treatment preferences and goals of recovery, sources of support, access to care and barriers to engagement in care, and challenges to reintegration. Given the cognitive and emotional challenges faced by many Veterans with TBI and the demands and strains on family and friends who support them (hereafter referred to as "care partners"), patientand community-oriented research that explores these lived experiences and what they reveal about gaps in systems of care is essential for developing effective strategies to ameliorate those gaps. Objectives Community-based participatory research (CBPR) photovoice methods will be used to engage OEF/OIF/OND Veterans with TBI and their care partners in developing photo-narratives that illuminate and convey experiences of community reintegration after TBI, including goals for recovery, sources of support, treatment preferences, and unmet needs. These photo-narratives will be used as the basis for engaging key stakeholders-Veterans and care partners, community-based organizations (CBOs) serving Veterans, VA and non-VA clinicians, program managers, researchers, and policymakers-to identify target areas and strategies to improve access to and engagement in care for Veterans and care partners, strengthen relationships (between VA, Veterans, care partners, and CBOs), and enhance community reintegration for Veterans. A blueprint for CBPR/Partnered research at VA will be developed, including identification of best practices for developing and sustaining collaborations, engaging Veterans and care partners in interpretation and dissemination of findings, exploring impact of participation on stakeholders, and harnessing the strength of visual- and narrative-based findings to meet the strategic goals of VA and community partners. Methods Forty-five OEF/OIF/OND Veterans with TBI and 45 care partners (total N=90) will create and share photo-narratives that communicate their experiences and perspectives regarding community reintegration needs, challenges, and resources. This two-site study will include Veterans who primarily utilize VA care, as well as those who are non-VA users or dual-care users. Methods will be primarily qualitative, including individual photo-elicitation interviews with Veterans and care partners, follow-up dyadic interviews with Veteran-care partner pairs, and small group discussions. In keeping with a CBPR model, interpretation and dissemination of findings will engage key stakeholders as partners through activities emphasizing advocacy, community-building, and education. Findings from a mixed methods process and impact evaluation will be used to inform VA's efforts to incorporate CBPR/person-centered approaches into health services research and quality improvement efforts. Anticipated Impact on Veteran's Healthcare Data generated through photovoice methods, in the form of powerful photo-narratives, will enable Veterans and care partners to actively participate in describing and characterizing the impact of TBI on family and community relationships, goals for recovery, treatment preferences, and challenges to accessing and engaging in care. Partnered research involving Veterans, their care partners, and VA and community stakeholders, will result in alignment of goals, strategies, and resources to improve systems of care and sources of support for Veterans with TBI. A long-term goal is to build VA's capacity to undertake community-engaged research to inform implementation of patient-centered care practices, policies, and programs aimed at improving the lives of Veterans and their families.