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

使用 Photovoice 传达 mTBI 对部署后重新融入的影响

基本信息

批准号：
10008974
负责人：
Jennifer Gala True
金额：
--
依托单位：
SOUTHEAST LOUISIANA VETERANS HEALTH CARE
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-04-01 至 2019-09-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10008974
关键词：
Address Advocacy Affect Ambulatory Care Facilities Area Behavioral Caring Clinic Cognitive Collaborations Collection Communication Communities Comorbidity Data Data Collection Education Emotional Family Family Relationship Freedom Friends Goals Health Services Accessibility Health Services Research Healthcare Impact evaluation Improve Access Individual Interview Locales Mental disorders Methods Modeling Participant Patient-Centered Care Patients Policies Process Recovery Research Research Personnel Resources Rural Services Site Source Surveys Traumatic Brain Injury Veterans Visual Work barrier to care base care systems community based participatory research community building community reintegration epidemiology study experience follow-up improved innovation mild traumatic brain injury operation person centered preference programs social

项目摘要

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.

描述（由申请人提供）：在9/11后擦除的退伍军人中，高达23％的退伍军人可能遭受了脑损伤（TBI）。流行病学研究已记录了TBI在持久自由的退伍军人（OEF），伊拉克自由（OIF）和新黎明（OND）中的持久影响，包括合并症的高率。关于有TBI的退伍军人的现场经验，包括对家庭和其他社会关系的影响，社区互动，治疗偏好和恢复的目标，支持的来源，获得护理的机会和关怀障碍以及重新整合挑战的影响，知之甚少。鉴于许多具有TBI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的需求和压力（以下称为“护理伙伴”），探索这些实时经验及其在护理系统中揭示的差距的研究对于制定有效的策略来减轻这些差距至关重要。基于社区的目标参与研究（CBPR）光电图方法将用于吸引OEF/OIF/OND退伍军人与TBI及其护理伙伴一起开发照相叙事，以阐明和传达TBI之后社区重新融合的经验，包括恢复的目标，支持的来源，支持的来源，治疗偏好和无效的需求。这些摄影作品将被用作吸引关键的利益相关者和护理伙伴，基于社区的组织（CBO），为退伍军人，VA和非VA临床医生，计划经理，研究人员以及决策者和决策者服务的目标领域和策略，以改善对退伍军人和护理伙伴的范围，Veterans and Veterans，Veter，Veter，Veter，Veter，Va.退伍军人的重返社会。将开发用于VA的CBPR/合作研究的蓝图，包括确定开发和维持协作的最佳实践，吸引退伍军人和护理伙伴参与发现和传播发现，探索参与对利益相关者的影响，并利用基于视觉和叙事的发现的实力，以实现VA和社区合作伙伴的战略目标。方法45个具有TBI和45个护理伙伴（总n = 90）的OEF/OIF/OND退伍军人将创建和共享照片叙事，以传达其有关社区重新融合需求，挑战和资源的经验和观点。这项两站日的研究将包括主要利用VA护理的退伍军人，以及非VA用户或双重护理用户的退伍军人。方法将是主要的定性，包括与退伍军人和护理伙伴的个人照片引起访谈，与资深伙伴对的后续二元访谈以及小组讨论。为了与CBPR模型保持一致，对发现的解释和传播将通过强调倡导，社区建设和教育的活动来吸引关键的利益相关者作为合作伙伴。从混合方法过程中的发现和影响评估将用于为VA努力将CBPR/以人为本的方法纳入卫生服务研究和质量改进工作。以强大的照相叙事的形式，对通过光提供方法产生的对退伍军人的医疗保健数据的影响，将使退伍军人和护理伙伴能够积极参与描述和表征TBI对家庭和社区关系的影响，恢复目标，治疗偏好，治疗偏好，挑战和访问和参与护理的挑战。涉及退伍军人，他们的护理伙伴以及VA和社区利益相关者的合作研究将导致目标，策略和资源一致，以改善TBI的护理系统和对退伍军人的支持来源。一个长期的目标是建立VA进行社区参与研究的能力，以告知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。