Community reintegration: Transition between the figured worlds of military and family life
Abstract: This paper argues the benefits of characterizing occupational transitions as movement between figured worlds, which are socially constructed units that are characterized by particular people and activities, and that shape identities. Further, positive withdrawal, which is a purposeful decision to limit participation when the requirements of engaging surpass self-perceived ability, describes limited engagement with a figured world. To illustrate the utility of this lens, the community reintegration of military service members as they finish deployment and return to family and community life is explored. The figured worlds of military and family are drawn from first person accounts of deployment and reintegration experiences from the perspectives of both service members and spouses. The constructs of figured world and positive withdrawal are found to be useful ways to describe community reintegration for both service members and families and the complex shifts in identity associated with the transition process. The framework presented expands on the occupational science literature by presenting a framework for non-linear, bidirectional occupational transitions in which individuals return to familiar settings rather than enter novel ones. The constructs of figured world and positive withdrawal can contribute to future theory development and research with populations that experience similar occupational transitions.
Abstract: Introduction: Persistent inequities exist in obstetric and neonatal outcomes in military families despite universal health care coverage. Though the exact underlying cause has not been identified, social determinants of health may uniquely impact military families. The purpose of this study was to qualitatively investigate the potential impact of social determinants of health and the lived experiences of military individuals seeking maternity care in the Military Health System. Materials and methods: This was an Institutional Review Board-approved protocol. Nine providers conducted 31 semi-structured interviews with individuals who delivered within the last 5 years in the direct or purchased care market. Participants were recruited through social media blasts and clinic flyers with both maximum variation and homogenous sampling to ensure participation of diverse individuals. Data were coded and themes were identified using inductive qualitative research methods. Results: Three main themes were identified: Requirements of Military Life (with subthemes of pregnancy notification and privacy during care, role of pregnancy instructions and policies, and role of command support), Sociocultural Aspects of the Military Experience (with subthemes of pregnancy as a burden on colleagues and a career detractor, postpartum adjustment, balancing personal and professional requirements, pregnancy timing and parenting challenges, and importance of friendship and camaraderie in pregnancy), and Navigating the Healthcare Experience (including subthemes of transfer between military and civilian care and TRICARE challenges, perception of military care as inferior to civilian, and remote duty stations and international care). Conclusions: The unique stressors of military life act synergistically with the existing health care challenges, presenting opportunities for improvements in care. Such opportunities may include increased consistency of policies across services and commands. Increased access to group prenatal care and support groups, and increased assistance with navigating the health care system to improve care transitions were frequently requested changes by participants.