“Stepping up to the plate”: Identifying cultural competencies when providing health care to Canada’s military and Veteran families
Abstract: Introduction: Military family life is characterized by frequent relocations, regular periods of separation, and living with the persistent risk of injury or death of their military family member. Te cumulative efects of these life events impact the health and wellness of military and Veteran families (MVFs) and may be exacerbated by challenges of accessing and navigating new health care systems when families relocate or when confronted with health care providers (HCPs) unaware of their experiences. Developing cultural competency in HCPs has been found to be benefcial to both the service provider and the service user. Te purpose of this study is to identify cultural competencies for HCPs who work with MVFs. Methods: We completed a qualitative study using critical incident one-on-one interviews with HCPs. We used framework analysis for data analysis. Results: In total, we completed nine interviews with HCPs who have experience working with MVFs. Cultural competencies were identifed in the domains of cultural awareness, cultural sensitivity, cultural knowledge, and cultural skills. Evidence also indicates the role of the ecological context on the ability of HCPs to be culturally competent. Discussion: Necessary competencies have been identifed when providing culturally competent care to MVFs. Te results highlight the need for MVF cultural competency training during pre-service health professional curricula and continuing education. We have acknowledged the need for policy and regulatory changes to facilitate the access and utilization of culturally informed health care. Finally, the cultural competencies identifed will contribute to the development of an MVF cultural competency model for HCPs working in Canada.
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.