A patient-informed qualitative evaluation of an online chronic pain treatment for military, police, and Veterans
Abstract: Introduction: Chronic pain is a significant problem among military, police, and Veteran populations. An online acceptance-based behavioural treatment for chronic pain was developed and tailored to this specific population. A randomized controlled trial demonstrated the efficacy of the intervention; however, dropout rates were a concern. To address this issue, the authors sought the perspectives of previous participants of the intervention. The goal of the present study was to identify areas to refine online chronic pain treatment to enhance its acceptability and thereby improve completion rates. Methods: Participatory action research methodology was used to conduct a series of focus groups with participants who previously completed the treatment. Through group discussions, participants offered feedback and suggestions for improvements to the program. Data were analyzed using interpretive thematic analysis. Results: Three main themes emerged in this qualitative evaluation of the strengths and weaknesses of the online chronic pain program that highlighted the elements of the target population that participants felt needed to be considered: 1) their unique characteristics, 2) their interconnection, and 3) their individual diff erences. Discussion: Although participants generally found the program acceptable, they identified areas for improvement. This patient feedback will guide a future revision of the program, intended to better meet the particular cultural sensitivities of military, police, and Veterans, thereby enhancing their treatment experience and reducing dropout rates. The results of this study may be a useful guide for clinicians adapting interventions for military and police populations.
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.