Influence of family factors on service members' decisions to leave the military
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Abstract: Service member retention is a crucial aspect in maintaining and advancing the U.S. military and its mission. To increase retention, it is important to understand why active duty personnel voluntarily leave while they are still highly qualified. For married service members, spouses likely influence the decision to stay or leave military service. The current study used data from the Millennium Cohort Family Study for 4,539 dyads comprising service members and their spouses to investigate family predictors of voluntary military separation. Multivariate mediation analyses were conducted to evaluate the role of military satisfaction (spouse and service member) and work–family conflict as mediators of the effects of both family life and military stressors on risk for military separation, while accounting for spouse and service member demographics. Results identified significant family factors operating through work–family conflict and military satisfaction that were associated with increased likelihood of service member voluntary separation, including number of children, spouse bothered by finances, and service member months away from home. Service members with spouses who reported higher levels of social support were significantly less likely to voluntarily separate, after operating through both work–family conflict and military satisfaction. Findings suggest that work–family conflict and military satisfaction play an important synergistic role in predicting the impact family and career factors have on voluntary separation. These modifiable factors may guide potential interventions to increase military retention efforts.
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.