Investigating the Moral Challenges Experienced by UK Service Police Veterans
Abstract: Previous research has explored the negative effects of exposure to potentially morally injurious events among armed forces veterans and active-duty military personnel generally. However, this current pilot research provides a unique contribution to the extant research literature by examining the specific moral challenges experienced by a potentially at-risk and under-researched sub-group of military personnel. Semi-structured interviews were conducted with 10 United Kingdom (UK) Service Police veterans to identify any moral challenges encountered during their military service and to investigate the experience of moral dissonance underlying these events. Using Interpretative Phenomenological Analysis (IPA), four main themes (with sub-themes) emerged from the data: (a) violation of a moral code, (b) experience of disillusionment, (c) attempted resolution of moral dissonance, and (d) risk and protective factors for moral dissonance. Evidence of the types of moral challenges encountered by Service Police veterans during their military service and the negative consequences of moral dissonance was explored for the first time. Some of these findings overlap with existing evidence from non-Service Police research, although novel insights were also identified, such as the attempts of Service Police veterans to resolve moral dissonance through acting with moral courage, self-preservation, or seeking acceptance. The current research therefore provides a rationale for further investigation into the experience of moral dissonance and impact of exposure to morally injurious events in this sub-population of veterans. Potential implications for advancing conceptual understanding of moral injury and informing interventions to prevent the development of morally injurious outcomes are discussed.
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.