Health and Wellbeing Study of Serving and ex-Serving UK Armed Forces Personnel: Phase 4
Abstract: The study has been running since 2003 with the aim of investigating the impact of deployment to Iraq (Operation TELIC) and Afghanistan (Operation HERRICK) on the health and wellbeing of serving and ex-serving personnel.
Data have been collected over three previous phases - Phase 1 (2004/06), Phase 2 (2007/09), and Phase 3 (2014/16), with the most recent phase taking place over 2022/23. In addition to examining key mental health outcomes such as CMD, probable PTSD and alcohol misuse, this phase also collected new data on additional topics relevant to UK serving and ex-serving personnel including complex PTSD (C-PTSD), loneliness and caring responsibilities.
For Phase 4 (2022/23), we followed up participants who took part in the previous phase in 2014/16. 4104 participants completed the survey. 69% of the sample had deployed to Iraq and/or Afghanistan and 72% had left service.
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.