Introduction: Military family life is characterized by mobility, separation, and increased risk for injury or death of the military member, which impacts the health and well-being of all family members. Additional stress is experienced when accessing and navigating a new health care system. Unknown to most Canadians is the reality that military and Veteran families (MVFs) access the civilian health care system; this indicates a need for military family cultural competency among health care providers. This current research identifies aspects of military family cultural competency to inform health care provision to MVFs. Method: A qualitative study using one-on-one interviews was completed with MVFs. Critical Incident Technique (CIT) was used to develop interview questions. Framework analysis was used for data analysis. Results: In total 17 interviews were completed including:1 family (female military spouse, male military member and child); 1 male Veteran; and 15 female military spouses (1 Veteran; 1 active member). Military family cultural competency domains such as cultural knowledge (characteristics of military families; impacts of mobility, separation, and risk) and cultural skills (building relationships; use of effective and appropriate assessments and interventions) were identified. The ecological context was also described as impacting the health care experience. Discussion: The reported experiences of MVFs in this study have highlighted the gaps in the military family cultural knowledge and military family cultural skills Canadian health care providers have when providing care. Results of this study can be used to develop continuing education for health professionals and inform future research.
Introduction: Canadian military spouses have reported issues accessing and maintaining high quality health care. There is no Canadian research quantifying the scope of the problem. Methods: This is a retrospective cohort study using administrative data. We included military spouses and dependents relocated to Ontario between January 8, 2008 and March 31, 2013, along with a matched civilian reference group. We measured hospitalizations, emergency department (ED) visits, and physician visits. Comparisons of first health care contact, medical health services use, and time to first health services use controlled for age, sex, and geography. Results: The cohort included 7,508 military family members and 30,032 matched civilians. Point of first health care system contact differed between military family members and the civilian reference group ( p < 0.001). Military family members had a longer time to their first health care contact than the civilian reference group (median 118 days vs. 84 days, p < 0.001). Similarities and differences between military family and civilian health services use existed. For example, military children and youth were less likely to see a paediatrician than the civilian reference group (17.7% vs. 26.0%, p < 0.001), and less likely to receive non-influenza vaccinations (23.2% vs. 32.3%, p < 0.001). Discussion: This study provides evidence supporting the hypothesis that military families have different access to, and use of, provincial health services than the general Ontario population and suggests support during relocations is needed. It is important to further understand how these patterns impact health outcomes and continuity of care and to contextualize these findings with potential differences in the underlying need for health services.
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. The cumulative effects 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) un aware of their experiences. Developing cultural competency in HCPs has been found to be beneficial to both the service provider and the ser vice user. The purpose of this study is to identif y cultural competencies for HCPs who work with MVFs. Methods: We completed a qualitative study using critical incident one-on-one inter views with HCPs. We used framework analysis for data analysis. Results: In total, we completed nine inter views with HCPs who have experience working with MVFs. Cultural competencies were identified 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 identified when providing culturally com petent care to MVFs. The 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 identifi ed will contribute to the development of an MVF cultural competency model for HCPs working in Canada.
Introduction: For some Canadian Armed Forces Veterans who are released, the military-to-civilian transition (MCT) process may be complicated by signifi cant mental health problems (e.g., post-traumatic stress disorder, depression, anxiety). Family members (i.e., spouses, adult children, parents) who serve as the primary caregivers for Veterans with mental health problems devote signifi cant energy to seeking and fi nding social support as they navigate the MCT. Th e primary purposes of this qualitative study were to 1) hear from these family members and learn about the obstacles to and successes in accessing formal and informal social supports during the MCT and 2) understand how accessing such supports was aff ected by the Veteran's mental health problems. Methods: A sequential, multiple qualitative design was used, involving both in-depth individual interviews and focus groups with English-and French-speaking family members (N = 36) living in Eastern, Central, and Western Canada (i.e., individual, n = 27; focus groups, n = 9). Data coding was facilitated through the qualitative data analysis soft ware MAXQDA, and data analysis was conducted using grounded theory strategies. Results: Amid numerous indicators of signifi cant resolve and commitment to health, family members revealed signifi cant issues (e.g., mental health stigma of the Veteran, caregiver burden and burnout) that contributed to notable barriers in accessing both informal (i.e., extended family, friends, online support groups) and formal (i.e., Operational Stress Injury Social Support, Military Family Resource Centres) support systems helpful in navigating the MCT. Discussion: Results are discussed in the context of how the Veteran's mental health compounded barriers for family members who sought to access informal and formal support services that would provide comfort, fi nancial aid, respite, and counsel to the Veteran family in the MCT. Building on the resilience of military-connected families, gaps in the systems of formal and informal care are discussed in the context of how bold and creative changes (e.g., proactive signposting) might facilitate the MCT for Veterans with mental health problems.
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