How can we get Iraq- and Afghanistan-deployed US Veterans to participate in health-related research? Findings from a national focus group study

Abstract

BackgroundResearch participant recruitment is often fraught with obstacles. Poor response rates can reduce statistical power, threaten both internal and external validity, and increase study costs and duration. Military personnel are socialized to a specific set of laws, norms, traditions, and values; their willingness to participate in research may differ from civilians. The aims of this study were to better understand the views of United States (US) Veterans who served in Operation Enduring Freedom (OEF)/ Operation Iraqi Freedom (OIF) on research and motivators for participating in research to inform recruitment for a planned observational study of respiratory health in OEF/OIF Veterans.MethodsWe conducted 10 focus groups in a purposive sample of OEF/OIF Veterans (n = 89) in five US cities in 2015. Key topics included: reasons for participating or declining to participate in health-related research, logistics around study recruitment and conduct, compensation, written materials, and information sharing preferences for study results. Two authors independently coded the data using template analysis.ResultsParticipants identified three criteria that motivated a decision to participate in health-related research: 1) adequate compensation, 2) desire to help other Veterans, and 3) significance and relevance of the research topic. For many, both sufficient compensation and a sense that the study would help other Veterans were critical. The importance of transparency arose as a key theme; Veterans communicated that vague language about study aims or procedures engendered distrust. Lastly, participants expressed a desire for studies to communicate results of their specific health tests, as well as overall study findings, back to research participants.ConclusionsOEF/OIF Veterans described trust, transparent communication, and respect as essential characteristics of research in which they would be willing to participate. Additional studies are needed to determine whether our results generalize to other US Veterans; nevertheless, our results highlight precepts that have been reported as important for recruitment in other populations. Researchers may benefit from using community-engaged research methods to seek feedback on recruitment materials and strategies prior to initiating research. For costly studies targeting a large sample (i.e. in the thousands), it may be important to test a variety of recruitment strategies.Electronic supplementary materialThe online version of this article (10.1186/s12874-018-0546-2) contains supplementary material, which is available to authorized users.

Reducing Veterans' Risk for Suicidal Behaviors: A Qualitative Study to Inform Development of the RECLAIM Health Promotion Program

“…Similarly, veterans in previous studies have indicated a general distrust with the VA healthcare system and add that vague language can fuel this distrust and is off-putting. 12,13 As such, the findings from this study regarding the use of the word lifestyle and the negative feelings it elicited among our participants caused us to consider alternate wording (i.e., holistic health promotion program) to provide a clear and more positive perception of RECLAIM to veterans.…”

Reducing veterans' risk for suicidal behaviors: A qualitative study to inform development of the RECLAIM health promotion program

“…Similarly, veterans in previous studies have indicated a general distrust with the VA healthcare system and add that vague language can fuel this distrust and is off-putting. 23,24 Therefore, it is important to consider alternate terminology to eliminate this as a potential barrier to participating in the RECLAIM program. As such, the ndings from this study regarding the use of the word lifestyle and the negative feelings it elicited among our participants forced us to consider alternate wording (i.e., holistic health promotion program) to provide a clear and more positive perception of RECLAIM to veterans.…”

“…While efforts have been made to prevent and reduce veteran suicide, the rate of suicide among post-9/11 veterans (ages [18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] remains the highest of all veteran cohorts and has increased by 76% from 2005-2017, 6 indicating that more work is needed to effectively reduce the rate of suicide among this veteran cohort. Current suicide reduction and prevention strategies often narrowly focus on extreme psychopathology (e.g., post-traumatic stress disorder) and are frequently directed at veterans who have already indicated intent to harm.…”

Toward Veteran-Centered Research: A Veteran-Focused Community Engagement Project

“…The project design incorporated the findings of prior research indicating that military personnel might be reluctant to participate in research due to the sensitivity of the topics, lack of trust, and concerns regarding lack of anonymity and perceived risks to privacy (Littman, True, Ashmore, Wellens, and Smith, 2018). To reduce veteran concerns about privacy and address this community's reluctance to participate in recorded dialogue sessions, a field note template was developed to guide discussions and enable the CARM to take careful notes about what was said including direct quotes.…”

“…This is particularly evident among the nation's 22 million US veterans. Despite a critical need for evidence-based approaches to service-related health issues, veterans are frequently reluctant to partner with or participate in the research enterprise (Bush, Sheppard, Fantell, & Bell, 2013;Braun, Kennedy, Sadler, & Dixon, 2015;Littman, True, Ashmore, Wellens, & Smith, 2018;Williams, Gatien, & Hagerty, 2012;Funderburk, Spinola, & Maisto, 2015). The purpose of this multi-state project was to invite veterans to dialogue about (1) their research priorities; (2) perceived barriers to research participation; (3) recommended strategies for engaging veterans in research; and (4) their preferences for receiving research findings.…”