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Musilli MG, Fuller SM, Wyatt B, Ryals TR, Haischer-Rollo G, Drumm CM, Vereen RJ, Plowden TC, Blevins EM, Spalding CN, Konopasky A, Lutgendorf MA. Qualitative Analysis of the Lived Experience of Reproductive and Pediatric Health Care in the Military Health Care System. Mil Med 2024:usae238. [PMID: 38781008 DOI: 10.1093/milmed/usae238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/15/2024] [Accepted: 04/28/2024] [Indexed: 05/25/2024] Open
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.
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Affiliation(s)
- Megan G Musilli
- Department of Gynecologic Surgery & Obstetrics, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Shara M Fuller
- Department of Gynecologic Surgery & Obstetrics, Naval Medical Center San Diego, San Diego, CA 92134, USA
| | - Brelahn Wyatt
- Department of Gynecologic Surgery & Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Teri R Ryals
- Department of Obstetrics and Gynecology, Navy Medicine Readiness and Training Command Bremerton, Bremerton, WA 98312, USA
| | - Gayle Haischer-Rollo
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Caitlin M Drumm
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Rasheda J Vereen
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Torie C Plowden
- Department of Gynecologic Surgery & Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Erin M Blevins
- Department of Pediatrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Carmen N Spalding
- Department of Nursing, Sharp Healthcare System, San Diego, CA 92123, USA
| | - Abigail Konopasky
- Department of Medical Education, Geisel School of Medicine at Dartmouth , Hanover, NH 03755, USA
| | - Monica A Lutgendorf
- Department of Gynecologic Surgery & Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
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Dodge J, Sullivan K, Miech E, Clomax A, Riviere L, Castro C. Exploring the Social Determinants of Mental Health by Race and Ethnicity in Army Wives. J Racial Ethn Health Disparities 2024; 11:669-684. [PMID: 36952121 PMCID: PMC10933139 DOI: 10.1007/s40615-023-01551-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 01/26/2023] [Accepted: 02/22/2023] [Indexed: 03/24/2023]
Abstract
OBJECTIVE To explore the social determinants of mental health (SDoMH) by race/ethnicity in a sample with equal access to healthcare. Using an adaptation of the World Health Organization's SDoMH Framework, this secondary analysis examines the socio-economic factors that make up the SDoMH by race/ethnicity. METHOD This paper employed configurational comparative methods (CCMs) to analyze various racial/ethnic subsets from quantitative survey data from (N = 327) active-duty Army wives. Data was collected in 2012 by Walter Reed Army Institute of Research. RESULTS Initial exploratory analysis revealed the highest-scoring factors for each racial/ethnic subgroup: non-Hispanic Black: employment and a history of adverse childhood events (ACEs); Hispanic: living off post and a recent childbirth; junior enlisted non-Hispanic White: high work-family conflict and ACEs; non-Hispanic other race: high work-family conflict and not having a military history. Final analysis showed four models consistently explained clinically significant depression symptoms and four models consistently explained the absence of clinical depression symptoms, providing a solution for each racial/ethnic minority group (non-Hispanic Black, Hispanic, junior enlisted non-Hispanic White, and non-Hispanic other). DISCUSSION These findings highlight that Army wives are not a monolithic group, despite their collective exposure to military-specific stressors. These findings also highlight the potential for applying configurational approaches to gain new insights into mental health outcomes for social science and clinical researchers.
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Affiliation(s)
- Jessica Dodge
- Center for Clinical Management Research, Health Services Research and Development, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
| | - Kathrine Sullivan
- Silver School of Social Work, New York University, 1 Washington Square North, New York, NY, 10003, USA
| | - Edward Miech
- Regenstrief Institute, Center for Health Services Research, 1101 W 10th Street, Indianapolis, IN, 46202, USA
| | - Adriane Clomax
- Center for Innovation and Research on Veterans and Military Families, Suzanne Dworak-Peck School of Social Work, 669 West 34th Street, Suite 201D, Los Angeles, CA, 90089, USA
| | - Lyndon Riviere
- Walter Reed Army Institute of Research, 503 Robert Grant Ave., Silver Spring, MD, 20910, USA
| | - Carl Castro
- Center for Innovation and Research on Veterans and Military Families, Suzanne Dworak-Peck School of Social Work, 669 West 34th Street, Suite 201D, Los Angeles, CA, 90089, USA
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Morris K. Effect of spousal military deployment during pregnancy on neonatal birth outcomes: a systematic review. BMJ Mil Health 2023:e002454. [PMID: 37400129 DOI: 10.1136/military-2023-002454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/15/2023] [Indexed: 07/05/2023]
Abstract
INTRODUCTION Stress experienced during pregnancy is associated with adverse birth outcomes including preterm delivery (PTD) and low birth weight (LBW). Pregnant spouses and partners of deployed military personnel can experience heightened stress due to several factors associated with the military lifestyle. This systematic review aims to ascertain whether deployment at the time of delivery increases the risk of PTD and/or LBW in babies born to pregnant spouses or partners of deployed service persons. METHODS A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method by searching EMBASE, Medline, PubMed and Global Health databases from inception to March 2021. Keyword searches were used to identify primary research, English language journal articles, that included any military branch and reported a measure of PTD and/or LBW of babies born to spouses/partners of deployed service persons. Risk of bias was assessed with validated tools appropriate for study type and a narrative synthesis was performed. RESULTS Three cohort or cross-sectional studies fulfilled the eligibility criteria. All three studies were conducted in the US military, were published between 2005 and 2016 and included a cumulative total of 11 028 participants. Evidence suggests that spousal deployment may be a risk factor for PTD, although strength of evidence is weak. No association between spousal deployment and LBW was found. CONCLUSION Pregnant spouses and partners of deployed military personnel may be at increased risk of PTD. The strength of evidence is limited by a paucity of rigorous research in this area. No studies were identified that included service women in the UK Armed Forces. Further research is required to understand the perinatal needs of pregnant spouses/partners of deployed service persons and to understand if there are unmet clinical or social needs in this population.
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Affiliation(s)
- Kirsten Morris
- Public Health Registrar, Army Medical Services, Camberley, UK
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