Community Effect of Alcoholism: A Photovoice Study in Saint Vincent and the Grenadines.

The Icahn School of Medicine at Mount Sinai and the Saint Vincent/Grenadines Ministry of Health, Wellness and the Environment have been collaborating since 2012 in addressing the plight of alcoholism in Saint Vincent and the Grenadines (SVG). SVG is a middle-income country with few resources available for those who suffer from alcohol use disorders, and these efforts have centered on establishing and monitoring alcohol self-help groups based on the "Alcoholics Anonymous model" (AA model) in several communities in Saint Vincent and the Grenadines. In the summer of 2014, the efforts evolved to include an in-depth investigation of the experience of members of self-help group members via the qualitative research method known as Photovoice. Photovoice is a community based participatory research method in which a set of research questions are explored qualitatively through photographs, interviews, and focus groups. In June 2014, a Photovoice project was established with the longest running self-help group on the island of Saint Vincent in the fishing community of Barrouallie. This project consisted of three rounds of photo-taking, individual interviews, and focus groups, and analysis of the data revealed a number of broad themes relevant to perceptions about the impact of problematic drinking and about drinkers themselves; about the applicability of the AA model in SVG; and about factors that may perpetuate or mitigate problem drinking. It was evident that current and recovering alcoholics believed that there were different types of drinkers who because of their gender, public drinking or tendency for violence could be labeled as "irresponsible." These findings suggest areas for future interventions and research in SVG.

Facilitating culture-centered communication between health care providers and veterans transitioning from military deployment to civilian life.

OBJECTIVE: To describe returning veterans' transition experience from military to civilian life and to educate health care providers about culture-centered communication that promotes readjustment to civilian life. METHODS: Qualitative, in-depth, semi-structured interviews with 17 male and 14 female Iraq and Afghanistan veterans were audio recorded, transcribed verbatim, and analyzed using Grounded Practical Theory. RESULTS: Veterans described disorientation when returning to civilian life after deployment. Veterans' experiences resulted from an underlying tension between military and civilian identities consistent with reverse culture shock. Participants described challenges and strategies for managing readjustment stress across three domains: intrapersonal, professional/educational, and interpersonal. CONCLUSIONS: To provide patient-centered care to returning Iraq and Afghanistan veterans, health care providers must be attuned to medical, psychological, and social challenges of the readjustment experience, including reverse culture shock. Culture-centered communication may help veterans integrate positive aspects of military and civilian identities, which may promote full reintegration into civilian life. PRACTICE IMPLICATIONS: Health care providers may promote culture-centered interactions by asking veterans to reflect about their readjustment experiences. By actively eliciting challenges and helping veterans' to identify possible solutions, health care providers may help veterans integrate military and civilian identities through an increased therapeutic alliance and social support throughout the readjustment process.