RESUMO
BACKGROUND: Research has documented a consistent and strong association between adverse childhood experiences (ACE) and negative health outcomes in adulthood. The Department of Defense is expanding health surveillance of military members and considering the inclusion of ACE questions. OBJECTIVE: To explore the perceptions and attitudes of service members and spouses regarding the use of ACE questions in routine health surveillance. METHOD: Forty-one active duty service members and spouses were interviewed at two Army troop medical centers. Semistructured qualitative interviews were used to examine their views regarding the use of ACE questions in military health surveillance. RESULTS: Participants believe there is value in health surveillance; however, they are cautious about providing ACE or other information that may be perceived negatively, without confidentiality reassurances. CONCLUSION: Successful employment of ACE questions in active duty military health surveillance will depend on the ability of military health officials to ensure confidentiality and to communicate the relevance of ACE to health status.
Assuntos
Sobreviventes Adultos de Maus-Tratos Infantis , Atitude , Militares/psicologia , Vigilância da População/métodos , Inquéritos e Questionários , Criança , Feminino , Nível de Saúde , Humanos , Entrevistas como Assunto , MasculinoRESUMO
OBJECTIVE: To gain insight about Department of Defense providers' and health care beneficiaries' opinions regarding provider-patient communication of health care for post-deployment health concerns. METHODS: Thirty-five Department of Defense primary care providers and 14 military beneficiaries participated in focus groups at five military medical treatment facilities. We audiotaped, transcribed, and qualitatively analyzed semi-structured focus group interviews to determine attitudes and beliefs about war-related health concerns, symptoms, and health care quality. RESULTS: Focus groups revealed important insights about provider and patient perspectives of communication and care in four general areas: physician-patient trust, validity of symptoms and concerns, exchange of health information, and barriers to care. CONCLUSION: Provider-patient communication contributes to patient satisfaction with medical care; poor communication may contribute to decreased patient satisfaction and provider effectiveness. The military health care system poses several challenges to provider-patient communication: the dual nature of the provider's role, the occupational relationship between illness and health care, pre- and post-deployment issues, and continuity of care impact patient and provider perspectives. The prevalence of various beneficiary and provider concerns regarding health care communication requires further study, particularly for the severely wounded. PRACTICE IMPLICATIONS: The quality of information exchanged and of the interpersonal relationship impact medical decision making, particularly in occupational health settings such as the military. Attention to these issues may improve patient outcomes including satisfaction, adherence, trust, health status, and quality of life.
Assuntos
Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Comunicação , Medicina Militar/organização & administração , Militares/psicologia , Médicos de Família/psicologia , Adulto , Competência Clínica , Feminino , Grupos Focais , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Avaliação das Necessidades , Educação de Pacientes como Assunto , Papel do Médico/psicologia , Relações Médico-Paciente , Atenção Primária à Saúde/organização & administração , Pesquisa Qualitativa , Inquéritos e Questionários , Confiança , Estados Unidos , GuerraRESUMO
This article describes the collective experience of a multidisciplinary network of researchers, practitioners, and program evaluators who support appropriate research and evaluation methods in working with Native peoples. Our experience underlines the critical importance of culture in understanding and conducting research with the diverse populations of American Indians and Alaska Natives, and documents the need for community-based, collaborative, participatory action research. We discuss the major findings of the first American Indian Research and Program Evaluation Methodology national symposium, and articulate a set of 20 guiding principles for conducting research and program evaluation.