Study protocol of a telephone problem-solving intervention for Spanish-speaking caregivers of veterans post-stroke: an 8-session investigator-blinded, two-arm parallel (intervention vs usual care), randomized clinical trial.

BACKGROUND: Stroke is one of the leading causes of death and the main cause of long-term disability in the United States. The significant risk factors of stroke among Hispanics are well-documented. The majority of stroke survivors return home following a stroke and are cared for by family caregivers. Due to the abrupt nature of strokes, caregivers experience unexpected changes and demands that oftentimes lead to caregiver burden and depression. Given the significant risk factors for stroke in Hispanics and the influence of culture in family norms and family management, we developed a telephone and online problem-solving intervention for Spanish-speaking stroke caregivers. This study tests the impact of a telephone and online problem-solving intervention for Spanish-speaking stroke caregivers on caregiver outcomes. METHODS: The design is a two-arm parallel randomized clinical trial with repeated measures. We will enroll 290 caregivers from 3 Veterans Affairs (VA) medical centers. Participants randomized into the intervention arm receive a problem-solving intervention that uses telephone and online education and care management tools on the previously developed and nationally available RESCUE en Español Caregiver website. In the usual care group, participants receive the information and/or support caregivers of veterans with stroke normally receive through existing VA resources (e.g., stroke-related information and support). The primary outcome is change in caregiver's depressive symptoms at 1- and 12-weeks post-intervention. Secondary outcomes include changes in stroke caregivers' burden, self-efficacy, problem-solving, and health-related quality of life (HRQOL) and veterans' functional abilities. We will also determine the budgetary impact, the acceptability of the intervention and participation barriers and facilitators for Spanish-speaking stroke caregivers. DISCUSSION: This is an ongoing study. It is the first known randomized controlled trial testing the effect of a telephone and online problem-solving intervention in Spanish for caregivers of veterans post-stroke. If successful, findings will support an evidence-based model that can be transported into clinical practice to improve the quality of caregiving post-stroke. TRIAL REGISTRATION: ClinicalTrials.gov: NCT03142841- Spanish Intervention for Caregivers of Veterans with Stroke (RESCUE Español). Registered on February 23, 2018. Protocol version 8. 08.11.2022.

Translation, cultural adaptation, and psychometric properties of the Spanish version of the Combat Exposure Scale (CES-S) with U.S. military Spanish speaking Latino veterans living in the Caribbean: A cross-sectional preliminary data study.

OBJECTIVE: The Combat Exposure Scale (CES) is one of the most used self-report instruments to assess various combat situations experienced by military personnel. This article presents a comprehensive translation and cultural adaptation of the CES to Spanish and its psychometric properties. METHOD: Fifty-five (n = 55) U.S. military Spanish-speaking Latino veterans diagnosed with combat-related PTSD were recruited from 2018 to 2020 to participate in this cross-sectional preliminary data study at the VA Caribbean Health Care System. The translation and cultural adaptation followed the recommendations by Chavez & Canino (2005). Statistical analysis included principal component factor analysis, internal consistency analysis, and content validity analysis. It included two different expert bilingual committees composed of veterans with combat experience and university professors at a doctoral level. RESULTS: The CES-S consists of seven items. The principal component factor analysis resulted in one factor and the content validity of =1. CES-S has an internal consistency of α=.84. CONCLUSION: The CES-S is suitable for its use with Spanish-speaking Latino veteran samples. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Homeless veterans in the Caribbean: Profile and housing failure.

This research assesses sociodemographic, psychosocial, and military characteristics and their role in homelessness programs readmission to provide a profile of the Caribbean Homeless Veteran of the U.S. military. We evaluated 620 healthcare records of veterans who requested services at the Homeless Program of the VA Caribbean Healthcare System from 2005 to 2014. Statistical analyses consisted of Chi square, Fisher's exact test, Wilcoxon-Rank Sum tests, and generalized linear models of regression with Poisson distribution. Homeless veterans were characterized by being male, serving in the Army, having low social support, poor house affordability, extreme poverty, unemployment, and psychiatric disorders. Veterans from Operation Iraqi Freedom, Operation Enduring Freedom, and Operation New Dawn conflicts exhibited more readmission prevalence risk ratio overall and when adjusted for all factors than veterans of previous conflicts. Psychosocial factors such as substance use, social isolation, legal problems, and psychiatric disorders were identified in the readmission process. Results suggest assistance beyond housing is needed to end veteran homelessness.

Esta investigación evalúa características sociodemográficas, psicosociales y militares y su rol en la readmisión a programas para personas veteranas del ejército de los Estados Unidos sin hogar en el Caribe. Evaluamos 620 registros de salud de personas veteranas que solicitaron servicios en el Programa para personas sin hogar del Sistema de Salud de Veteranos del Caribe del 2005 al 2014. Los análisis estadísticos consistieron de chi cuadrado, la prueba exacta de Fisher, pruebas de suma de rangos de Wilcoxon y modelos lineales generalizados de regresión con distribución de Poisson. Las personas veteranas sin hogar se caracterizaron por ser hombres, sirviendo en el Army, con bajo apoyo social, baja asequibilidad de vivienda, pobreza extrema, desempleo y trastornos psiquiátricos. Las personas veteranas de los conflictos Operación Libertad Iraquí, Operación Libertad Duradera y Operación Nuevo Amanecer mostraron una mayor tasa de riesgo de prevalencia de readmisión en general en comparación con personas veteranas de conflictos anteriores. Factores psicosociales como el uso de sustancias, el aislamiento social, los problemas legales y los trastornos psiquiátricos se identificaron como importantes en el proceso de readmisión al programa. Los resultados sugieren que se necesita asistencia más allá de la vivienda para lograr que veteranos/as mantengan un hogar.

Caribbean Homeless Women Veterans: Military and Psychosocial Characteristics and the Association of Service-connected Disabilities.

Women Veterans are one of the fastest growing groups among homeless people. Previous studies on race, ethnicity and homelessness have emphasized the important differences on predictors, health risks, behaviors, and service outcomes between different groups. These differences are crucial to inform policy makers and program developers in order to solve this social issue. This research assesses sociodemographic, psychosocial and military characteristics and their role in service-connected disabilities to provide a profile of the Caribbean Homeless Women Veteran of the U.S. military. We evaluated 46 healthcare records of women Veterans who requested services at the Homeless Program of the VA Caribbean Healthcare System (VACHS) from 2005 to 2014. Statistical analyses consisted of Chi square, Fisher's exact test, Wilcoxon-Rank Sum tests, and Logistic Regression. Extreme poverty, unemployment, unaffordable housing, psychological disorders and low social support were the most prevalent characteristics. Women with psychological disorders had eight times higher the odds of having a service-connected disability than women without psychological conditions. Implications of study results are discussed for VACHS and future research with this population.

Las mujeres Veteranas son uno de los grupos de mayor crecimiento entre las personas sin hogar. Estudios previos sobre raza, etnia y falta de vivienda han enfatizado en las diferencias en torno a los predictores, los riesgos de salud, los comportamientos y la utilización de servicios entre los diferentes grupos. Estas diferencias son cruciales para la creación de políticas publicas y programas que ayuden a resolver este problema social. Esta investigación evalúa las características sociodemográficas, psicosociales y militares y su papel en las discapacidades relacionadas al servicio militar para proporcionar un perfil de las mujeres caribeñas Veteranas sin hogar de las fuerzas armadas de los EE. UU. Evaluamos 46 registros de salud de mujeres Veteranas que solicitaron servicios en el Programa para Veteranos sin Hogar del Sistema de Salud de Veteranos del Caribe (VACHS por sus siglas en inglés) desde 2005 hasta 2014. Los análisis estadísticos incluyeron Chi cuadrado, prueba exacta de Fisher, pruebas de suma de rango de Wilcoxon y regresión logística. La pobreza extrema, el desempleo, la vivienda inasequible, los trastornos psicológicos y el poco apoyo social fueron las características más prevalentes. Las mujeres con trastornos psicológicos tenían ocho veces más probabilidades de tener una discapacidad relacionada con el servicio militar que las mujeres sin condiciones psicológicas. Se discuten implicaciones de los resultados del estudio tanto para VACHS como para futuras investigaciones con esta población.