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Center for Health Equity Research and Promotion

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From War to Home: Through the Veteran's Lens

Original Abstract for "Photovoice as an Educational Intervention to Improve Care of OEF/OIF Veterans"

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PI: Gala True, PhD, Core Investigator, Center for Health Equity Research and Promotion, Philadelphia VA Medical Center and Research Assistant Professor, Division of Geriatric Medicine, University of Pennsylvania School of Medicine 

Funded by VA Health Services Research & Development (HSR&D). 


Photovoice is an innovative participatory research tool that empowers individuals to convey their experiences, perspectives, and needs through visual images and first person narratives. Establishing feasibility of Photovoice with OEF/OIF Veterans will provide a novel approach to engaging Veterans in their own care, improving patient-provider communication, and sensitizing VA providers and staff to the experiences of returning Veterans. Our long-term goal is to develop a scalable version of Photovoice as an educational intervention to enhance the provision of patient-centered care to OEF/OIF Veterans.

Project Background: 

Veterans returning from combat deployments as part of Operations Enduring Freedom (OEF) and Iraqi Freedom (OIF) face complex challenges in making the transition to post-deployment life. The VA is uniquely positioned to meet the needs of combat Veterans and support successful reintegration. However, less than half of returning Veterans come to the VA for care, and many of those who do fail to attend follow-up appointments. Many OEF/OIF Veterans lack a sense of connection with the VA, and in return, VA leadership, providers and staff may have difficulty relating to the deployment and post-deployment experiences of combat Veterans. Innovative approaches are needed to help bridge these gaps in knowledge and understanding and to promote an environment of patient-centered care for OEF/OIF Veterans at the VA. Building a sense of connection, rapport, and trust among stakeholders (VA leadership/providers/staff and Veterans) while enabling clinicians to see illness and health through the patient's eyes are key elements of a patient-centered care model, an essential step to improving the equity and quality of care provided by the VA to returning Veterans.

Project Objectives: The primary aim of the proposed pilot project is to establish feasibility of Photovoice with OEF/OIF Veterans. Our secondary aims are to explore preliminary effectiveness of Photovoice as an educational intervention to: 1. increase health communication self-efficacy and decrease social anxiety for Veteran participants and 2. positively impact attitudes and knowledge of VA leadership, providers, and staff as relates to the experiences and needs of OEF/OIF Veterans. Findings from the pilot study will inform the design of a multi-site study of Photovoice as an educational intervention for Veterans and VA providers/staff, including identification of appropriate outcome variables and data collection tools. The broad, long-term objective of the work is to improve the quality and equity of care for OEF/OIF Veterans.

Project Methods: In this mixed methods study, 40 OEF/OIF Veterans will participate in a Photovoice project to produce statements made up of pictures and words that communicate their experiences and perspectives related to combat deployment(s) and post-deployment reintegration. The sample will include Veterans who are being treated at a VA Medical Center (e.g. for chronic pain, Traumatic Brain Injury, polytrauma and/or PTSD). The sample will also include OEF/OIF Veterans who have not accessed VA care; these participants will berecruited through local universities, National Guard and Reserve units, and Vet Centers. Findings from the Photovoice project will be disseminated to VA leadership, providers and staff through a Photovoice exhibit onsite at the Medical Center, Grand Rounds presentations, and other educational and training events at the Medical Center and associated CBOCs. Preliminary effectiveness of Photovoice participation as an intervention to increase self-efficacy and decrease social anxiety among OEF/OIF Veterans will be measured by change in responses to questionnaires administered before and after Photovoice participation. The impact of attending a Photovoice exhibit or presentation on VA providers and staff will be assessed through written
comments and small-group discussions.