Indiana University-Purdue University Indianapolis (IUPUI) / Traumatic brain injury (TBI) has emerged as a major cause of morbidity among U.S. soldiers who have served in Iraq and Afghanistan. Even mild TBI (mTBI) can result in cognitive impairments that can impact how veterans experience such things as physical symptoms, emotions and behaviors, instrumental activities of daily living, interpersonal interactions, and community reintegration. The purpose of this study was to develop a comprehensive self-management intervention for veterans with mTBI to facilitate their community reintegration upon returning from deployment to combat zones. This study was conducted in two Phases. Phase I entailed collecting qualitative data regarding needs, concerns, strategies used, and advice given by eight veterans with mTBI, guided by a conceptual model derived from Ferrans’ and colleagues’ health-related quality of life model and the TBI literature. Six key categories and predominant themes emerged providing further support for the model (cognitive impairments, physical symptoms, emotions and behaviors, instrumental activities of daily living, interpersonal interactions, and community reintegration). Guided by the conceptual model, a mTBI Veteran Needs and Concerns Checklist and 14 algorithms making up the VETeranS Compensate, Adapt, REintegrate (VETSCARE) intervention were developed. Phase II entailed obtaining review of the mTBI Veteran Needs and Concerns Checklist and the 14 VETSCARE algorithms from six TBI experts. On a scale of 1 to 5, with 5 being strongly agree, expert ratings provided moderate evidence of content validity for the checklist (3.33), and for the 14 algorithms (problem relevance 3.92, accuracy 3.73, feasibility 3.80, acceptability 3.84). The average overall expert rating for the VETSCARE intervention was 3.82. The checklist and the 14 algorithms are being revised based on specific comments provided by the experts. Once revised, the mTBI Veteran Needs and Concerns Checklist and the VETSCARE intervention will be tested for feasibility in a future pilot study with veterans with mTBI who have recently returned from combat zones in Iraq and Afghanistan.

Approximately 1.76 million men and women have served in the Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) military campaigns since October 2001. The transition from living in a war zone to resuming a fulfilling life at home is often difficult for veterans. The purpose of this mixed methods study was to gain understanding of the issues that complicate health for veterans and approaches veterans used to resolve complicating health issues associated with the challenge of coming home from war. Qualitative data collection and analysis was guided by story inquiry method. Quantitative data was collected using the 36-item Short-Form Health Survey, Version 2 (SF-36v2) and analyzed using QualityMetric Health Outcomes[TM] Score Software, Version 4.0. Seven OEF/OIF veterans who had completed at least one tour of duty in Iraq since October 2001 participated in this study. Three themes emerged from the qualitative data that capture the complicating health issues that participants encountered when coming home from war: flipping the switch, figuring out how to belong, and living the stress of a new normal. Two themes emerged from the qualitative data that capture approaches used to resolve complicating health issues associated with returning home from war: connecting with others and choosing a positive attitude. Quantitative data revealed that the majority of participants scored at or above general population norms on three of the subscales that measure physical health, as well as on two of the subscales that measure mental health; however a significant percentage scored below norms on the subscale that measures social functioning (57%) and on the subscale that directly measures mental health (43%). / All three themes describing complicating health issues that emerged during qualitative data analysis resonated with the SF-36v2's measures of mental health, especially social functioning which inquires about experiences with social interactions. Both themes describing movement toward resolving resounded strongly with the SF-36v2's measures of mental health. From this study's findings, changes to policy and practice, education of nurses and post-secondary faculty, and future research have been recommended to continue to assist the war veteran who is coming home. / by LisaMarie Wands. / Thesis (Ph.D.)--Florida Atlantic University, 2011. / Includes bibliography. / Electronic reproduction. Boca Raton, Fla., 2011. Mode of access: World Wide Web.