Where are all the veterans? A mixed methods assessment of a systematic strategy to increase veteran registration in UK primary healthcare practices
Abstract: Objectives: To identify effective initiatives to increase veteran registration in UK primary healthcare (PHC) practices. Design: A structured and systematic strategy was designed to improve the number of military veterans correctly coded within PHC. A mixed methods approach was adopted to evaluate the impact. PHC staff provided anonymised patient medical record data that used Read and Systematised Nomenclature of Medicine - Clinical Terms codes to identify the number of veterans within each PHC practice. This included baseline data, then scheduled further information after two phases of internal advertisement and two phases of external advertisement of different initiatives intended to raise veteran registration. Qualitative data was acquired through post-project interviews with PHC staff to ascertain the effectiveness, benefits, problems and means for improvement. A modified Grounded theory was used for the 12 staff interviews. Setting and participants: Twelve PHC practices in Cheshire, England, participated in this research study with a combined total of 138 098 patients. Data was collected between 01 September 2020 until 28 February 2021. Results: Overall, veteran registration increased by 218.1% (N=1311). Estimated coverage of veterans increased from a coverage of 9.3% to a coverage of 29.5%. There was an increased population coverage ranging from 5.0% to 54.1%. The staff interviews revealed improved staff commitment and their taking ownership of the responsibility to improve veteran registration. The primary challenge was the COVID-19 pandemic, in particular the significantly reduced footfall and the communication opportunities and interface with patients. Conclusions: Managing an advertising campaign and improving veteran registration during a pandemic caused huge problems, but it also presented opportunities. Enabling a significant increase in PHC registration during the harshest and most testing conditions indicates that the accomplished achievements have substantial merit for wider adoption and impact.
Abstract: Disordered eating is a prevalent and relevant health concern that remains understudied among U.S. military veterans. Avoidant/restrictive food intake disorder (ARFID) is a newly recognized feeding and eating disorder characterized by overly restrictive eating due to (a) picky eating, (b) lack of appetite, and (c) fear of aversive consequences related to eating. The Nine-Item ARFID Screen (NIAS) is a recently developed ARFID screening tool with initial validation studies demonstrating psychometric support. However, the psychometric properties of the NIAS have not been investigated in a veteran sample. To advance our understanding of ARFID screening tools that may be appropriate for use in veterans, the present study examined the factor structure of the NIAS using survey data from a large national sample of recently separated veterans (N = 1,486). Measurement invariance across key subgroups was tested in addition to exploring differential associations between the NIAS and related constructs. Results suggested that a three-factor model provided an excellent fit of the data and demonstrated scalar invariance across self-identified men and women, race and ethnicity, and sexual and gender minority (SGM) identity. Some subgroups had higher latent means on the picky eating (women, SGM, non-Hispanic Black), appetite (women, SGM), and fear (women) factors. The NIAS had some overlap with another measure of disordered eating and was moderately correlated with psychosocial impairment and mental health. Overall, the NIAS may be a useful screening tool for ARFID in veterans, given support for the three proposed subscales and equivalence across diverse identities.