ABSTRACT
Pacific Island veterans suffer from greater severity of posttraumatic stress disorder (PTSD) compared with Caucasian veterans but face substantial barriers to mental health care. However, the factors that may dissuade or facilitate veterans in the Pacific Islands from seeking mental health care are not known. The main aim of this study was to identify how internal and external factors interact to impact wounded warriors' access to and use of mental health services. Veterans residing in 5 rural Pacific Island locations were mailed recruitment materials. Other veterans were made aware of the project by key stakeholders in their communities. Thirty-seven male veterans (across 5 focus groups) and 1 female veteran (via individual interview) participated. The study utilized an analytic design in which taped focus group discussions were transcribed verbatim and coded for major themes. Results indicated that most veterans identified Veterans Affairs (VA) as a positive source for health care. However, common concerns acknowledged were as follows: (a) difficulty navigating the VA system, (b) time associated with receiving care, (c) family stigma, (d) community stigma, (e) cultural differences, and (f) a lack of knowledge about VA services and benefits. Facilitators of care included the following: (a) individual knowledge and self-efficacy, (b) networking with other veterans, (c) family support, and (d) rural community support. All factor levels interacted in subtle ways to ultimately impact access to care. Next steps are described, including projects designed to better meet the needs of rural Pacific Island veterans. (PsycINFO Database Record
Subject(s)
Culture , Health Services Accessibility , Mental Disorders/therapy , Mental Health Services , Veterans Health , Veterans/psychology , Adult , Aged , Female , Focus Groups , Health Knowledge, Attitudes, Practice , Humans , Male , Mental Disorders/psychology , Middle Aged , Native Hawaiian or Other Pacific Islander , Patient Acceptance of Health Care , Qualitative Research , Rural Population , Social Stigma , United States , United States Department of Veterans Affairs , Young AdultABSTRACT
The Veterans Affairs mission to provide equitable, accessible, and patient-centered care necessitates that culturally appropriate interventions are available when cultural differences may jeopardize engagement in care. However, within the VA, wounded warriors residing in rural areas in the Pacific Islands have been offered interventions that were developed and tested using largely urban mainland populations. The objectives of this article were to (a) document the cultural adaptation of a cognitive-behavioral clinical intervention for use by rural Pacific Island veterans, and (b) report feasibility data for the intervention. The 5-stage Map of the Adaptation Process (assessment, selection, preparation, piloting, and refinement) was used to structure the work. The resultant intervention, called "Koa," is a multisession family psychoeducational program that integrates selected Pacific Islander values, beliefs, and healing traditions with an empirically based mainstream U.S. INTERVENTION: To pilot Koa, rural Pacific Island dyads (28 veterans and 28 family members) participated via video teleconference and completed pre- and post- intervention measures. Outcome data indicated that participants perceived the intervention to be highly acceptable, useful, and relevant. Relationship quality scores substantially improved postintervention as measured by the Dyadic Relationship Scale (95% CI [-10.97, -1.84], t(22) = -2.9, p = .008, d = -0.53 for veterans; 95% CI [-11.06, -2.47], t(21) = -3.28, p = .004, d = -0.68 for family members). Family caregiving burden also improved significantly. The positive results of this investigation support the development of culturally adapted mental health interventions for culturally distinct subgroups of veterans and their families. (PsycINFO Database Record
Subject(s)
Cognitive Behavioral Therapy/methods , Culturally Competent Care , Family Therapy/methods , Stress Disorders, Post-Traumatic/therapy , Veterans/psychology , Adult , Family , Feasibility Studies , Female , Humans , Male , Middle Aged , Native Hawaiian or Other Pacific Islander/psychology , Patient Satisfaction , Patient-Centered Care , Rural Population , Stress Disorders, Post-Traumatic/psychology , United StatesABSTRACT
Poorly managed anger responses can be detrimental to one's physical and psychosocial well-being. Cognitive behavior therapies (CBT) have been found to be effective in treating anger disorders. A key component of CBT treatment is exposure to the anger arousing stimuli. Virtual reality (VR) environments can elicit potent reactions and may facilitate the treatment of anger. An anger VR environment with six video vignettes was developed by this study to examine the anger arousal potential of VR. Outcome measures included assessment of emotional reactivity, state anger, and presence. The results showed that significant anger arousal occurred during exposure to the VR environment, and arousal was greater when viewed in an immersive HMD than a non-immersive flat screen. In addition, presence was found to moderate the effects of VR. Low presence resulted in low reactivity regardless of the display modality.
