Research translation for military and veteran health: research, practice, policy

Abstract

Military service presents unique challenges and opportunities for health care and public health. In the USA, there are over 2 million military servicemembers, 20 million veterans, and millions more military and veteran family members. Military servicemembers and eligible family members, many veterans, and retirees receive health care through the two largest learning health care systems in the USA, managed and delivered through the Departments of Defense (DoD), Veterans Affairs (VA), and contracted health care organizations. Through a network of collaborative relationships, DoD, VA, and partnering health care and research organizations (university, corporate, community, and government) accelerate research translation into best practices and policy across the USA and beyond. This article outlines military and veteran health research translation as summarized from a collaborative workshop led by experts across health care research, practice, and administration in DoD, VA, the National Institutes of Health, and affiliated universities. Key themes and recommendations for research translation are outlined in areas of: (a) stakeholder engagement and collaboration; (b) implementation science methods; and (c) funding along the translation continuum. Overall, the ability to rapidly translate research into clinical practice and policy for positive health outcomes requires collaborative relationships among many stakeholders. This includes servicemembers, veterans, and their families along with researchers, health care clinicians, and administrators, as well as policymakers and the broader population.

Keywords: Evidence-based health care; Implementation science; Military; Research translation; Veteran.

Fig 1

Research translation for military and veteran health.

Fig 2

Example of stakeholder engagement with key informants and an advisory board. This figure outlines the process of stakeholder engagement used to help develop the intervention and manual for the Strong Families Strong Forces study [19]. After initial planning, the process started with recruiting and interviewing key informants, then feedback analysis, manual amendment, and forming a stakeholder advisory board for feedback on the amended manual and intervention leading up to the actual implementation of the intervention study.

Fig 3

VA National Center for Health Promotion and Disease Prevention (NCP) Partnership Model.

Fig 4

Common Military and Veteran Health Researcher Career Paths and Funding. BS = Bachelors of Science [degree]; DoD = Department of Defense; Fel = Fellowship; Int = Internship; MD = Medical Doctorate [degree]; Mil Serv = Military Service; NIH = National Institutes of Health; PhD = Philosophy Doctorate [degree]; Res = Residency (medical); VA = Department of Veterans Affairs. Timeline of Year 0 would typically begin at age 18 after high school graduation, signifying Year 0 on a person’s path to career research, which typically begins in undergraduate degree studies with a scientific focus (e.g., Bachelor of Science) and progresses through doctoral education (most common is PhD, secondary for health research is MD as well as DO, DNP, DPT, DC, DMD, DrPH, EdD, JD, etc.) and training (e.g., fellowships but also residency or internships for MDs, clinical psychologists, and other clinician tracts) to becoming a full career researcher. The timeline corresponds to estimated time along the career continuum, such as 4 years to earn an undergraduate degree or for a standard military enlistment, an additional 3–5 years for a PhD/MD, a 2 year fellowship, and earliest career researcher status at around year 10 and extending as many as an additional 90 years. An active duty military researcher’s career typically begins after earning a doctoral degree with entrance into active duty for residency or internship as a clinician that also does research, in some cases as a scientist, and military retirement typically occurs after 20–40 years of service (mandatory age removal at age 62 years). Gray lines and font on items such as the career awards are to signify that these are not as common as the black lined, more standard training, and funding streams for researchers.