Moral Distress, Mental Health, and Risk and Resilience Factors Among Military Personnel Deployed to Long-Term Care Facilities During the COVID-19 Pandemic: Research Protocol and Participation Metrics

Abstract

Background: The earliest days of the COVID-19 pandemic in Canada were marked by a significant surge in COVID-19 cases and COVID-19-related deaths among residents of long-term care facilities (LTCFs). As part of Canada's response to the COVID-19 pandemic, Canadian Armed Forces (CAF) personnel were mobilized for an initial emergency domestic deployment to the hardest-hit LTCFs (Operation LASER LTCF) to support the remaining civilian staff in ensuring the continued delivery of care to residents. Akin to what was observed following past CAF international humanitarian missions, there was an expected increased risk of exposure to multiple stressors that may be psychologically traumatic and potentially morally injurious in nature (ie, related to core values, eg, witnessing human suffering). Emerging data from health care workers exposed to the unprecedented medical challenges and dilemmas of the early pandemic stages also indicated that such experiences were associated with increased risk of adverse mental health outcomes.

Objective: This study aims to identify and quantify the individual-, group-, and organizational-level risk and resilience factors associated with moral distress, moral injury, and traditional mental health and well-being outcomes of Operation LASER LTCF CAF personnel. This paper aimed to document the methodology, implementation procedures, and participation metrics.

Methods: A multimethod research initiative was conducted consisting of 2 primary data collection studies (a quantitative survey and qualitative interviews). The quantitative arm was a complete enumeration survey with web-based, self-report questionnaires administered at 3 time points (3, 6, and 12 mo after deployment). The qualitative arm consisted of individual, web-based interviews with a focus on understanding the nuanced lived experiences of individuals participating in the Operation LASER LTCF deployment.

Results: CAF personnel deployed to Operation LASER LTCF (N=2595) were invited to participate in the study. Data collection is now complete. Overall, of the 2595 deployed personnel, 1088 (41.93%), 582 (22.43%), and 497 (19.15%) responded to the survey at time point 1 (3 mo), time point 2 (6 mo), and time point 3 (12 mo) after deployment, respectively. The target sample size for the qualitative interviews was set at approximately 50 considering resourcing and data saturation. Interest in participating in qualitative interviews surpassed expectations, with >200 individuals expressing interest; this allowed for purposive sampling across key characteristics, including gender, rank, Operation LASER LTCF role, and province. In total, 53 interviews were conducted.

Conclusions: The data generated through this research have the potential to inform and promote better understanding of the well-being and mental health of Operation LASER LTCF personnel over time; identify general and Operation LASER LTCF-specific risk and protective factors; provide necessary support to the military personnel who served in this mission; and inform preparation and interventions for future missions, especially those more domestic and humanitarian in nature.

International registered report identifier (irrid): DERR1-10.2196/44299.

Keywords: COVID-19; Canadian Armed Forces; centre de soins de longue durée; deployment; health care; logistics support; long-term care facility; mental health; military; moral distress; moral injury; older adult; operational organization; qualitative interviews; quantitative; quarantine; readiness; resilience; risk factors; survey; well-being.

Figure 1

Timeline of Operation LASER long-term care facility (LTCF) deployment, approvals, and data collection. CAF: Canadian Armed Forces; CDS: Chief of Defence Staff; CFHS: Canadian Forces Health Services; DGMPRA: Director General Military Personnel Research and Analysis; DRDC-TRC: Defence Research and Development Canada–Toronto Research Centre; HREC: Human Research Ethics Committee; T1: time point 1; T2: time point 2; T3: time point 3.

Figure 2

Survey participation flow across data collection time points. LTCF: long-term care facility; T1: time point 1; T2: time point 2; T3: time point 3.

Figure 3

Participant attrition across survey sections. C-PIQ: Complementary and Integrative Research Pandemic Impact Questionnaire; COM-B: Capability, Opportunity, and Motivation–Behavior; COPE: Coping Orientation to Problems Experienced; GAD-7: Generalized Anxiety Disorder Scale; HDO: Human Dimensions of Operations; K-10: Kessler Psychological Distress Scale; MH: mental health; MIOS: Moral Injury Outcome Scale; MMD: Measure of Moral Distress; PCL-5: Posttraumatic Stress Disorder Checklist for the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition; PHQ-9: Patient Health Questionnaire–9; PPE: personal protective equipment; PTGI: Posttraumatic Growth Inventory; T1: time point 1; T2: time point 2; T3: time point 3.