BACKGROUND/RATIONALE:
Over 10,000 men and women have been deployed from Puerto Rico (PR) to serve in the wars in Iraq and Afghanistan. No known investigative team has developed education interventions for this special subgroup of OEF/OIF veterans and their families. Because culture has a far-reaching effect on how one interprets experiences, processes new information, and learns to adapt, it is critical that OEF/OIF education materials are evaluated, adapted to meet the needs of the PR population, and then translated into PR Spanish

OBJECTIVE(S):
The specific objectives are the following: (1) Review and analyze currently available or existing education materials on post-deployment readjustment, (2) Adapt educational materials to pre-identified needs of OEF/OIF veterans and families based on findings from a previously funded project and our analysis of available materials, and (3) Pilot test and modify the adapted education materials and determine the most effective methods to disseminate the materials to help PR veterans and families access education materials.

METHODS:
Our team collected literature and patient education materials from journals, brochures, websites, and directly from our champions/partners in PR veteran-related and VA organizations. We evaluated the collected patient education materials for ease of use, readability, accuracy, visual appeal, cultural relevance, and potential for comprehension, using the Patient Education Evaluation Rating Scale (PEERS), an instrument developed for this project. Based on our reviews and from findings from qualitative interviews that we conducted with PR veterans and family in another project, we adapted the collected education materials. To pilot test the adapted materials, we conducted and analyzed focus group interviews with PR healthcare providers and veterans.


FINDINGS/RESULTS:
The research team collected approximately 300 patient education documents that were organized in a computer database, the Seamless Transition Resources and Information for Veterans and Educators (STRIVE). To guide the reviews of the collected materials, the team developed and tested the Patient Education Evaluation Rating Scale (PEERS). Based on the reviews and input from our PR partners and Spanish-speaking team members, we developed 12 fact sheets that were written in PR Spanish, included PR symbols (i.e.,flag symbols/colors, coqu ), and were targeted to veterans, family members, and employers. Social marketing techniques, such as consistent branding, eye-catching graphics, positive statements, brief messages, bullets to emphasize main points, and a summary section ("remember") were successfully used. Community-based participatory research approaches were used to establish buy-in and to develop education materials that appealed to the PR population. We pilot tested the fact sheets with focus groups of PR healthcare providers and veterans, who provided primarily positive comments and suggested minor language and content changes.

IMPACT:
The Seamless Transition Resources and Information for Veterans and Educators (STRIVE), the Patient Education Evaluation Rating Scale (PEERS), and 12 PR OEF/OIF Fact Sheets to help veterans and families adjust following deployment are products developed in this project that can be used by other VA researchers, educators, and clinicians. The project highlighted that education materials on post-deployment readjustment should be directed to multiple targets - veterans, families, employers/coworkers, and the community at large and disseminated using various methods (i.e., printed formats, online, radio, television). The project underscored the need for materials written in the Spanish language and designed specifically for the PR population.

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External Links for this Project

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PUBLICATIONS:

Journal Articles

1. Hannold EM, Freytes IM, Uphold CR. Unmet health services needs experienced by Puerto Rican OEF/OIF veterans and families post deployment. Military medicine. 2011 Apr 1; 176(4):381-8. [view]

Conference Presentations

1. Freytes IM, Bober J, Romero S, Hannold EM, Barak S, Wing KL, Uphold CR. A Best Practice Approach to Patient Education for Diverse Populations. Poster session presented at: VA / DoD Facility Based Educators Annual Meeting; 2008 May 27; San Antonio, TX. [view]
2. Uphold CR, Bober J, Freytes IM, Wing KL. Community Reintegration and Puerto Rican OEF/OIF Veterans and Families. Poster session presented at: VA QUERI National Meeting; 2008 Dec 11; Phoenix, AZ. [view]
3. Uphold CR. Developing a Fundable Research Grant. Paper presented at: National Organization of Nurse Practitioner Faculties Annual Conference; 2007 Apr 12; Washington, DC. [view]
4. Wilson DL, Bober J, White M, Freytes IM, Uphold CR. Development of the Patient Education Evaluation Rating Scale (PEERS). Poster session presented at: American Geriatrics Society Annual Meeting; 2008 May 1; Washington, DC. [view]
5. Uphold CR, Bober J, Freytes IM, Matos-Toro M, Wing KL, Romero S, Hannold EM, Barak S. Implementation Science Study to Improve Readjustment of Puerto Rican OEF/OIF Veterans and Families. Poster session presented at: AcademyHealth Annual Research Meeting; 2008 Jun 9; Washington, DC. [view]
6. Uphold CR, Freytes IM, Knauff L, Wing KL, Anderson SA, Easey KL. Improving Community Reintegration of OEF/OIF Veterans and Families Living in Puerto Rico through Printed and Web-based Education. Paper presented at: University of West Florida Deployment Mental Health Symposium; 2010 May 6; Pensacola, FL. [view]
7. Hannold EM, Freytes IM, Bober J, Uphold CR. Post-Deployment Readjustment Needs of Puerto Rican OEF/OIF Veterans & Families. Paper presented at: AcademyHealth Annual Research Meeting; 2008 Jun 8; Washington, DC. [view]
8. Uphold CR, Rittman MR, Boylstein CA, Hannold EM, Freytes IM. Readjustment Processes of OEF/OIF Veterans & Families Living in Puerto Rico. Paper presented at: VA Nurses Organization Annual Meeting; 2007 May 10; Washington, DC. [view]
9. Freytes IM, Bober J, Wing KL, Uphold CR. The Impact of War on the Readjustment of Puerto Rican Veterans and their Families. Poster session presented at: AcademyHealth Annual Research Meeting; 2008 Jun 8; Washington, DC. [view]

DRA: Military and Environmental Exposures
DRE: none
Keywords: Education (patient), Operation Enduring Freedom, Operation Iraqi Freedom
MeSH Terms: none