Grounded Theory Focus Group Findings in Combat Veterans With Driving Performance Issues

BACKGROUND: Combat veterans (CVs) face an increased incidence of motor vehicle crashes leading to injury or death and have reported driving difficulty that impacts their community integration (Plach & Sells, 2013). Both battlemind training for combat, such as evasive driving maneuvers, and deployment experiences impact their driving postdeployment. Moreover, medical conditions common in CVs returning from conflicts in Iraq and Afghanistan, such as traumatic brain injury and posttraumatic stress disorder, are also purported to underlie CV driving difficulty.

PURPOSE: We sought to understand driving performance issues from the lived experiences of CVs in order to tailor an occupational therapy driving intervention (OT–DI; Classen et al., 2014). Specifically, we used an existing conceptual model (Hannold, Classen, Winter, Lanford, & Levy, 2014) to illustrate the interplay among CVs’ driving knowledge and skills, emotional regulation, assessment of the environment and situations when driving, and behavioral responses.

DESIGN AND METHOD: We used grounded theory (GT) methods to examine findings from two moderated focus groups in relation to an existing conceptual model. Participants included seven men enrolled in a larger study of an OT–DI (Classen et al., 2014; Szafranski, 2015). Based on verbatim transcripts of two focus groups, team members created an initial coding scheme and expanded it as the analysis progressed. Using a GT approach and an iterative process, we built on a conceptual model illustrating CV driving perspectives (Hannold et al., 2014). The GT study and subsequent focus groups received approval from the participating university institutional review board, the Veterans Affairs Research Committee, and the Department of Defense Human Research Protection Office. Participants signed an informed consent and an authorization to record their focus group responses.

RESULTS: The conceptual framework developed by Hannold et al. (2014) proposed that driver-related factors (e.g., health, past driving experiences) and deployment-related experiences (e.g., improvised explosive device blast exposure) influence CVs’ physical, cognitive, and emotional perceptions while driving, as well as their responses. As in the conceptual model, CVs in our focus groups identified driving as an important daily activity.

CVs illustrated how battlemind training and deployment experiences impacted their civilian driving and contributed to driving performance issues. CVs described driving performance and behaviors in relation to triggers, or stimuli in the driving environment they perceived as stressful and that often resulted in risky or undesired driving behaviors (e.g., CV driving outside of his or her lane in response to roadside debris). When reacting to triggers, CVs usually attempted to moderate behaviors via environmental strategies (e.g., use of cruise control) or personal strategies (e.g., avoiding driving in peak traffic). CVs reported situations with negative outcomes when the challenge of the driving task exceeded their ability to cope using strategies or when they failed to use strategies when needed. Examples included instances of battlemind driving (e.g., erratic driving to avoid a trigger), anxiety, and aggressive incidents (road rage).

CONCLUSION: Using grounded theory, we determined that CVs provided a rich description of their driving perspectives postdeployment and driving responses. Although CVs reported awareness of unsafe driving behaviors, they were not always successful in appropriately moderating their responses to perceived triggers, supporting a need for intervention.

IMPACT STATEMENT: Our findings further inform the conceptual model proposed by Hannold et al. (2014). Participants’ reported strategies are now included for testing in an effectiveness trial (Classen et al., 2014).

References

Classen, S., Cormack, N. L., Winter, S. M., Monahan, M., Yarney, A., Lutz, A. L., & Platek, K. (2014). Efficacy of an occupational therapy driving intervention for returning combat veterans. OTJR: Occupation, Participation and Health, 34, 176–182. https://doi.org/10.3928/15394492-20141006-01

Hannold, E. M., Classen, S., Winter, S., Lanford, D. N., & Levy, C. E. (2014). An exploratory pilot study of driving perceptions among OIF/OEF veterans with mTBI and PTSD. Journal of Rehabilitation Research and Development, 50, 1315–1330. https://doi.org/10.1682/JRRD.2013.04.0084

Plach, H. L., & Sells, C. H. (2013). Occupational performance needs of young veterans. American Journal of Occupational Therapy, 67, 73–81. https://doi.org/10.5014/ajot.2013.003871

Szafranski, E. (2015). Understanding combat veterans perspectives on strategies to manage unsafe driving and preferences for driving intervention. Gainesville: University of Florida. Retrieved from http://ufdc.ufl.edu/AA00037467/00001