Date Presented 4/19/2018
Combat veterans face an increased risk of motor vehicle crashes and driving difficulty that affects community reintegration. Occupational therapy practitioners need to understand the importance and use of qualitative inquiry, including grounded theory, to inform clinical trials of a driving intervention.
Primary Author and Speaker: Sandra Winter
Additional Authors and Speakers: Mary Jeghers, Emily Reid
BACKGROUND AND PURPOSE: Returning combat veterans face increased risk of motor vehicle crashes leading to injury or death and have reported driving difficulty that affects their community reintegration (Plach & Sells, 2014). Medical conditions and driving-related experiences often contribute to veterans’ driving difficulty. Our previous work progressed from a pilot to an efficacy study and is now examining effectiveness of a driving intervention for returning veterans using mixed methodology. With the lack of published literature on veterans’ lived experiences, there is a need for researchers to evaluate veteran perspectives to further inform driving intervention strategies. Our objective was to connect an existing conceptual framework illustrating potential factors underlying veterans’ driving behavior (Hannold et al., 2014) with core theories and knowledge from occupational therapy. We sought theories and knowledge pertaining to interactions among person, environment, and occupation, especially those related to task competency and stress.
METHOD: We used a grounded theory design incorporating moderated focus groups. As part of a larger randomized controlled trial (Classen et al., 2014) testing an occupational therapy–based driving intervention, we examined combat veterans’ perspectives on driving by conducting two focus groups (N = 8). Participants were returning veterans from conflicts in Iraq and Afghanistan with diagnoses of mild traumatic brain injury, posttraumatic stress disorder, or orthopedic injury who reported driving difficulty. We digitally recorded, transcribed, and verified transcripts from both focus groups. Our analysis used a constant comparative method to examine focus group data in light of the existing conceptual framework (Hannold et al., 2014), developing new codes as needed.
RESULTS: During the iterative process and expansion of the existing model, we found that emerging themes showed strong connections with three occupational therapy concepts: (1) person–environment–occupation, (2) environmental press, and (3) continuum of driving response. For the person–environment–occupation theme, veterans’ driving knowledge, skills, and emotional regulation interacted with their driving environment and behavioral responses, influencing driving competence. Regarding environmental press, the environment placed certain demands on veterans, affecting their coping skills, strategies, and ability to respond. For example, our data show that veterans attempted to adapt a perceived environmental threat before eliciting a response.
Finally, the continuum of driving responses was influenced by levels of hypervigilance and could range from appropriate driving (e.g., veteran remains calm even though someone pulls out in front of him or her) to the extreme of fight-or-flight response (e.g., veteran hears a tire explode while driving and cannot return to vehicle for an extended amount of time). Responses to driving triggers could vary on the basis of veteran arousal levels. Our findings illustrate that veterans may use multiple strategies to moderate triggers in order to reach a specific behavior.
CONCLUSION: Using grounded theory methods and connection to occupational therapy theories, we expanded our existing conceptual model of factors influencing veterans’ driving after deployment. Our grounded theory work helped inform our current randomized clinical trial of a driving intervention. Furthermore, by connecting our existing conceptual framework to occupational therapy theory and knowledge, we have improved our potential for raising awareness inside and outside of military and veteran environments. Funding source: Department of Defense grant award W81XWH-11-1-0454.
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. Occupational Therapy Journal of Research, 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
