TSNRP Military Family Speaker Series Care of the Military Family Part II
Topic 1: Theory, Intersectionality, and Gender-diverse Military Families: Answering the Call
Description: Maintaining a ready, lethal, military force capable of rapidly defending national interests, requires constant vigilance for threats to servicemembers’ health and well-being. Family issues are critical and may undermine individual servicemembers’ physical and mental readiness. The social milieu and diversity of military families has changed since the initial 1994 military family report. However, in the 2021 “Joining Forces” White House initiative, the health and readiness of military families remains a national priority.
Recent policy changes allow sex and gender diverse (SGD), lesbian, gay, bisexual, transgender, or queer individuals to serve, marry, and have children, adding to the diversity of military families. While little is known about the actual numbers and healthcare needs of military SGD families, approximately 85,504 US servicemembers identify as SGD. Sex and gender diverse members are more likely to experience mental and physical health disparities, discrimination, stigma, access to care issues, and decreased social support. A recent military family scoping review included no SGD military family articles. One newer article cited a lack of appropriate support services for SGD military families. This dearth of research is compounded by a thin theoretical foundation for research and development of interventions for all military families. We propose a social ecological intersectionality model (SEM-IM) to inform heath and readiness-centered SGD military family research. Objectives: synthesizing appropriate literary evidence and describe a SEM-IM to inform health and readiness SGD military family research.
Methods: Theory building synthesis strategy with literature-identified concepts pertinent to SGD military families.
Results: Elements from an SEM for military women and Intersectionality were combined. The SEM-IM considers the entire sociocultural environment and social determinants of health (e.g., where people live, learn, work, recreate, worship, and age) on four interconnected levels: macrosystem, exosystem, mesosystem, and microsystem. Intersectionality addresses the point at which the interdependent constructs of sex, gender, race/ethnicity, and social factors converge, interact, and influence individual/family health
Implications: A clear understanding of the multiple socio-ecologic levels influencing health and readiness of SGD military families will enable recognition of leverage points for practice and policy recommend.
1. Describe key concepts in the first mid-range theory for sex and gender diverse military families
2. Discuss steps in the synthesis strategy of theory building
LTC Leilani A. Siaki, PhD, NP-BC, FAANP
Dr. Meagan Petersen, DNP, CNM
Mrs. Katherine Walker, MSN, RN
Topic 2: Prenatal Intervention Improved Pregnancy Outcomes at Three Military Installations
Description: Pregnancy specific anxiety and depressive symptoms are directly associated to adverse pregnancy and birth outcomes, such as low birthweight (LBW), and preterm birth (PTB). Early intervention to support mothers is critical in mitigating adverse outcomes. The Mentors Offering Maternal Support (M-O-M-S™) program, focuses on early peer support to decrease prenatal anxiety and depression.
Objective: Examine the effect of the M-O-M-S program on decreasing pregnancy anxiety & depression and improving birth outcomes, and its sustained effects.
Methods: Following IRB approval, individuals with first trimester pregnancies were consented and randomized to the M-O-M-S intervention or control group (standard prenatal care) at San Antonio (BAMC/SAMMC), San Diego (NMCSD), and Ft Lewis-McChord (JBLM). Ten sessions of the M-O-M-S™ program offered opportunities to discuss personal concerns aligned to pregnancy anxiety. Measures of anxiety and depression were collected at 12, 16, 24, and 32 weeks gestation and again at 2, 12, and 18 weeks postpartum, along with birth outcomes of LBW defined as ≤ 2500 grams and PTB as <37 weeks.
Findings: A total of 1,494 participants completed the study: BAMC (n = 571), JBLM (n = 548), and NMCSD (n = 375). Of these, 54% were AD, with the following Service representation: 25% Air Force, 47% Army, 23% Navy, and 5% Marines or Coast Guard, with racial/ethnic profiles: White, non-Hispanic (55%), Black/African American (15%), Hispanic/Latinx (22%), Asian (5%), and Other (3%), and predominantly enlisted (60%). Prenatal depression was diagnosed in 10%. Those in the M-O-M-S™ program had a lower probability of 19.7% and 23% for both LBW and PTB respectively for a lower depression trajectory given in both adjusted (p<.0014) and unadjusted (p<.0001) models. Sustained effects were seen for significantly lower depression scores postpartum for the same group (p<.03).
Implications for Military Nursing: The findings reinforce the importance of early pregnancy intervention for improving prenatal mental health and birth outcomes. While certain prenatal birthing classes may help alleviate some fears and anxiety, the classes are generally offered only in the third trimester, which does not help with the downstream effects on pregnancy. The success of the M-O-M-S™ intervention emphasizes the importance of communities as a force in shaping health and readiness, and for improving the health of mothers and infants.
1. Summarize the benefits associated with early mentored prenatal support, and the connection to improved birth outcomes.
2. Describe the connection of prenatal anxiety, depressive symptoms, and isolation to poor birth outcomes and the corollary to the COVID-19 pandemic.
Presenter: Col(ret) Karen Weis, PhD, RNC-OB, FAAN
Co-Authors: Dr. Meagan Petersen, DNP, CNM
Mrs. Katherine Walker, MSN, RN
Virtual Platform: GoToWebinar
Target Audience: Members of the Military Community, Providers for Military Families, Nurse Researchers
CME/CE: 1 hrs
This webinar is sponsored by: