Veteran Voices in Research: Origins

Summary: Veteran Voices in Research showcases the people and programs that foster Veteran engagement and demonstrates how Veteran collaborators improve the quality, relevance, and impact of VA research. This inaugural issue, "Origins," explains how Veteran engagement became a formal practice among VA researchers, and offers insights into the value Veteran collaborators bring to the table.

Since VA's first studies into post-World War I ailments, Veteran expertise has always proven to enhance research quality. For most of the last century, this engagement was a personal matter: a partnership that united doctor and patient by their shared goal of better lives for all Veterans. Each one unique to the situation and people involved.

As communication technology advanced and the world shrank, VA investigators began to form their own groups, sharing success stories and guidance on how to best engage Veterans in their research. The Patient Protection and Affordable Care Act of 2010 formalized this expansion by establishing the non-profit Patient-Centered Outcomes Research Institute (PCORI), which funded patient-guided research nationwide.

By 2013, VA was establishing its own formal Veteran engagement groups and panels, starting with the Seattle-Denver Center of Innovation (COIN) Veteran Research Engagement Board (VREB) and the Portland Center to Improve Veteran Involvement in Care (CIVIC)Veteran Engagement Group.

"We were very intentionally looking for Veterans who were interested in science, and how we make decisions, and innovating healthcare," said Kelty Fehling, an investigator at the Seattle-Denver COIN. "Our researchers would bring their projects at an early enough stage that they could make modifications and say, for example, 'Hey, I need help on design of some of these intervention materials. It feels like it's not really resonating with Veterans right now.' And they'd workshop that together. The engagement was at all different stages, even then."

In 2015, VA Health Systems Research (HSR) established a Veteran Engagement Workgroup to foster collaborations between Veterans and researchers. Led by Dr. Sarah Ono, PhD, of the Portland CIVIC, and Dr. Justeen Hyde, PhD, of VA's Center for Health Optimization and Implementation Research (CHOIR), a team from seven VA centers later developed the Strengthening Excellence in Research through Veteran Engagement (SERVE) Toolkit, which was released in 2018. Next, VA's Office of Rural Health funded the Growing Rural Outreach through Veteran Engagement (GROVE) Center in 2020 to focus on involving rural Veterans in research.

"Creating more of these Veteran engagement spaces for rural Veterans is harder to do than at our urban academic centers," said Fehling, who also serves as GROVE's co-leader.

GROVE Hub is a regularly updated digital platform where Veterans and caregivers far from research centers can learn about opportunities and connect with project leaders. It also provides online resources for researchers interested in collaborating with rural Veterans and caregivers.

Today, Veteran engagement plans are a required element in all HSR research proposals, and more than 37 Veteran engagement groups-and counting-work with researchers nationwide, most through COINs or Consortia of Research (COREs).

"It gives the Veterans a chance to make their mark and to say: 'We can help this investigator do this really important work. They may not be able to get it right without us','" said Ray Facundo, Army Veteran, GROVE project manager, and health science specialist at VA's Denver-Seattle Center of Innovation. "They love hearing about new projects, and they love being able to influence different parts of them throughout the whole journey."

The members of the Growing Rural Outreach through Veteran Engagement (GROVE) Center staff.

The views expressed in this publication are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.