The purpose of this study is to evaluate the efficacy of a gender-sensitized social-connectedness physical activity program in relation to key markers of well-being among military veteran men over 6 months.
The transition to civilian life can bring about substantive challenges for military veterans. Particular challenges include a loss of identity, feelings of loneliness and isolation, difficulties with finding and retaining employment, substance misuse, and problems adjusting to very different work and cultural environments. A growing body of scientific evidence also indicates that military veterans are at notable risk of depleted mental health (e.g., depression, suicide ideation). The study involves broadening the evaluation (e.g., assess its impact on mental and physical health) and reach (e.g. extend to other Canadian cities) of a recently developed pilot program, Purpose After Service through Sport (PASS), which was completed in Vancouver in 2020 and assessed for its feasibility and acceptability. The results from this pilot study revealed that the program was well-received (by both military leadership and veterans themselves), fostered a sense of social connectivity among veterans, resulted in (self-reported) physical and psychological health benefits, and displayed considerable potential for scale up and evaluation using a randomized controlled trial (RCT) design. The PASS Randomized Trial draws from the empirical evidence related to (a) the mental health benefits of regular physical activity, (b) benefits of group-based programs that foster social connectivity, (c) the importance of, and potential derived from, developing and implementing gender-sensitized programs, and (d) the pilot study described above.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
SINGLE
Participants randomized to this condition will be invited to take part in weekly ball hockey games (once per week), that will last approximately 60 minutes, and will be followed by opportunities to socially connect afterwards. The results of our feasibility study indicated that the PASS program acted as an important conduit to direct participants to other support services and resources (e.g., counseling, career transition centre, employment, education). Military veteran men are often reluctant to access such supports, especially if they attach stigma to such services (e.g., mental health services). At each site, a military veteran will be trained as a facilitator to operate as a conduit to refer participants to the relevant support services and agencies.
University of British Columbia
Vancouver, British Columbia, Canada
Change in well-being (psychological flourishing) over the course of the intervention
Diener's (2010) flourishing scale will be used in the baseline survey, and will be in each monthly survey to track changes in flourishing over the study period. There are 8 items, phrased in a positive direction. Scores can range from 8 (strong disagreement with all items) to 56 (strong agreement with all items), with higher scores indicating individuals who have a more positive view of themselves in important areas of functioning.
Time frame: Tracked monthly for 6 months (baseline, followed by 6 months of intervention)
Changes in life satisfaction over the course of the intervention
Life satisfaction will be assessed using the 1-item question by Fleeson (2004), with responses anchored from 0 to 10 where 0 means "the worst possible life overall" and 10 means "the best possible life overall".
Time frame: Tracked monthly for 6 months (baseline, followed by 6 months of intervention)
Change in global physical and mental health over the course of the intervention
Global indicators of physical and mental health will be assessed using items by Hays et al. (2009), each anchored on a 5-point scale (1 = "poor", 5 = "excellent") with higher scores reflecting better physical and mental health.
Time frame: Tracked monthly for 6 months (baseline, followed by 6 months of intervention)
Change in stress over the course of the intervention
The 1-item Statistics Canada (2012) stress question will be used in the baseline survey and in monthly surveys to track changes in psychological stress over the study period. The SCSQ is a 1-item question, with responses anchored on a 5-point scale, with a possible scoring of 1 ("not at all stressful") to 5 ("extremely stressful"), with higher scores indicating more stress.
Time frame: Tracked monthly for 6 months (baseline, followed by 6 months of intervention)
This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.
Change in anxiety over the course of the intervention
The 7-item generalized anxiety disorder scale (Spitzer et al., 2006) will be used to assess anxiety symptoms. Items are anchored on a 4-point scale (0 = "not at all" to 3 = "nearly every day") with higher scores indicative of more frequent experience of anxiety symptoms.
Time frame: Tracked monthly for 6 months (baseline, followed by 6 months of intervention)
Change in post-traumatic stress disorder symptomology over the course of the intervention
The 20-item PTSD checklist for diagnostic and statistical manual of mental disorders-fifth edition (Bovin, 2016) will be used to assess PTSD symtomology. Items are anchored on a 5-point scale (1 = "not at all", 5 = "extremely") with higher scores reflective of higher levels of PTSD symptomology.
Time frame: Tracked monthly for 6 months (baseline, followed by 6 months of intervention)
Change in depression over the course of the intervention
The 10-item center for epidemiologic studies depression scale by Andresen et al. (1994) will be used in the baseline survey, and will be in each monthly survey to track changes in depression symptoms over the study period. The possible range in scores is 0 to 30 depending on number of symptoms, with those symptoms weighted by frequency experienced in a week. Higher scores indicate more or more frequent symptoms.
Time frame: Tracked monthly for 6 months (baseline, followed by 6 months of intervention)
Change in resilience over the course of the intervention
The brief resilience scale by Smith et al. (2008) will be used in the baseline survey, and will be in each monthly survey to track changes in resilience over the study period. This instrument uses a mean scoring system with a possible range in scores from 1-5; higher scores indicate the individual perceives they have a better ability to 'bounce back' and recover from stressful events and/or situations.
Time frame: Tracked monthly for 6 months (baseline, followed by 6 months of intervention)
Change in social identification over the course of the intervention
The degree to which participants in the intervention condition identify with others in the program will be assessed using items adapted from the 4-item scale by Doosje et al. (1995). Note that this measure will only be administered to participants in the experimental (i.e., intervention) condition. Items are anchored on a 7-point scale (1 = "strongly disagree", 7 = "strongly agree") with higher scores reflecting greater social identification with the group.
Time frame: Tracked monthly for 6 months (baseline, followed by 6 months of intervention)
Change in social connectedness over the course of the intervention
Social connectedness will be assessed using the 20-item social connectedness scale - revised (Lee et al., 2001). Items are anchored on a 6-point scale (1 = "strongly disagree", 6 = "strongly agree") with higher scores reflecting greater social connectedness with others.
Time frame: Tracked monthly for 6 months (baseline, followed by 6 months of intervention)
Change in loneliness over the course of the intervention
Loneliness will be assessed using the 3-item loneliness scale (Hughes et al., 2004) in which items are anchored on a 3-point scale (1 = "hardly ever", 3 = "often") with higher scores reflecting greater loneliness.
Time frame: Tracked monthly for 6 months (baseline, followed by 6 months of intervention)
Change in leisure-time physical activity over the course of the intervention
Leisure-time physical activity will be assessed using a modified version of the leisure score index (Courneya et al, 2004) that has been applied to Godin's leisure time exercise questionnaire (Godin \& Shepard, 1985). Participants report the frequency per week and time per exercise session of any mild, moderate, or strenuous exercise that participants complete.
Time frame: Tracked monthly for 6 months (baseline, followed by 6 months of intervention)
Change in sleep quality over the course of the intervention
Sleep quality will be assessed using the 1-item measure developed by Buysse et al. (1989), that is anchored on a 4-point scale (1 = "very bad", 4 = "very good") with higher scores reflective of better sleep.
Time frame: Tracked monthly for 6 months (baseline, followed by 6 months of intervention)
Program adherence over the course of the intervention
Assessed using program logs maintained by location managers (intervention condition only).
Time frame: Weekly attendance at PASS program sessions over 6 month intervention
Access and use of health services over the course of the intervention
Assessed, among intervention participants only, with a single question, "As a result of the PASS program, have you accessed support services for any of the following areas of need?", followed by an indication of which services were accessed, if any.
Time frame: Assessed over 6 months (descriptive measure)