Longitudinal Association of Quality of Life and Health Behaviors with Service Member Readiness

Longitudinal Association of Quality of Life and Health Behaviors with Service Member Readiness

Yunnuo Zhu - Naval Health Research Center, San Diego

Sheila Castaneda - Naval Health Research Center, San Diego

Isabel Jacobson - Naval Health Research Center, San Diego

Crystal Lewis - Naval Health Research Center, San Diego

Felicia Carey - Naval Health Research Center, San Diego

Scott Roesch - Naval Health Research Center, San Diego

Rudolph Rull - Naval Health Research Center, San Diego

“The effectiveness of the United States military is largely dependent on the readiness of its military force. While readiness is a broad concept, the Department of War (DoW) has used terms such as “operational readiness” and “individual medical readiness” to identify parts of the framework that contribute to overall readiness. Operational readiness, or the ability of service members, units, and military systems to properly execute assigned functions and complete mission objectives, is critical to optimizing the probability of success in military conflicts while individual medical readiness, or the degree to which a service member is physically and mentally fit for duty, is a component of operational readiness which sustains unit readiness.” (p. 2)

“The identification of health factors associated with readiness within military populations can inform strategies to improve health, well-being, and readiness among service members and their families. However, current screening tools in use do not fully encompass behavioral, psychosocial, and health-related quality of life (HRQOL) factors that may be crucial to promoting service member readiness. HRQOL is the emotional and physical capacity of an individual to function in their daily lives. While there is evidence that certain behaviors (e.g., sleep or substance use) impact readiness and retention, little is known about how such behaviors in conjunction with HRQOL predict readiness.” (p. 3)

“By measuring how HRQOL is associated with these varied measures of readiness outcomes, in conjunction with baseline health factors, the study aimed to assess the potential utility of HRQOL as a meaningful clinical screening tool to assess service member readiness.” (p. 3)

The researchers analyzed baseline measures from the Department of Defense’s Millennium Cohort Study administrative and medical records. They found that “high physical HRQOL scores were associated with all indicators of military readiness except positive military satisfaction. Low physical HRQOL scores were associated with all measured predictors of readiness, not solely with physical indicators of poor readiness. Previous findings from the Millennium Cohort Study found that physical HRQOL was lower among service members injured during deployment, suggesting that service members with low physical HRQOL may have more medical health care needs, resulting in lost workdays or more time spent seeking health care.” (p. 12)

“This study examined HRQOL and health behaviors in relation to several measures of readiness in a large, contemporary study of service members. Findings suggest that HRQOL has the potential to be a useful tool to monitor readiness of service members. Routine assessment of HRQOL starting at baseline and with repeated measures during annual wellness exams in a clinical setting, for example, could be utilized to identify and monitor changes in service member readiness. The brevity of the VR-12 and the consistency of its association with readiness outcomes after adjustment for covariates suggests that it can be an efficient and practical tool in identifying service members who may be struggling with physical or mental readiness. Further research is needed to corroborate the utility of HRQOL as a screening tool to identify individuals with diminished military readiness and to identify actions that can improve HRQOL and subsequently, readiness.” (p. 13)

“While this study had notable strengths, including its longitudinal design, inclusion of service members from all service branches, use of military and electronic health records, and strong statistical power due to the large sample size, there are also limitations to note. Participants were required to complete two study surveys and remain on active duty during both study cycles, which limited the sample size and generalizability of study findings and may have introduced a healthy survivor bias. Second, while there is no “gold standard” measure of readiness, the measures used in this study may not fully encompass military readiness. However, the measures selected for this study were selected to reflect multiple physical and mental facets of military readiness.” (p. 13)

Additionally, “many survey measures are self-reported and may be susceptible to recall error or bias. The military has a strong culture of stoicism; these cultural biases, including a desire to appear strong and mask vulnerabilities, may result in underreporting of physical and mental health issues. Also, it is important to note that while high utilization of non-preventive health care may be an indicator of lack of readiness, low utilization is more nuanced and indicative of multiple, potentially conflicting factors. For example, low utilizers may include service members who do not need non-preventive health care, but also may include those facing barriers to care such as lack of time or child care, or those concerned with potential stigma or career limitations due to care seeking. This study includes many baseline health behaviors such as sleep, drinking, and mental health measures (e.g., baseline probable PTSD and depression), but does not include a comprehensive physical fitness measure such as a physical fitness assessment, which was unavailable for this study and may confound the association between HRQOL and readiness measures.” (p. 13)