Qualitative exploration of traumatic brain injury-related beliefs among U.S. military veterans

Purpose/Objective: Explore cognitive, affective, and experiential factors that inform veterans' traumatic brain injury (TBI)-related beliefs. Research Method/Design: Qualitative descriptive study of 22 veterans who received care for TBI at a VA Medical Center in the Northeastern United States using directed content analysis. Measures included a semistructured interview, demographic survey, the Alcohol Use Disorders Identification Test-Consumption Items (AUDIT-C), Patient Health Questionnaire-9 (PHQ-9), PTSD Checklist (PCL), Neurobehavioral Symptom Inventory (NSI), and Insomnia Severity Index (ISI). Results: Results were organized according to Leventhal et al.'s (1997) illness perception model, including veterans' self-reports regarding: (a) knowledge of TBI, labels, and symptoms (identity); (b) etiology (cause); (c) the biopsychosocial impact of TBI (consequences); (d) symptom chronicity (timeline); and (e) recovery expectancy and management strategies (controllability). Participants identified common causes of TBI, as well as acute symptoms. Uncertainty was present with regard to TBI nomenclature, recovery expectancies and trajectories, and the impact of co-occurring mental health diagnoses. Conclusions/Implications: Opportunity exists to improve TBI-related education in the course of routine, patient-centered care. Clinicians should take into account the subjective beliefs and experiences, including co-occurring mental health conditions, that inform patients' illness representations to improve patient-provider communication and the quality of TBI care.