Studying military and Veteran health using a life-course approach: Lessons learned from a Canadian record linkage study

Introduction

The “life-course” approach to research considers how something from one stage of a person’s life (e.g., an experience or exposure) may impact them later in life. In military research, the life course is broadly looked at in four different stages: 1) before military service; 2) during service; 3) transitioning out of service; and 4) life after military service.

The Canadian Forces Cancer and Mortality Study (CFCAMS) is an example of a study that uses the life-course approach as it examines data from during and after military service to assess relationships between military service and health outcomes (cancers and deaths) in serving CAF personnel and Veterans.

What is this research about?

The Department of National Defence (DND), Veterans Affairs Canada (VAC) and Statistics Canada work together on the CFCAMS. This paper looks at the challenges faced with this project and solutions to address them. It is hoped that documenting these experiences from the CFCAMS will support others using a life-course approach in their research.

What did the researchers do?

The researchers examined challenges associated with the CFCAMS project and placed them into four categories: 1) institutional; 2) data; 3) budget; and 4) human resources. The researchers defined these challenges and outlined solutions to help address them.

What did the researchers find?

1. Institutional

Challenge: Many organizations have processes in place to secure information and protect privacy. Though important, these processes can create barriers to health research, particularly when it comes to sharing or combining data with other organizations.

Solution: Find a secure environment that is respectful of the rules of each organization participating in the project. Partnering with Statistics Canada, which has the legislative ability to collect data through the Statistics Act, has facilitated the safe sharing of departmental and other data sets with Statistics Canada in support of the CFCAMS project.

Challenge: When multiple groups are working together, each organization may have different research priorities.

Solution: Work collaboratively to establish a research question that supports the joint vision of the project and also aligns with the research priorities of each organization. Although VAC and DND have different mandates and serve different populations, they were able to come up with a mutually beneficial research question to guide the CFCAMS with the focus of studying the health (especially mortality and cancer) of those with a history of military service (still-serving or released).

2. Data

Challenge: Data on health outcomes are mostly collected for administrative purposes with no thought for potential future research. As a result, the data can be difficult to obtain due to restrictions on the use or sharing of information. The data may also be incomplete or of poor quality for research purposes.

Solution: Create a combined data resource by linking together the available sets of data that support the project. For CFCAMS, DND pay data and provincial/territorial vital statistics databases were securely transferred to Statistics Canada where information was pieced together into an integrated dataset. Piecing together multiple sources of health data into a useful format is time consuming and challenging, but integrated data sources are critical for understanding the complex relationships between a person’s experiences and health outcomes throughout their life.

3. Budget

Challenge: Lack of money is one of the most common barriers to research which has costs associated with accessing and linking data, paying qualified personnel to analyze data, and disseminating research findings.

Solution: Identify research priorities that can be focused on within the project’s budget so, though limited, progress can still be made, while continuing to seek opportunities to expand upon existing resources. With a finite amount of funds available, only a few research questions can be undertaken using the CFCAMS dataset each year.

4. Human Resources

Challenge: For research to be soundly conducted, qualified individuals must be recruited, trained, and retained. This element of research is not only impacted by the above-noted budget challenges, but equally so by the availability of qualified health researchers - a highly specialized field that requires years of post-secondary education and experience.

Solution: Strong recruitment and retention plans, along with adequate financial resources, can help attract and keep experienced health research staff. However, with the limited amount of qualified researchers, human resources-related challenges continue to be an ongoing issue for CFCAMS.

Source

Rolland-Harris E, Bryan S, and VanTil L. Studying military and Veteran health using a life-course approach: Lessons learned from a Canadian record linkage study. Journal of Military, Veteran and Family Health. February 2024. doi.org/10.3138/jmvfh-2022-0071