Nutritional Functioning after Mild Traumatic Brain Injury in Military Veterans: Operationalizing a New Approach

Research Objectives To use the International Classification of Functioning, Disability and Health (ICF) to operationalize “nutritional functioning” in military veterans with mild brain injury, by 1) evaluating physical and psychosocial functioning in relation to nutrition, and 2) assessing how veterans’ experiences shape their use of food. Design A convergent mixed methods study comprised of semi-structured interviews and quantitative surveys. Interview guides were developed using the ICF as a framework. Setting Outpatient polytrauma rehabilitation centers at 3 VA medical centers: Palo Alto, California, San Antonio, Texas, and Tampa, Florida. Participants Veterans who served after 9/11, met diagnostic criteria for polytrauma (mild brain injury and 1+ comorbidity), and had received care at 1 of the 3 rehabilitation centers were eligible. 37 veterans completed all surveys and participated in an interview. Interventions None. Main Outcome Measures Themes from survey responses and semi-structured interview data were pooled into core constructs, and influencing factors. Results Nutritional functioning is characterized by 5 core constructs, including food background, nutrition knowledge, meal aptitude, resource navigation, and navigation to/of food spaces. Nutritional functioning is also shaped by 5 influencing factors, including injuries and health conditions, ideological and cultural exposures, relationships, current beliefs, and current behaviors. Conclusions We were able to identify previously unexplored factors that shape how this population conceives of nutrition in their daily lives. In addition to daily struggles arising from their injuries, Veterans strongly identify with military cultural expectations. These expectations not only influence how injured Veterans view nutrition and health, but also shape their perceptions of their injuries and their core identities. As a result, nutritional functioning comprises far more than economic concerns or adequate food access. The results of this study are being used to create a measure of nutritional functioning that can be used to develop integrative nutrition interventions aimed at improving injured veterans’ psychosocial functioning. Author(s) Disclosures This presentation is based on work supported, in part, by the Department of Veterans Affairs, but does not necessarily represent the views of the Department of Veterans Affairs or the US Government.