DRRI Memo

Memo regarding changes to the T3 Survey

All changes made to the approved survey were done to improve the readability and flow of the survey, as well as to reduce participant burden. The changes are described below.

Reorganized the survey sections

The original survey had 26 sections (A thru Z), and sometimes jumped back and forth between topics. For example, a section on educational experiences was sandwiched between sections related to work. We decided to reorganize the survey and combine all of the relevant sections into a corresponding section, i.e., all of the work-related questions now appear together, all of the parenting questions appear together, etc. Although the content is the same, the revised survey now has 17 sections. We also ordered the sections in a way we thought would be the most logical and easy for participants to follow—starting with family, romantic relationships and parenting, followed by work and education sections, then questions about physical and mental health, followed by use of various services (healthcare, family services, vocational and educational services, etc).

Improve instructions and ensure consistency in the timeframes for questions

In the original approved survey, we noticed that several sections were either missing instructions or had instructions that were not very informative (e.g., original sections C, D, F, G, L). In those cases, we added a sentence or two describing the purpose of the set of questions (see revised section A), or added detail to the instructional prompt before the questions (see revised section D; e.g., “During the past six months when you have been working…”). We also noticed that throughout the survey, there was inconsistency in the timeframe the questions were referencing, with some sections not even referencing a timeframe. To decrease confusion and make it easier for participants, we decided that the time frame for most questions should be six months (and three months for mental health questions), and we have revised each section accordingly. Finally, several of the scales/measures were missing response labels for the response options (e.g., on questions where participants responded 1 to 7, only options 1, 4, 7 were given labels). We added response labels to all potential response options throughout the survey wherever they were missing (Original Section D, I, K M,O).

Deleting, Combining, and Restating Questions

We decided to delete several questions from the survey because we decided they were redundant to other questions we asked or because they provided a level of detail that we no longer felt we needed. In the original survey, we deleted questions 12a and 12b from Section I, 11a and 11b from Section M, 22a and 22b from Section D, 16a and 16b from E, and shortened Section L to 12 questions from 18. We also deleted 3 questions from the Service Connected Disability section (Section W in the original), and deleted 2 questions about the importance of education and vocational programs to meeting educational/employment goals (original Sections U and V). We also combined questions where we could. In the parenting section (Original Section M), we deleted two questions that asked if participants had been in a parenting role in the past 30 days and in the past year, and replaced these questions with one question asking participants how long they had been in a parenting role (in months and years). In both the educational and employment/vocational sections (Original Sections U and V), we combined questions 1 and 2 to be more concise. In Section K of the original survey, we now restate the questions as statements and revised the response options to strongly disagree to strongly agree. This is to be more consistent with how similar questions are asked throughout the survey. Section S of the original survey (now Section N, Use of VA Healthcare benefits/services) was not laid out in the best way, was repetitive, and asked for a level of detail in responses that we decided we did not need (e.g., asking how many times they went to the ER or received outpatient care). So we took the information we were requesting in questions 5-24 and combined them into an easy-to-read table where participants could just respond to whether they had used each type of service since deployment at a VA, non-VA, or both VA and non-VA facilities, or they could indicate they had never received that type of care. Thus, we simplified both what we were asking and how we asked it (but the content didn’t change). Finally, in the Romantic Relationships section (Original Section H, now Section B), we revised the response format for the question “How long have you been in your current relationship” from a forced choice option to a free-response option, allowing participants to fill in the months and years (rather than providing them a set number of options).

Additional Questions

In order to improve clarity and enhance the quality of the data, it was also necessary to add a few additional questions to the survey. These questions expanded upon or revised existing questions in the survey. These additional questions will provide further key context to our study findings, and importantly, they do not add to respondent burden.

In the relationship (new Section B), parenting (new Section C), and education experiences (new Section E), we added a question that asked participants who had not served in the specified role why that was the case. We added 12 questions to the post-deployment stress section (new Section K). Since the first approval of the survey, the original measure we included has been revised and updated. The new measure includes additional items, as well as some of the old items. The new measure is now the gold standard measure for self-reported post-traumatic stress symptoms, and so it is important we include it. However, because we used the older version in previous surveys, we need to include both the old and new version to be able to conduct longitudinal data analyses. Because of the overlap between the two measures, we only added the new questions that are part of the revised measure. We added 5 questions to the alcohol section. 4 questions ask for additional information about problem drinking, and 1 question assesses smoking frequency. We added 7 questions that assess beliefs about mental illness (new Section L). We now ask participants to report how much time they have been in school since returning from deployment (new Section E). We now ask participants one question about their type of discharge from military service (new Section M). In new Section O, we now ask a question about satisfaction with VA family services, use of family services outside of VA and about use of three different types of family therapy. In new Section P, we now a question about use of non-VA employment services, and a question about satisfaction with VA employment programs.

Details of changes to the T3 Survey

1. Reordered/combined sections to improve the flow of the survey for respondents

Sec.	Original	Revised	Changes made in the revision:
A	Employment	Family Experiences	Moved section L to Section A, and moved the family-relevant questions from Section Z to the beginning of this section (# of children, living situation); moved marital status question from Section H in the original to new Section A
B	Employment Hours/Performance	Romantic Relationship Experiences	Combined sections H, I, J, K into one section
C	Work Satisfaction	Parenting experiences	Combined sections M and N
D	Work	Work Experiences	Combined Sections A, B,C, D, F, G
E	Education	Education	Moved education question from section Z to Section E;
F	Perceived underemployment	Day-to-day activities	Section O was moved up
G	Work-Family conflict	Current health	Section X was moved up
H	Relationship status	Satisfaction with life	Section Y was moved up
I	Romantic relationship experiences	Feelings and emotions	Section Q was moved up
J	Romantic relationship conflicts	Alcohol and tobacco use	Section R was moved up
K	Relationship Satisfaction	Post-deployment stress	Section P was moved up
L	Family experiences	Beliefs	New section
M	Parenting	Service-connected disability	Moved section W up
N	Parenting satisfaction	Use of health care benefits/services	Moved section S up
O	Day-to-day activities	Use of family services	Moved section T up
P	Post-deployment stress	Use of education/employ. services	Combined sections U and V
Q	Feelings and emotions	Race/ethnicity	New section
R	Alcohol use
S	Use of health care benefits/services
T	Use of family services
U	Vocational Rehabilitation
V	Education & Training
W	Service-connected disability
X	Current health
Y	Satisfaction with life
Z	Additional survey information

Specific Revisions to each of the new sections

Family Experiences

• Time period for answering questions was missing in original; added “past 6 months”

• Added an introductory statement to the instructions clarifying what the set of questions is asking.

• Shortened number of questions from 18 to 12.

Romantic Relationships Experiences

• Changed the response format for how long you have been in current relationship to free response rather than forced choice

• Changed time period to 6 months from 30-days

• Deleted questions 12a and 12b

• For relationship satisfaction measure (Section K in original), questions were restated as statements instead of questions; response format changed from low-high satisfaction to strongly disagree-strongly agree

• Added a 6-month time period for questions since that was missing

• Changed time period for the romantic relationships conflicts to 6 months from 30-days

• Added question asking why people have not been in a relationship

Parenting Experiences

• Added questions about why not serving in a parenting role

• Added question about how long in parenting role; this replaced two similar questions about being in a parenting role in the past 30 days and past year;

• Deleted 2 questions 11a and 11b

• Changed time frame for all questions to past 6 months

Work Experiences

• Changed all time frames to past six months

• Added more detail to the instructions for the satisfaction and perceived over qualification questions

• Deleted questions 22a and 22b from original section D (work functioning)

• Added instructions for original section G (work-family conflict)

• Added response options to all potential response categories

Education Experiences

• Changed time frame to past six months

• Deleted questions 16a and 16b

• Added question about why not in school

• Added question about how much time is spent in school in per week

• Added question about how long they have been in school since leaving military service

Day-to-day activities

• Changed time period to past 6 months

• Added response labels to options that were not previously labeled

Alcohol and Tobacco Use

• Added the timeframe to the overall instructions to simplify the question wording and to avoid repeating it for each question

• Added 4 additional questions about drinking

• Added questions about tobacco use

Post-deployment stress

• Added 12 questions because a new version of the measure was developed; there was some overlap between the old and new versions, so we only added the new items; this was done so that we can continue to do longitudinal analyses using the older form of the scale that participants completed while also using the new version of the scale which will be the gold-standard for self-report measures of PTSD

Beliefs

Added 7 questions assessing beliefs about mental illness

Service Connected Disability

• Added question about separation from service

• Deleted question about status of recent claim application

• Deleted question about pension including adi/assistance

• Deleted question about how important disability payments are in meeting needs

Use of VA Healthcare benefits/services

• Revised this entire section to improve readability and decrease the repetitive nature of the questions; instead of asking questions about how often the care was used and where the care was received, we created a table listing the different types of healthcare and whether they had been used since leaving military service at VA, non-VA, both VA/Non-VA, or not at all. Thus, the overall content of the section did not change and would be easier for participants to respond to.

Use of Family Services

• Added a question about using family services outside of the VA

• Added question about satisfaction with VA family services

• Added 3 questions about use of family therapy/family consultation

Use of Educational and Employment Services/Programs

• Combined questions 1 and 2 in the original voc rehab section

• Added two response options to question about use of Vocational rehab program (other and did not use)

• Deleted question about importance to meeting educational/employment goals

• Added question about use of other non-VA employment services

• Added question about satisfaction with VA employment programs

• Combined question 1 and 2 from the original education/training section

• Deleted question about importance in meeting educational goals