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Method

Data sources

The study obtained data from two sources: the nominal rolls and the self-report questionnaire. The data from the nominal rolls covered the ADF members’ demographic characteristics—age, sex, rank, Service (Navy, Army or Air Force), service type (currently serving, ex-serving, or reservist)* and Timor-Leste deployment history (deployment or no deployment).

The self-report questionnaire assessed physical, mental and family health and risk and protective factors. It also captured additional demographic information. Scientifically validated measures accounted for most of the questionnaire. Not all sample groups received all measures and questions. For example, participants in the Timor-Leste partner sample were asked questions specifically about their experience of Timor-Leste deployment. In contrast, because the study focused on the family perspective, ADF members were not asked a number of questions. Finally, as noted, ADF members who were MilHOP participants and had consented to linking received only 10 questions and had their data from MilHOP incorporated in the Timor-Leste Family Study database.

The following section describes all the measures and questions; Table 3.1 provides an overview of the questions received by each of the sample groups and lists the maximum number of questions.

The self-report questionnaire measures and questions

All measures and questions in the self-report questionnaire were selected for their relevance to an aspect of the research aims. Measure length, the use of such measures in other studies of military populations, and the availability of Australian normative comparisons were also important considerations. Consultation with the study’s Scientific Advisory Committee and key stakeholders—particularly the Veterans and Veterans Families Counselling Service—also guided the selection of the measures and questions.

Participants were advised that they did not have to answer every question and that if a question distressed them they should refer to the list of support services provided with their questionnaire.

There were six categories of measures and questions:


  • demographic information

  • deployment information

  • physical health outcomes

  • mental health outcomes

  • family health outcomes

  • risk and protective factors.

Demographic information


Partners were asked about marital status, Indigenous status, personal and family history with the ADF, employment, household composition and education. They were also asked to report the number of children living with them and provide details of each child’s birth year and sex.

Deployment information


A set of questions asked partners to list the locations to which or operations on which their ADF member deployed. They were also asked ‘How many deployments has your partner been on since you have been together?’ and ‘Is your partner currently deployed?’ ADF members who were not MilHOP participants were asked to list their deployments.

Another set of questions asked about the partner’s experience of their ADF member’s Timor-Leste deployment and, among other things, sought information about social networks and communication—for example, ‘How often did you communicate with your partner when he/she was deployed to Timor-Leste?’


Physical health

Pregnancy outcomes

Pregnancy outcomes were measured using a 10-item scale for partners’ responses to questions about the outcomes of all their pregnancies or their ADF member’s pregnancies. Among the outcomes listed were ‘child born alive’ and ‘ectopic pregnancy’. For each outcome the partners were asked to note the number of occurrences. The scale was adapted from that used in the East Timor Health Study. An additional question asked whether the partner or their ADF member had visited a doctor to discuss fertility problems.

The Short Form-12v2 Health Survey

The SF-12 (Ware et al. 2002) is a 12-item scientifically validated survey designed to produce a measure of physical and mental health. Responses are provided through Likert scales. An example question is ‘How much time during the past 4 weeks have you felt downhearted and depressed?’ The SF-12 is used in many health studies; the National Health Survey (Australian Bureau of Statistics 2006) is an example.
The Alcohol Use Disorder Identification Test

The AUDIT (Saunders et al. 1993) is a 10-item scientifically validated test designed to produce a measure for the detection of risky drinking. Questions are asked about alcohol consumption, drinking behaviour and dependence, and the consequences or problems related to drinking. Responses are provided through a Likert scale. An example of the questions is ‘How often do you have six or more drinks on one occasion?’ The AUDIT was created by the World Health Organization and is widely used.
Smoking

Smoking behaviour was assessed with two questions: ‘Over your lifetime have you smoked as much as 100 cigarettes or a similar amount of tobacco?’ and ‘Do you currently smoke as much as one cigarette per day (or 1 cigar per week or 1 gram of tobacco per month)?’ These questions have been used in other studies
—for example, the Australian Longitudinal Study on Women’s Health (www.alswh.org.au 2012).

Mental health

Kessler-10

The K10 (Kessler & Mroczek 1994) is a 10-item scientifically validated instrument designed to produce a measure of an individual’s global level of psychological distress. Individuals rate their level of anxiety and depressive symptoms during the preceding four weeks by reporting the frequency of each experience on a five-point scale ranging from ‘all of the time’ to ‘none of the time’. An example of the questions is ‘About how often did you feel depressed?’ The K10 is a well-used measure in many studies—for example, HILDA (the Household, Income, and Labour Dynamics in Australia survey) (www.melbourneinstitute.com/hilda/ 2012).

The Posttraumatic Stress Disorder Checklist – Civilian Version

The PCL-C (Dobie et al. 2002; Weathers et al. 1993) is a scientifically validated checklist designed to produce a measure of the symptoms of PTSD that are identified in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association 2000). Individuals rate how much they have been bothered by a problem in the past month by checking a five-point Likert scale ranging from ‘not at all’ to ‘extremely’. An example is ‘Trouble falling or staying asleep’. The civilian version is most commonly used in research, even in military populations. Additionally, the MilHOP study used it, and it was important to use the same measure in this study to enable data sharing.

Family health

Family Adaptability and Cohesion Evaluation Scale

FACES-IV (Olson et al. 2006) is a scientifically validated scale designed to produce a measure of family functioning. Sixty-two statements about family members are rated on a five-point Likert scale ranging from ‘strongly disagree’ to ‘strongly agree’. An example statement is ‘Family members are very good listeners’. An abridged version of FACES-IV has been used in the US Department of Defense Millennium Cohort Study (www.millenniumcohort.org 2012).
The Work–Family Conflict Scale

The WFC (Netemeyer et al. 1996) is a five-item scientifically validated scale designed to produce a measure of the impact of work interference on home life. Individuals are asked to rate their agreement with each statement on a five point Likert scale ranging from ‘strongly agree’ to ‘strongly disagree’. An example statement is ‘The demands of my/my partner’s work interfere with my/our home and family life’. The scale has been used in studies of military couples—for example, looking at direct and indirect effects of operational tempo on soldiers and spouses (Adams et al. 2005).

The Strengths and Difficulties Questionnaire

The SDQ (Goodman 2005) is a scientifically validated questionnaire designed to produce a measure of the behaviour and emotions of children aged four to 10 and 11 to 17 years. Individuals rate a series of statements for each child living with them as ‘not true’, ‘somewhat true’ or ‘certainly true’. The statements relate to emotional symptoms, conduct problems, hyperactivity and inattention, peer relationship problems, and prosocial behaviour (behaviour aimed at helping others). The impact supplement was also used in the Timor-Leste Family Study. It asks questions about the impact of any reported problems. An example question from the supplement is ‘Do the difficulties upset or distress your child?’. The SDQ is used in the Longitudinal Study of Australian Children (www.aifs.gov.au/growingup/ 2012).

Risk and protective factors

Relationship satisfaction

Relationship satisfaction was measured by three questions exploring consideration of divorce or separation, satisfaction with the marriage or relationship, and the impact of military commitments on the family. An example question is ‘Have you or your spouse/partner ever seriously suggested the idea of divorce or permanent separation within the last year?’ Similar questions are included in the HILDA survey (www.melbourneinstitute.com/hilda/ 2012).
Sources of support: Timor-Leste deployment

Twelve questions measured the availability and use of and satisfaction with services and social networks. Services included those associated with Defence (for example, the Defence Community Organisation) and those available in the general community (such as a general practitioner). Partners were asked to rate how helpful services and networks were while their ADF member was away, on a scale of ‘not helpful’ to ‘quite helpful’ or to note that they ‘did not use this resource’ or ‘resource was not available OR did not know about this resource’.

The Brief COPE

The Brief COPE (Carver 1997) is a scientifically validated instrument designed to produce a measure of emotion-focused and problem-focused coping. In this study partners were asked to respond to statements about the coping styles they used for any problems related to their experience as the partner of an ADF member. Responses are provided through a four-point scale ranging from ‘none of the time’ to ‘a lot’. An example statement from this measure is ‘I’ve been criticising myself’. The Brief COPE is currently used in the LASERR Study (the Longitudinal ADF Study Evaluating Retention and Resilience) (Department of Defence 2012b).
The Quality of Relationships Inventory

The QRI (Pierce et al. 1991) is a scientifically validated inventory designed to produce a measure of a partner’s perception of relationship support, conflict and depth. It consists of 25 questions that are answered through a four-point Likert scale that ranges from ‘not at all’ to ‘very much’. An example question is ‘How often does this person [current relationship] make you feel angry?’ The QRI has been used successfully in studies of married and committed couples (Verhofstadt et al. 2006).
The Woman Abuse Screening Tool

The WAST (Brown et al. 2000) is a scientifically validated tool designed to produce a measure of partner abuse. Partners were asked to rate the level of tension in their relationship and the level of difficulty involved in resolving arguments. Six questions required them to respond on a scale ranging from ‘often’ to ‘never’. An example question is ‘Do arguments ever result in hitting, kicking or pushing?’ Questions similar to those in the WAST are used in the Australian Longitudinal Study on Women’s Health (www.alswh.org.au 2012).

Mental health and service use

Partners were asked if they had sought help in the past year for stress or family problems and if they had been unable to fulfil their usual responsibilities for more than a month in the past five years. Those who answered ‘yes’ were asked to nominate the type of problem (for example, ‘anxiety’), whether it was diagnosed by a doctor, whether they received treatment and, if so, what type of treatment.
Barriers to seeking care

Six items assessed potential barriers to seeking care. On a five-point Likert scale ranging from ‘strongly agree’ to ‘strongly disagree’, partners were asked how each of the listed concerns would affect their decision to seek help. An example concern is ‘People would treat me differently’. Barriers to care items were sourced from the Millennium Cohort Study (www.millenniumcohort.org 2012).
The Duke Social Support and Stress Scale

The DUSOCS (Parkerson et al. 1990) is a scientifically validated scale designed to produce a measure of the amount of support family and non-family relationships provide. Partners were asked to rate how supportive six types of family members (for example, parents) and four types of non-family members (for example, co-workers) were to them on a scale of ‘none’ to ‘a lot’ or ‘there is no such person’. The DUSOCS has been used in a number of different studies
—for example, in a study of clients of family planning clinics (Rohrer & Young 2004).
Partners’ attitudes to the military

Partners’ attitudes to the military were measured by means of a three-item instrument rated on a five-point Likert scale ranging from ‘strongly agree’ to ‘strongly disagree’ or from ‘very high’ to ‘very poor’. An example item is ‘I talk up the Navy/Army/RAAF as a great organisation to be associated with’. This instrument was adapted from the Millennium Cohort Study (www.millenniumcohort.org 2012).

Table 3.1 summarises the measures and question types that the sample groups received.


Table 3.1 Measures and questions received by sample groups

Measures and question types

Maximum questions

Timor-Leste partner

Comparison partner

ADF member

Demographic information

16





a

Deployment questions

4





a

Timor-Leste deployment questions

21



X

X

Pregnancy outcomes

11




X


Short Form-12v2 Health Survey

12





a

Alcohol Use Disorder Identification Test

10





a

Smoking

2





a

Kessler-10

10





a

Posttraumatic Stress Disorder Checklist – Civilian Version

27





a

Family Adaptability and Cohesion Evaluation Scale

62



X


Work–Family Conflict Scale

5







Strengths and Difficulties Questionnaire

33 (1 child)





X

Relationship satisfaction

3







Sources of support: Timor-Leste deployment

13



X

X

Brief COPE

28





X

Quality of Relationships Inventory

25



X


The Woman Abuse Screening Tool

11





X

Mental health and service use

5





X

Barriers to seeking care

9





X

Duke Social Support and Stress Scale

12





X

Partners’ attitudes to the military

34





X

a. Data obtained from the MilHOP study if ADF member had participated in that study and consented to data sharing.

Recruitment


Recruitment of participants involved a three-stage approach that was approved by the ethics committees (see Figure 3.2).



Figure 3.2 The recruitment procedure

Invitations


The majority of ADF members were invited by email because the study team considered this would encourage members to complete their questionnaire online. (The link to the online consent form and questionnaire was provided in the email invitation.) Additionally, email is a speedier and cheaper communication method than post. Email addresses were obtained from the nominal roll. ADF members who did not have an email address listed on the nominal roll were sent an invitation by post.

The partners of ADF members were invited by email or post, depending on what contact information was provided in the nominal roll or by their ADF member. All partners were sent an invitation and a consent form. They were able to decide independently if they wished to participate in the study.

The invitation packages (both online and postal) contained the following:


  • an invitation to participate in the study from the chief investigator

  • an information sheet

  • a consent form

  • a letter of support for the study from the DVA Repatriation Commissioner

  • a list of support and counselling organisations available to serving and ex serving ADF members and their families

  • the Australian Defence Human Research Ethics Committee’s Guidelines for Volunteers.

Reminders

The Timor-Leste Family Study ethical approvals required that the sample not be contacted within two weeks of a previous contact. Individuals from the sample who had not responded (that is, neither consented to nor declined participation) two weeks after their initial invitation were sent a reminder card, by either email or post depending on how they were sent their invitation.

Phone follow-up


The phone numbers of individuals who did not respond to an email or postal reminder were given to a team of trained telephone contact staff. (The phone numbers had been obtained from the nominal rolls.) The phone team were police checked, had signed confidentiality agreements, and did not have access to participants’ questionnaire responses.

The phone team discussed the study with individuals to determine whether they had received an invitation and to explain what participation involved. The team particularly encouraged ADF members who were not MilHOP participants to consent to providing their partner’s contact details to the study team so that the number of partners invited to participate (that is, the partner sample) increased. All interactions with individuals were logged following a strict protocol.


Promotional activities


The study team also engaged in promotional activities in order to encourage participation. Articles and posters were placed in Defence and veteran community magazines, newspapers and newsletters and on websites.

Questionnaire administration


Participants could elect to complete their questionnaire online or in hard copy. Ninety-four per cent chose online completion.

The advantage for an online participant compared with a hard-copy participant was that the online questionnaire provided customised questions based on previous responses; that is, some questions were not displayed if previous responses revealed that these questions were not relevant to the participant (this included the child questionnaires).


Hard-copy questionnaires were mailed to participants on request. Two copies of each of the four to 10 years and 11 to 17 years child questionnaires were sent with every hard-copy partner questionnaire. The study team advised partners wishing to complete the questionnaire on paper and who had more than two children in the same age group to contact the team for additional copies. The child questionnaires could also be downloaded on the Timor-Leste Family Study website.

Analysis procedures


Data were analysed using the statistical analysis programs SAS 9.2, Stata 10.0 and SPSS19. Specific analyses were adjusted for age, sex and education status, as well as for Service (Navy, Army or Air Force) and rank (officer or enlisted) to account for differences in demographics between the Timor-Leste and comparison groups when assessing the effects of the Timor-Leste deployment. The demographic variables adjusted for in the analysis were chosen before analysis began; they were chosen on the basis of evidence in the literature. Because of rounding, percentages presented throughout this report might not add to 100.




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