{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:55:03Z","timestamp":1791215703201,"version":"4.1.0"},"reference-count":17,"publisher":"Oxford University Press (OUP)","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Care for environmental hazards is a particular concern for the Department of Veterans Affairs (VA), which has encouraged \u201cexposure-informed care\u201d (EIC). A recent Delphi study conceptualized 6 core components of EIC (e.g., build trust, assess and document). The current quality improvement project used qualitative interviews with Veterans to understand if and how these core components of EIC are reflected in patient perspectives of their military environmental exposure care at the VA to guide the development of future Veteran-centered tools and education to support the implementation of EIC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>Participants (N\u2009=\u200953) were Veterans who received care at the VA for military environmental exposures. Veterans were interviewed and the team iteratively developed an initial codebook using quotes and supportive statements. The codebook was then applied to the previously established EIC core components and the team identified statements that suggested the presence or absence of EIC.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Findings suggest that when asked broadly about their care for exposure-related conditions, EIC core components are reflected in patient perspectives. The presence and absence of all 6 EIC components were found in Veterans\u2019 perspectives of their exposure-related healthcare. Veterans described specific actions from their providers and VA that were important to EIC. Their descriptions suggest the core components work synergistically to impact perceptions of care for military exposures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>The results of this project suggest that future tools to support the implementation of EIC should address EIC core components. Veterans described actions from providers and VA identified as EIC and may be used to design strategies to implement EIC. These strategies should consider incorporating multiple core components into implementation efforts, since Veterans\u2019 descriptions suggest the core components synergistically work together to impact care for military exposures.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usag424","type":"journal-article","created":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T11:17:27Z","timestamp":1788520647000},"source":"Crossref","is-referenced-by-count":0,"title":["How Veterans Describe Military Environmental Exposure-Informed Care: A Quality Improvement Study"],"prefix":"10.1093","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9280-8100","authenticated-orcid":false,"given":"Rachel L","family":"Boska","sequence":"first","affiliation":[{"name":"The Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System , Little Rock, AR 72205,","place":["United States"]},{"name":"Department of Psychiatry, University of Arkansas for Medical Sciences , Little Rock, AR 72205,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katharine J","family":"Bloeser","sequence":"additional","affiliation":[{"name":"War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System , East Orange, NJ 07018,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikayla B","family":"McAdams","sequence":"additional","affiliation":[{"name":"War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System , East Orange, NJ 07018,","place":["United States"]},{"name":"Mental Health and Behavioral Sciences Services, Providence VA Healthcare System , Providence, RI 02908,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1350-8773","authenticated-orcid":false,"given":"Lisa M","family":"McAndrew","sequence":"additional","affiliation":[{"name":"War Related Illness and Injury Study Center (WRIISC), Veterans Affairs New Jersey Health Care System , East Orange, NJ 07018,","place":["United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,10,5]]},"reference":[{"key":"2026100511260455400_usag424-B1","author":"Vetearns Health Adminsitration","year":"2024"},{"key":"2026100511260455400_usag424-B2","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1097\/JOM.0b013e3182570506","article-title":"Prevalence of environmental and other military exposure concerns in operation enduring freedom and operation Iraqi freedom veterans","volume":"54","author":"Quigley","year":"2012","journal-title":"J Occup Environ Med"},{"key":"2026100511260455400_usag424-B3","doi-asserted-by":"publisher","first-page":"294","DOI":"10.1097\/01.jom.0000184868.77815.2a","article-title":"Environmental history-taking in clinical practice: knowledge, attitudes, and practice of primary care physicians in Italy","volume":"48","author":"Nicotera","year":"2006","journal-title":"J Occup Environ Med"},{"key":"2026100511260455400_usag424-B4","doi-asserted-by":"publisher","first-page":"760","DOI":"10.1007\/s11524-006-9071-4","article-title":"The environment in pediatric practice: a study of New York pediatricians\u2019 attitudes, beliefs, and practices towards children\u2019s environmental health","volume":"83","author":"Trasande","year":"2006","journal-title":"J Urban Health"},{"key":"2026100511260455400_usag424-B5","doi-asserted-by":"publisher","first-page":"550","DOI":"10.1097\/01.jom.0000128153.79025.e4","article-title":"Occupational medical history taking: how are today\u2019s physicians doing? A cross-sectional investigation of the frequency of occupational history taking by physicians in a major US teaching center","volume":"46","author":"Politi","year":"2004","journal-title":"J Occup Environ Med"},{"key":"2026100511260455400_usag424-B6","first-page":"e269","article-title":"Family medicine residents\u2019 knowledge of, attitudes toward, and clinical practices related to environmental health: multi-program survey","volume":"65","author":"Sanborn","year":"2019","journal-title":"Can Fam Physician"},{"key":"2026100511260455400_usag424-B7","doi-asserted-by":"publisher","first-page":"114211","DOI":"10.1016\/j.socscimed.2021.114211","article-title":"\u201cBecause the country, it seems though, has turned their back on me\u201d: experiences of institutional betrayal among veterans living with Gulf war illness","volume":"284","author":"Bloeser","year":"2021","journal-title":"Soc Sci Med"},{"key":"2026100511260455400_usag424-B8","doi-asserted-by":"publisher","first-page":"119757","DOI":"10.1016\/j.lfs.2021.119757","article-title":"Healthcare providers\u2019 perceived learning needs and barriers to providing care for chronic multisymptom illness and environmental exposure concerns","volume":"284","author":"McAndrew","year":"2021","journal-title":"Life Sci"},{"key":"2026100511260455400_usag424-B9","doi-asserted-by":"publisher","first-page":"665","DOI":"10.1007\/s12529-019-09817-z","article-title":"Coping with medically unexplained physical symptoms: the role of illness beliefs and behaviors","volume":"26","author":"Sullivan","year":"2019","journal-title":"Int J Behav Med"},{"key":"2026100511260455400_usag424-B10","author":"Pape","year":"2024"},{"key":"2026100511260455400_usag424-B11"},{"key":"2026100511260455400_usag424-B12","author":"Boska"},{"key":"2026100511260455400_usag424-B13","doi-asserted-by":"publisher","first-page":"75","DOI":"10.1186\/s13012-021-01143-x","article-title":"Implementation science issues in understanding, collecting, and using cost estimates: a multi-stakeholder perspective","volume":"16","author":"Eisman","year":"2021","journal-title":"Implement Sci"},{"key":"2026100511260455400_usag424-B14","doi-asserted-by":"publisher","first-page":"23","DOI":"10.1186\/1748-5908-5-23","article-title":"Part I, patient perspective: activating patients to engage their providers in the use of evidence-based medicine: a qualitative evaluation of the VA project to implement diuretics (VAPID)","volume":"5","author":"Pilling","year":"2010","journal-title":"Implement Sci"},{"key":"2026100511260455400_usag424-B15","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1093\/intqhc\/mzm042","article-title":"Consolidated criteria for reporting qualitative research (COREQ): a 32-item checklist for interviews and focus groups","volume":"19","author":"Tong","year":"2007","journal-title":"Int J Qual Health Care"},{"key":"2026100511260455400_usag424-B16","doi-asserted-by":"publisher","first-page":"i13","DOI":"10.1136\/qshc.2008.029058","article-title":"The SQUIRE (standards for QUality improvement reporting excellence) guidelines for quality improvement reporting: explanation and elaboration","volume":"17","author":"Ogrinc","year":"2008","journal-title":"Qual Saf Health Care"},{"key":"2026100511260455400_usag424-B17","doi-asserted-by":"publisher","first-page":"52","DOI":"10.7748\/nr2011.01.18.2.52.c8284","article-title":"Qualitative data analysis: the framework approach","volume":"18","author":"Smith","year":"2011","journal-title":"Nurse Res"}],"container-title":["Military Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag424\/71604412\/usag424.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article-pdf\/doi\/10.1093\/milmed\/usag424\/71604412\/usag424.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T15:26:06Z","timestamp":1791213966000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/milmed\/advance-article\/doi\/10.1093\/milmed\/usag424\/8865025"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,5]]},"references-count":17,"URL":"https:\/\/doi.org\/10.1093\/milmed\/usag424","relation":{},"ISSN":["0026-4075","1930-613X"],"issn-type":[{"value":"0026-4075","type":"print"},{"value":"1930-613X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,5]]},"article-number":"usag424"}}