A qualitative analysis of experiences in veteran voices and visions groups: developing a participant-informed model of connection, acceptance, and social integration.

PURPOSE/AIMS: This study applied a model of transformation for Hearing Voices Groups in the US developed by Hornstein et al. to Veteran Voices and Visions (VVV) groups adapted for a Veterans Affairs healthcare system. The aims were twofold: (1) identify instances of Discovery, Reframing, and Change and empirically confirm the salience of this model for our groups; and (2) identify the specific dynamics of change in our groups, thus refining and elaborating upon the existing model. METHOD: This study used a qualitative design with in-depth semi-structured interviews that were assessed pre-intervention, at 8 weeks, and at 16 weeks with 24 participants within five groups. Interviews were recorded and transcribed. Abductive analysis of the interview transcripts was conducted, first drawing theoretical insights from Hornstein et al.'s framework to organize and synthesize qualitative data deductively then using inductive rapid qualitative analysis to enrich and develop a theory of change specific to this study population. FINDINGS: While data from this study mostly align with the Hornstein et al. model of transformation, in our data, findings from each phase seemed to emphasize a different theme than that foregrounded in the Hornstein et al. model. We articulate these differences in a refined model of transformation. Our model makes an additional refinement by delineating two distinct tracks: an inner track reflecting how the group influences participants' relationships with themselves and their own experiences, and an outer track reflecting how participants relate to fellow group members. We also consider barriers and facilitators within each phase. IMPLICATIONS: Our findings indicate that the Hearing Voices approach can be successfully adapted to a large public mental healthcare system. They also provide a model for engagement with groups during the initial weeks and months of group attendance. VVV groups provided a valuable setting for connection, acceptance, and community that led to a greater sense of belonging and social integration.