Table 1
Demographic Characteristics of Participants (N = 23).
| CHARACTERISTIC | PARTICIPANTS |
|---|---|
| Age, mean (SD), range | 52.3 (9.5), 32–72 |
| Ethnicity, n (%) | |
| Caucasian | 20 (87) |
| European | 2 (8.7) |
| Aboriginal | 1 (4.3) |
| Service | |
| Navy | 7 (30.4) |
| Army | 10 (43.5) |
| Air Force | 6 (26.1) |
| Years in the ADF, mean (SD), range | 10.2 (14.3), 1–29 |
| Deployed overseas, n (%) | |
| Yes | 7 (30.4) |
| No | 16 (69.6) |
| Deployment condition(s), n (%) | |
| Warlike | 5 (71.4) |
| Non-warlike | 3 (42.9) |
| Peace keeping | 3 (42.9) |
| Other (surveying) | 1 (14.3) |
| Years since discharge, mean (SD), range | 22.8 (27.1), 0–54 |
| Reason for discharge, n (%) | |
| Medical | 10 (43.5) |
| Voluntary | 7 (30.4) |
| Administrative | 1 (4.3) |
| Other | 5 (21.7) |
| Place of residence, n (%) | |
| Metropolitan/urban | 11 (47.8) |
| Regional | 7 (30.4) |
| Rural/remote | 5 (21.7) |
| Highest level of education completed, n (%) | |
| Year 10 | 3 (13.0) |
| Year 11 or 12 | 2 (8.7) |
| University degree | 5 (21.7) |
| Post-graduate study | 2 (8.7) |
| Vocational | 11 (47.8) |
| Current work status, n (%) | |
| Unemployed | 1 (4.3) |
| Part-time | 1 (4.3) |
| Full-time | 5 (21.7) |
| Volunteer | 1 (4.3) |
| Medical pension | 10 (43.5) |
| Retired | 5 (21.7) |
| Relationship status, n (%) | |
| Single | 1 (4.3) |
| Married | 13 (56.5) |
| Partner/de facto | 2 (8.7) |
| Divorced/separated | 6 (26.1) |
| Other (widow) | 1 (4.3) |
| Pain length in years, n (%) | |
| 0–5 years | 2 (8.7) |
| 6–10 years | 4 (17.4) |
| 11–20 years | 4 (17.4) |
| 21 + years | 13 (56.5) |
| Pain onset, n (%) | |
| Gradual | 10 (43.5) |
| Acute | 13 (56.5) |
| Pain related to ADF service, n (%) | |
| Yes | 22 (95.7) |
| No | 1 (4.3) |
| Which statement best describes your pain?, n (%) | |
| Always present (always the same intensity) | 1 (4.3) |
| Always present (level of pain varies) | 18 (78.3) |
| Often present (pain free periods lasting less than 6 hours) | 3 (13.0) |
| Occasionally present (pain occurs once to several times per day, lasting up to an hour) | 1 (4.3) |
| Diagnosed with mental health condition, n (%) | |
| Yes | 20 (87.0) |
| No | 3 (13.0) |
| If yes, condition(s), n (%) | |
| Posttraumatic stress disorder | 13 (65.0) |
| Anxiety disorder | 16 (80.0) |
| Depressive disorder | 15 (75.0) |
| Panic disorder | 3 (15.0) |
| Alcohol use disorder | 6 (30.0) |
| Substance use disorder | 1 (5.0) |
| Other | 2 (10.0) |
| Currently receive DVA support for chronic pain Approved condition, n (%) | |
| Yes | 16 (69.6) |
| No | 7 (30.4) |
| Do you feel your chronic pain is currently well managed, n (%) | |
| Yes | 11 (47.8) |
| No | 12 (52.2) |
Table 2
Themes and Subthemes Developed from Focus Group Analysis.
| THEMES | SUBTHEMES |
|---|---|
| 1. The female veterans’ pain journey | Understanding military service experiences—recognising adverse cultural norms, malingering stigma, gender-specific challenges, and obligation to follow orders—all shaping pathways to injury and chronic pain. |
| The complex development and progression of chronic pain—a multifactorial journey from injury to management shaped by delayed diagnoses, comorbidities, hormonal and medication influences, and a vicious cycle of factors that perpetuate pain. | |
| Biopsychosocial impacts of pain—encompassing disruptions to career, challenges balancing responsibilities, altered physical activity and functioning, psychological and identity shifts, and experiences of social withdrawal, stoicism, and stigma. | |
| 2. Perceived barriers to obtaining optimal healthcare | Barriers to obtaining optimal care—multifaceted challenges including financial costs, time constraints, limited social support, difficulties finding suitable providers, access challenges with referrals, relocation and geography, and inadequate DVA coverage and individualised care. |
| Systemic factors—Broader challenges with navigating and transitioning between Defence, civilian, National Disability Insurance Scheme (NDIS), and DVA systems. | |
| Dissatisfaction with treatment—experiences of inadequate or dismissive care, confidentiality breaches, poor record handling, and degrading or misogynistic encounters in military and civilian systems. | |
| Awareness of entitlements and services—veteran and provider degree and source of knowledge of available supports for pain recovery/management/compensation. | |
| The weight of self-advocacy—the importance, cognitive load and emotional strain of self-advocating for needs in complex healthcare systems. | |
| 3. Perceptions of and experiences with DVA | Perceptions of and experiences with DVA—mixed interactions shaped by card type, service-related evidence requirements, system mistrust, slow and stressful processes, overtreatment concerns, and rehabilitation consultant experiences. |
| 4. Recommended facilitators for optimal healthcare | Recommended facilitators for optimal care—inclusive access to effective, holistic pain management, trauma-informed and gender-specific care, peer support, and increased female veteran-focused services. |
| Provider preferences—desire for clinicians who are ADF culturally competent, attentive and validating communicators, female or women’s health specialists, and who offer consistent, long-term care to support trust and therapeutic continuity. | |
| Recommendations for practitioner education—inclusive tools and training on military culture, DVA processes, women’s health and service-specific stressors for chronic pain, tailored for both general practitioners (GPs) and allied health professionals. |
Table 3
Participants’ Suggestions for Development of an Educational Resource for Healthcare Professionals.
| DOMAIN | RECOMMENDATION |
|---|---|
| Design and format | Checklist of (female) veteran-specific questions that should be asked as a component of a primary intake assessment |
| Video format with case scenarios | |
| Content | Resources and services available for veterans on White Cards |
| The extent of female involvement in specific military roles, basic training regimes, combat, etc., and considerations required to accommodate for female physiological, biomechanical, and ergonomic differences | |
| Military-specific stressors on the body, tailored to each service branch and specific job roles | |
| Understanding of compensable DVA claims processes | |
| Greater women’s health knowledge and impact of pregnancy, hormones, etc. on pre-existing injuries | |
| Current pain management protocols and treatments | |
| Overview of military culture and lifestyle | |
| Implementation | On-boarding training module to prepare clinicians for treating veterans |
| Extend scope and target to not only GPs, but Allied Health professionals as well |