title: Facilitating culture-centered communication between health care providers and veterans transitioning from military deployment to civilian life.
abstract: OBJECTIVE
  To describe returning veterans' transition experience from military to civilian life and to educate health care providers about culture-centered communication that promotes readjustment to civilian life.
  
  
  METHODS
  Qualitative, in-depth, semi-structured interviews with 17 male and 14 female Iraq and Afghanistan veterans were audio recorded, transcribed verbatim, and analyzed using Grounded Practical Theory.
  
  
  RESULTS
  Veterans described disorientation when returning to civilian life after deployment. Veterans' experiences resulted from an underlying tension between military and civilian identities consistent with reverse culture shock. Participants described challenges and strategies for managing readjustment stress across three domains: intrapersonal, professional/educational, and interpersonal.
  
  
  CONCLUSIONS
  To provide patient-centered care to returning Iraq and Afghanistan veterans, health care providers must be attuned to medical, psychological, and social challenges of the readjustment experience, including reverse culture shock. Culture-centered communication may help veterans integrate positive aspects of military and civilian identities, which may promote full reintegration into civilian life.
  
  
  CONCLUSIONS
  Health care providers may promote culture-centered interactions by asking veterans to reflect about their readjustment experiences. By actively eliciting challenges and helping veterans' to identify possible solutions, health care providers may help veterans integrate military and civilian identities through an increased therapeutic alliance and social support throughout the readjustment process.
authors.affiliation: San Francisco Veterans Administration Medical Center, San Francisco, USA; Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, USA; Department of Medicine, University of California, San Francisco, San Francisco, USA. Electronic address: Christopher.Koenig@va.gov.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Koenig
authors.affiliation: San Francisco Veterans Administration Medical Center, San Francisco, USA; Department of Psychiatry, University of California, San Francisco, San Francisco, USA.
authors.forename: Shira
authors.initials: S
authors.lastname: Maguen
authors.affiliation: San Francisco Veterans Administration Medical Center, San Francisco, USA; Department of Psychology, San Francisco State University, San Francisco, USA.
authors.forename: Jose D
authors.initials: JD
authors.lastname: Monroy
authors.affiliation: San Francisco Veterans Administration Medical Center, San Francisco, USA; Department of Medicine, University of California, San Francisco, San Francisco, USA.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Mayott
authors.affiliation: San Francisco Veterans Administration Medical Center, San Francisco, USA; Department of Psychiatry, University of California, San Francisco, San Francisco, USA; Department of Medicine, University of California, San Francisco, San Francisco, USA.
authors.forename: Karen H
authors.initials: KH
authors.lastname: Seal
mesh_terms: D000223:Adaptation, Psychological; D000293:Adolescent; D000328:Adult; D003142:Communication; D003469:Culture; D005260:Female; D006282:Health Personnel; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008889:Military Personnel / Q000523:psychology*; D018802:Patient-Centered Care; D036301:Qualitative Research; D012917:Social Adjustment; D012944:Social Support; D013313:Stress Disorders, Post-Traumatic / Q000517:prevention & control; D013637:Tape Recording; D014481:United States; D014728:Veterans / Q000523:psychology*
keywords: Culture; Health communication; Military veterans; Patient-centered care; Post-deployment health; Readjustment experience; USA