Decoding Veteran Participation: How to Make Health Research More Engaging
"Unlock insights into how research design and communication can encourage Iraq and Afghanistan veterans to participate in health studies, enhancing veteran healthcare and outcomes."
Recruiting participants for health research can be tough, especially when dealing with specific groups like veterans. Low participation rates can mess with the results, making studies less accurate and more expensive. Military personnel, with their unique backgrounds and values, might respond differently to research requests than civilians.
A recent study published in BMC Medical Research Methodology dives into this issue, focusing on US veterans who served in Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF). The goal? To figure out what motivates these veterans to participate in health research, which could then inform how future studies are designed and promoted.
Using focus groups across the United States, the researchers explored veterans' attitudes toward health studies. The findings offer practical tips for researchers aiming to engage this important population, ultimately helping to improve veteran healthcare through better research.
Measuring Veteran Participation: A Moving Target
Measuring exactly how many U.S. veterans take part in health research is not straightforward, as figures vary across studies, registries, and survey methodologies. Veterans are a sizable and diverse population whose health needs—spanning physical injuries, mental health, and chronic conditions—make reliable research engagement a priority. Available evidence generally points to meaningful shortfalls in participation, but precise numbers remain difficult to pin down without a standardized national reporting framework. For that reason, this article treats participation figures as indicative rather than definitive and focuses on the conditions that shape engagement.
Familiar Methods, Persistent Gaps
The standard approach to involving veterans in health research generally relies on registry- or clinic-based recruitment, mailed or electronic invitations, and outreach conducted through the VA and community organizations. Accepted practice emphasizes formal informed consent, clearly defined study protocols, and transparent data-handling procedures. These methods have known limitations: they can be slow, may only reach veterans already connected to care systems, and may do little to address deeper skepticism about research. As later sections explore, these shortcomings help explain why engagement remains a recurring challenge despite well-established recruitment machinery.
From Civil War Hospitals to a Century of VA Research
Veterans' health care in the United States traces its roots to the Civil War era. On March 3, 1865—a month before the war ended and the day before his second inauguration—President Abraham Lincoln signed a law establishing a National Soldiers and Sailors Asylum, later renamed the National Home for Disabled Volunteer Soldiers (NHDVS). World War I brought a major expansion when, in 1918, Congress tasked two Treasury agencies—the Bureau of War Risk Insurance and the Public Health Service—with operating hospitals specifically for returning veterans, creating the second largest system of veterans' hospitals. On the research side, the VA Medical Bulletin underscored the idea of a hospital-based research program seeking methods to cure disease through systematic bedside observation with an emphasis on outcomes. VA Research has since marked its 100th anniversary, with the program stating that virtually every American will benefit from a drug, therapy, treatment, or device developed through it at some point in their life.
The Veteran's Perspective: Key Motivators & Deal-breakers
The study pinpointed several factors that influence a veteran's decision to join a health study. These aren't just nice-to-haves; they're essential for building trust and ensuring veterans feel valued and respected throughout the process:
- Adequate Compensation: Recognizing the value of their time and contribution.
- Desire to Help Other Veterans: A strong sense of duty and camaraderie.
- Significance and Relevance of the Research: Understanding the impact and importance of the study.
An Evolving Evidence Base
Ongoing work on veteran participation in health research continues to evolve, with recent studies examining who takes part, how participants are reached, and what barriers and facilitators matter most. The peer-reviewed literature increasingly documents both motivations—such as research that speaks to issues veterans care about—and persistent obstacles such as mistrust. Because findings draw on varied cohorts and methods, conclusions in this area are best treated as preliminary. Readers should interpret summary figures cautiously until more standardized evidence accumulates across the field.
Mistrust, Barriers, and the Case for Participation
Engagement efforts do not always succeed, and the sources point to real headwinds. The veteran population may face barriers to research participation similar to those they encounter in accessing social and healthcare support—most notably a general mistrust of the research process. The U.S. Department of Veterans Affairs also contracts with private-sector providers to help ensure eligible veterans receive timely care, yet questions remain about the cost and quality of those services, and community care does not by itself resolve deeper participation shortfalls. Still, reasons to participate exist: for gender-diverse population groups, the role research can play in increasing understanding of the social, political, and health issues that affect them was identified as a facilitator for joining military health research. RAND's body of work likewise documents the physical and mental health, interpersonal, and employment problems that U.S. military veterans and their families face—problems that underscore why engagement matters even where it fails.
What Comparisons Reveal About Veterans and Participation
Comparative work highlights how veterans' experiences differ depending on where and how they get care. A December 2024 survey study in JAMA Internal Medicine reported veterans' perceptions of the timeliness, patient-centeredness, affordability, and quality of the care, services, and facilities they receive across the U.S., underscoring that VA and non-VA experiences are not interchangeable. On the participation side, RAND researchers investigated why veterans participate in many public assistance programs—including the Supplemental Nutrition Assistance Program (SNAP)—at lower rates than nonveterans, and detailed an approach for consistently estimating participation differences across veteran and nonveteran populations. A cross-sectional comparison of social drivers of health (SDOH) examined two cohorts of U.S. veterans who independently took part in research: the Department of Veterans Affairs (VA) Million Veteran Program (MVP) and the Behavioral Risk Factor Surveillance System (BRFSS). Taken together, these comparisons show that which veterans participate, and through which system, can materially shape what research finds.
Making Research Veteran-Friendly: Practical Takeaways
This research highlights that OEF/OIF veterans value trust, transparent communication, and respect when considering participation in health-related research. Researchers can use these insights to:
Engagement as a Partnership, Not a Recruitment Tactic
Across the evidence, a consistent theme emerges: engagement improves when research is designed with veterans rather than simply for them. Developing best practices in community-engaged research with veterans has the potential to draw on shared experiences to overcome barriers, build on facilitators, and improve research processes and outcomes—an approach rooted in a long tradition of community involvement in public-health research. Supporting infrastructure already exists: SSRS uses its nationally representative SSRS Opinion Panel of U.S. households to help researchers, policymakers, and organizations better understand the lives and experiences of those who have served, while NORC at the University of Chicago highlights that America's 18 million veterans have diverse experiences ranging from post-9/11 wounded warriors navigating recovery to Vietnam-era veterans managing long-term health conditions. As these sources emphasize, thoughtful, evidence-based research is essential to capturing the full range of veteran perspectives.
Toward More Adaptable Engagement Models
Looking ahead, the next wave of veteran research engagement will likely be defined by new recruitment and data-collection methods rather than incremental tweaks to existing ones. Developments in digital platforms, electronic health records, and community partnerships all hold promise, though their real-world impact is still being assessed. It is reasonable to expect growing attention to underserved subgroups—such as rural veterans and those recently separated from service—and to transparency about how data are used. Because these directions remain in flux, this outlook is deliberately conservative: the specific mechanisms that will most improve participation have yet to be firmly established in the literature.
The System Around the Research
Veteran health research sits within a larger system that is itself under strain. VA's VA Health Systems Research (HSR) is an intramural program funding eligible VA clinicians and investigators to identify and evaluate innovative strategies that lead to accessible, high-quality, cost-effective care for veterans and the nation. A September 2024 systematic review evaluating the impact of veterans' expanded care legislation underscores the importance of understanding healthcare access and experiences for veterans within the VA system and its programs, flagging areas that need attention such as geographic disparities and improving coordination between VA and community care providers. More broadly, a scoping review notes that military personnel and veterans meet unique health challenges stemming from the complex interplay of their service experiences, the nature of warfare, and their interactions with the health system. These systemic factors shape the context in which any individual recruitment effort must operate.
Veterans as Partners, Not Research Subjects
The human stakes behind participation numbers become visible in work that treats veterans as partners rather than subjects. A qualitative descriptive case study of veteran patient-researcher partnerships provides three key recommendations for engaging military Veterans and/or VA Veteran Patients in research to facilitate sustained teamwork and integration. A companion practical guide draws on combined experience across four case studies of veteran research on sensitive topics to illustrate successful engagement and help overcome veterans' lack of trust in the research process. Together, these sources show that sustained relationships and mutual respect—not one-off recruitment—are what make research meaningful to veterans in practice.
<ul> <li>Clearly Communicate Study Goals: Explain the study's purpose and how it will benefit veterans.</li> <li>Offer Fair Compensation: Acknowledge the time and effort veterans contribute.</li> <li>Build Trust Through Transparency: Provide detailed information about the study's procedures and data security measures.</li> <li>Share Study Results: Keep participants informed about the findings and their potential impact.</li> </ul>
By adopting these strategies, researchers can create more veteran-friendly studies, leading to higher participation rates, more accurate results, and ultimately, better healthcare for those who have served.