Studying military and Veteran health using a life-course approach: Lessons learned from a Canadian record linkage study

Abstract: The Canadian Forces Cancer and Mortality Study (CFCAMS) is an example of a study that uses the life-course approach to research. This article provides an overview of CFCAMS challenges and solutions. Institutional challenges arise from the different mandates of the Department of National Defence and Veterans Affairs Canada. These challenges were addressed by collaboration with Statistics Canada. Data-driven challenges were addressed by data linkage in a secure environment at Statistics Canada. Budget-based challenges could be addressed only for topics that aligned with funded priorities. Human-resource-related challenges include recruitment and retention of experienced personnel, and addressing these challenges is an ongoing issue. These interconnected challenges can leave gaps that result in unrealized stakeholder expectations. Policy-relevant research must incorporate these expectations. Understanding the roles and structures required to generate life-course research can lead to increased influence on policy and practice. Introduction: For military personnel, the life course can consist of pre-military, military, transition, and post-military stages. An example of a life-course approach is the record-linkage Canadian Forces Cancer and Mortality Study (CFCAMS). This article provides an overview of CFCAMS challenges and solutions. Methods: Challenges are organized into four categories: institutional, data driven, budget based, and human resource related. Results: Institutional challenges arise from the different mandates of the Department of National Defence and Veterans Affairs Canada. These challenges were addressed by collaboration with Statistics Canada and endorsement of the life-course research questions by all three departments. Data-driven challenges arise from data collected disjointedly for different stages of the life course. These challenges were addressed by data linkage in a secure environment that respected privacy and confidentiality. Budget-based challenges arise from the financial costs of creating new datasets. These challenges were addressed for topics that aligned with funded priorities. Human-resource-related challenges include recruitment and retention of experienced personnel. These challenges are exacerbated by the complexity of the data linkage environment, and addressing them is an ongoing issue. Discussion: Any research agenda that uses a life-course approach could address many policy-relevant research questions, but this ability is constrained by several diverse, yet interconnected, challenges. Stakeholder expectations may be unrealized when the interrelationship between these challenges leaves unfilled gaps. Collaborative research can only be successfully conducted if challenges in all four categories are addressed. The CFCAMS experience provides an understanding of the roles and structures required to generate research results to influence policy and practice.