Bridging the siloed landscape of health and wellness programming in the military: A systems approach to integration and communication

Abstract: INTRODUCTION: The U.S. Coast Guard and the Department of Defense have implemented numerous health, wellness, and prevention programs aimed at improving readiness and supporting the holistic well-being of service members and their families. These include healthcare services, behavioral health interventions, Armed Forces Wellness Centers, Integrated Primary Prevention efforts, the Holistic Health and Fitness program, and family support initiatives. However, these programs often operate in silos, with limited cross-program coordination, fragmented communication, and inconsistent user experiences. This study explores these challenges within the Coast Guard to inform systems-level recommendations for improved integration, visibility, and user-centered delivery across the military health and wellness landscape. MATERIALS AND METHODS: This study employed the elaborated Action Design Research methodology, which supports iterative problem-solving through cycles of diagnosis, engagement, reflection, and learning. Three diagnosis cycles were conducted, involving semistructured interviews with Coast Guard service members, family members, and senior leaders. Qualitative data analysis was guided by thematic analysis, drawing on structured coding techniques commonly used in qualitative research. Systems theory served as the conceptual framework to examine dynamic interdependencies and structural misalignments across the Coast Guard's health and wellness ecosystem. The study was exempt from Institutional Review Board review by Lake Erie College of Osteopathic Medicine. RESULTS: Five core themes emerged across stakeholder groups and diagnosis cycles: (1) fragmentation of services; (2) inconsistent and decentralized communication; (3) limited awareness and access to available resources; (4) disconnect between leadership intent and user experience; and (5) lack of structured feedback mechanisms. Participants described disconnected programs and services, scattered communication channels (outdated apps, isolated PDFs), and duplication of effort. Service members and their families reported difficulty navigating systems, with some paying out of pocket for services they were technically eligible for but unable to access because of gaps in provider or network coverage. Additionally, feedback mechanisms were described as informal and inconsistent, limiting the military's ability to adapt programs in real-time. CONCLUSIONS: This study highlights the pressing need to transition from a fragmented, program-centric model to a systems-based approach to health and wellness in the Coast Guard. Key recommendations include embedding cross-functional liaisons, establishing recurring interdisciplinary working groups, consolidating digital infrastructure, improving navigation, integrating family engagement, and institutionalizing real-time feedback loops. Implementing these strategies will require a paradigm shift from isolated, expert-led programs to coordinated, user-centered ecosystems. Without this shift, even innovative efforts risk remaining disconnected, duplicative, and insufficient to meet the evolving needs of the force. Aligning structures, strategies, and communication will be critical not only to improve well-being but also to strengthen performance, readiness, and retention across the military.