Instruments for measuring cultural and social environment well-being among Veterans: A systematic review

Introduction: The transition from military service to civilian life can affect Veterans’ well-being. The Veterans Affairs Canada cultural and social environment (CSE) domain reflects society’s dominant values, beliefs, and attitudes toward Veterans that influence their post-service well-being, including public perceptions, employer attitudes, and service-related characteristics at release (branch, rank, sex). A systematic review was conducted to identify instruments that measure the CSE domain. Methods: MEDLINE, EMBASE, PsycINFO, PTSDpubs, AgeLine, Sociological Abstracts and Social Sciences Abstracts databases were systematically searched to October 17, 2024 for studies reporting on instruments measuring CSE well-being. The risk of bias of eligible studies and psychometric properties of included instruments were evaluated using the COnsensus-based Standards for the Selection of Health Measurement Instruments tool. Three Veteran partners, members of the Canadian Armed Forces, reviewed and assessed the clarity and applicability of relevant instruments. Results: Seven instruments were eligible. Of these, four (57%) demonstrated sufficient structural validity, five (71%) internal consistency, two (29%) cross-cultural validity, one (14%) test-retest reliability, and six (86%) hypothesis testing for construct validity. The Social Well-Being Scale Short Form, Social Production Function Instrument for the Level of well-being Short Form, Deployment Risk and Resilience Inventory 2 and Neighbourhood Thriving Scale (NTS) demonstrated better psychometric properties than the other measures. The Veteran partners indicated that the NTS was the most relevant for capturing Veterans’ CSE well-being, despite being limited in context. Discussion: Among the four most promising instruments, the NTS demonstrated the greatest potential for measuring CSE; however, it requires validation among Veterans.