Dr Vivien Sabel

This PhD adopted a compassionate engagement approach, beginning with a scoping review that informed a three-phase study grounded in a bioecological framework of human development. The study explored barriers to engagement in health-related activities within the veteran community. It began with co-design consultation and attempted recruitment for a compassion-focused therapy (CFT) group adapted for physical health, based on prior delivery of CFT in a recovery centre. Recruitment challenges prompted a redesign, with reflexivity and methodological change explicitly incorporated throughout. Three research questions guided the study: (1) How do people connected to the veteran community define it? (2) What barriers and solutions exist for health activity and service engagement? (3) What impact does lived-experience research and co-production have on participants and the researcher? A critical realist stance underpinned reflexive thematic analysis to understand the pertinent themes and the lived-experience influence of the researcher working with the data. Data was collected via individual and dyadic interviews and one focus group, involving 16 participants with varied relationships to military service. Analysis indicated the veteran community extends beyond policy definitions to include families and civilian support personnel, who can experience injuries comparable to armed forces members. While the Armed Forces Covenant seeks to prevent disadvantage for veterans and families, it does not formally recognise civilian support personnel, despite informal inclusion being encouraged. Participants described military life as providing structured social determinants of health, making civilian transition challenging. Barriers included limited human and social capital to navigate complex services, cultural misunderstandings within public systems, and lack of accountability in the charity sector. Suggested solutions included enhanced transitional support (especially for medical discharge), lived-experience education for public services, peer support, greater scrutiny of veteran pathways and charity governance, and strengthening Armed Forces Covenant implementation. Participants valued engagement and co-review, contributing to analysis and outputs. Initial recruitment difficulties may reflect socioeconomic factors affecting motivation and capacity to engage. The bioecological framework offered insight into these influences and informed future development of military-adapted CFT interventions. A compassionate reflective tool was created to support researcher wellbeing and reflexivity. Families, particularly those with children with special educational needs, and individuals with dual military associated roles were identified as under-researched. No prior research was found on the civilian support community, making this study the first to document their lived experience. This highlights the need for further research into whether these groups face structural disadvantage under current policy and practice.