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Purpose After Service through Sport (PASS): A Social Identity-Informed Program to Support Military Veteran… Waldhauser, Katrina; O'Rourke, Joseph J.; Jackson, Ben; Dimmock, James A.; Beauchamp, Mark R. (Mark Robert), 1972- 2020-11-04

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PASS  1       Purpose After Service through Sport (PASS): A Social Identity-Informed Program to Support Military Veteran Well-Being  Waldhauser, K. J.1, O’Rourke, J. J. 1, Jackson, B.2, Dimmock, J.A.3, & Beauchamp, M. R. 1 1 School of Kinesiology, University of British Columbia 2 School of Human Sciences (Exercise and Sport Science), University of Western Australia 3 Department of Psychology, James Cook University  Corresponding Author: Mark R. Beauchamp 1-604-822-4864 mark.beauchamp@ubc.ca 122-6081 University Blvd Vancouver, BC, Canada, V6T 1Z1  Declaration of Interest  None. Acknowledgments  This study was funded by a Joseph Armand Bombardier Canada Graduate Scholarship from the Social Sciences and Humanities Research Council (SSHRC) of Canada to the first author and a SSHRC Explore Grant to the last author. The funding source did not have a role in any aspect of the study, including study design, data collection, analysis and interpretation of the data, writing, and decision to submit for publication.   IN PRESS (accepted November 4, 2020) -- Sport, Exercise, and Performance Psychology (American Psychological Association)  © 2020, American Psychological Association. This paper is not the copy of record and may not exactly replicate the final, authoritative version of the article. Please do not copy or cite without authors' permission. The final article will be available, upon publication, via its DOI: 10.1037/spy0000255   PASS  2  Abstract 1 Veterans who transition out of the military often face substantive challenges during their move to 2 civilian life, which include identifying appropriate opportunities for employment, supporting their 3 respective families, and developing high-quality social connections within their civilian lives more 4 generally. The importance of social connectivity, in particular, has recently been highlighted as an 5 important mechanism that can facilitate improved mental health and quality of life among veterans, 6 and represents a viable target for intervention. The purpose of the study was to examine military 7 veterans’ experiences of Purpose After Service through Sport (PASS) which is a sport-based 8 program, in Canada, underpinned by the social identity approach. We recruited 12 participants (Mage 9 = 39.83, SD = 8.07, Myears of service = 15.63, SD = 9.60), and using semi-structured interviews and 10 reflexive thematic analysis, identified several aspects of the program that participants experienced 11 and considered important. These included a variety of positive benefits (mental and physical health, 12 social connections, and access to resources), as well as military identity as a means of supporting 13 social connectivity. Participants also commented on salient environmental features of the program 14 that supported their involvement, as well as suggestions for program refinement. The study provides 15 evidence for the feasibility and acceptability of the PASS program as well as insight into veterans’ 16 experiences of this initiative. Future research should examine the efficacy/effectiveness of the PASS 17 program to support effective transitions and quality of life outcomes among military veterans using 18 causal (e.g., randomized trial) research designs. 19  Keywords: veterans; military; social identity; group dynamics; sport   20 PASS  3  Purpose After Service through Sport (PASS): A Social Identity-Informed Program to Support 21 Military Veteran Well-Being 22  Upon completion of military service, many veterans are at increased risk of mental health 23 deficits, including depression (Blore, Sim, Forbes, Creamer, & Kelsall, 2015), combat-related post-24 traumatic stress disorder (PTSD; Xue et al., 2015), as well as suicide (Bryan, 2015). One aspect that 25 contributes to these mental health challenges involves the transition from military to civilian life. 26 Military training requires an adoption of a new identity (based on selfless service, sacrifice, 27 discipline, and an emphasis on adopting a collective rather than personal identity) that is often 28 regarded as more important than previously held civilian identities (Shields et al., 2016). The 29 transition from a highly structured environment, designed to prepare individuals to respond to 30 emergencies and war, is in stark contrast to the norms and daily tasks experienced in civilian life. 31 Adjustment to civilian life can include difficulties regarding newfound autonomy, relating to non-32 military others, finding and maintaining employment (Keeling, Kintzle, & Castro, 2018), and a loss 33 of identity (Binks & Cambridge, 2018).  34 Although some veterans adapt well in their transition to civilian life (e.g., Van Til et al., 35 2017), many struggle with the adjustment. It is these veterans who are most difficult to reach and 36 support once they leave the military (Shields et al., 2016). In addition, there is evidence to suggest 37 that the variety of support services provided by governments are underutilized. For example, the 38 2010 Life After Service Study reported that more than a third (39%) of Canadian veterans with 39 mental health conditions, who were not receiving services provided by Veterans Affairs Canada, had 40 difficulty adjusting to civilian life (Thompson et al., 2012). In part, this is attributable to the well-41 known challenges of help-seeking behaviour in military cultures (and masculine cultures more 42 broadly) (Shields et al., 2016). This is particularly true for seeking services related to mental health 43 PASS  4  deficits due to stigma that sometimes accompanies such services (compared to, for example, seeking 44 employment services).  45 With a view to understanding the types of activities and programs that can be utilized to 46 support veterans, researchers have sought to explore the potential beneficial effects of sport and 47 exercise for veterans’ health and well-being. For instance, in a systematic review of the effects of 48 sport and physical activity on the well-being of combat veterans, Caddick and Smith (2014) found 49 that sport and physical activity programs resulted in enhanced well-being across a variety of 50 measures (e.g. positive affect, quality of life, subjective well-being). They found that across a range 51 settings (from Paralympics to multi-day sport camps), 8 of 11 studies reported that veterans 52 experienced enhanced social well-being through social support (e.g., camaraderie with other 53 veterans). Recent work has also focused on the potential treatment effects of exercise-as-medicine in 54 supporting veterans’ mental health (Caddick & Smith, 2018), in particular for veterans experiencing 55 mental health challenges, such as PTSD and combat-related trauma (Caddick & Smith, 2014). Other 56 work has examined the experiences of veterans involved in specific competitive events such as the 57 Invictus Games (Roberts et al., 2019, 2020), while others have explored the potential of specific 58 physical activities, such as surfing, to alleviate PTSD symptomology (Caddick, Smith, & Phoenix, 59 2015).  60 As a complement to this body of work, a growing body of evidence has highlighted the 61 importance of social connectivity, in particular, for supporting mental health and quality of life 62 among veterans (Kintzle, Barr, Corletto, & Castro, 2018). Research in the physical activity domain 63 has highlighted the value of participating in groups, in particular, by harnessing the power of both 64 social connectivity and physical activity, a means of supporting participant well-being (Beauchamp 65 & Rhodes, 2020; Ruissen et al., 2020). This work has been conceptualized as a ‘new psychology of 66 health’ (C. Haslam, Jetten, Cruwys, Dingle, & Haslam, 2018), underpinned by the tenets of social 67 PASS  5  identity (Tajfel & Turner, 1979) and self-categorization (Turner, Hogg, Oakes, Reicher, & Wetherell, 68 1987) theories, under the moniker of the social identity approach (C. Haslam et al., 2018; Turner, 69 1985; Turner et al., 1987; Turner, Oakes, Haslam, & McGarty, 1994). This approach posits that 70 group processes are “fundamentally grounded in people’s capacity to define themselves in terms of 71 their social identity” (p. 5, S. A. Haslam et al. 2020,)—their sense of self as a member of a social 72 group (Turner, 1982). One method of creating health-enhancing social connections is through 73 sharing a group membership, or identity with others. Social identities “define who we are” and 74 “provide us with belonging, meaning, and a sense of purpose” (Jetten et al., 2017, p. 797). In other 75 words, individuals derive a sense of meaning from the groups with which they self-identify. When 76 social identities are made salient, people become aware of the similarities that are shared among 77 others with that same group membership (Jetten et al., 2017). A considerable body of evidence has 78 emerged over the past decade which supports the notion that social identities are central to health and 79 well-being (Beauchamp & Rhodes, 2020; C. Haslam, Jetten, Cruwys, Dingle, & Haslam, 2018; S.A. 80 Haslam, Haslam, Jetten, Cruwys, & Bentley, 2019; Steffens et al., 2019). In particular, the results of 81 a recent meta-analysis of social identification-building interventions, aimed at promoting social 82 connectivity (within treatment groups), health and well-being, resulted in significant improvements 83 (in the medium to large effect size range) in physical health, quality of life, self-esteem, and 84 cognitive health, as well as reductions in anxiety, depression, and stress (Steffens et al., 2019). 85 The overall purpose of this study was to evaluate the feasibility and acceptability of a social-86 identity informed group-based physical activity program that was designed to promote social 87 connectivity, health, and well-being among veterans. The program (described in the Methods) was 88 designed to create opportunities for veterans and serving military to socially connect through 89 participation in sport, with built-in opportunities to network for employment and education needs, as 90 well as directing participants to relevant support services. Appraising program feasibility and 91 PASS  6  acceptability through high quality qualitative research is essential prior to ascertaining intervention 92 efficacy/effectiveness, through causal research designs (e.g., randomized trials) and subsequent 93 scale-up and broader implementation (Lancaster, 2015; O’Cathain et al., 2019, 2015). In this study, 94 feasibility and acceptability were examined by investigating veterans’ lived experiences (through an 95 interpretivist lens; see Methods) of this program via semi-structured interviews and reflexive 96 thematic analysis.  97 Methods 98 The Context 99 To support veterans (and their families), the Government of Canada—through Veterans 100 Affairs—offers a number of mental and physical health, counseling, transition, housing, financial and 101 employment services (www.veterans.gc.ca). One of its programs, named Solider On, is designed 102 support the recovery of ill and injured armed forces members and veterans by providing sport-based, 103 recreational, and creative opportunities and resources (www.soldieron.ca). Purpose After Service 104 through Sport (PASS) was designed as a program to complement existing veterans’ services with a 105 view to support veteran well-being, via the mechanism of a shared sense of social identity having 106 previously served in the armed forces. Unlike other programs which exist specifically for ill and 107 injured veterans (e.g., Soldier On), PASS was open to all veterans. The program was developed by 108 the last author through discussions with other military veterans living in Western Canada, and the 109 commanding officer of a Canadian Reserve regiment. The program was informed by both 110 psychological theory as well as logistical and practical requirements in partnership with the Canadian 111 military.  112 From a theoretical perspective, PASS was informed by the social identity approach (C. 113 Haslam et al., 2018; Turner, 1985; Turner et al., 1987, 1994), and empirical evidence that programs 114 designed to support social connectivity results in a number of well-being outcomes (Steffens et al., 115 PASS  7  2019). Within the social identity approach, social identities become psychologically meaningful (or 116 salient) on the basis of two psychological processes, namely ‘fit’ and ‘accessibility’ (Oakes, 1987; 117 Oakes, Haslam, & Turner, 1994). Fit occurs when people compare themselves to others within their 118 various social settings, and make appraisals based on how similar or dissimilar others (and other 119 groups) are to oneself. Accessibility on the other hand reflects one’s readiness to make use of a 120 particular social categorization, which arise through processes of socialisation within and across 121 various groups, such as with significant others (friends, family, workplace) or cultural surroundings 122 (Oakes, 1987; Oakes et al., 1994). The PASS program was underpinned by these mechanisms by (a) 123 bringing individuals together with shared experiences of having served in the military (high fit and 124 accessibility), and (b) offering the program at military armoury (high fit and accessibility), which 125 was designed to foster veterans’ sense of community. Finally, the program involved having 126 participants play ball hockey (not to be confused with field hockey). In addition to the physical and 127 mental health benefits derived from physical activity in general (Arem et al., 2015; Rebar et al., 128 2015), ball hockey was also identified as a quintessential Canadian sport (and thus fostering a sense 129 of shared identity, or a sense of ‘us’), in which Canadian military often participate during training (in 130 Canada) and on deployment overseas. 131 The program ran from September 2019 onwards out of a military armoury in Western 132 Canada. Veterans and current-serving military were invited to attend drop-in ‘ball hockey’ on Friday 133 evenings with a view to “(a) improve your health and physical fitness, (b) network and connect for 134 military and civilian needs, (c) blow off some steam in a semi-competitive environment, and (d) 135 connect and learn about support services and opportunities for former and leaving personnel”. The 136 program was designed with potential for scale-up from the outset (Lobb & Colditz, 2013), such that 137 if initial evidence points to its feasibility and acceptability (and downstream efficacy) the program 138 could be delivered on a wide basis elsewhere in Canada. From a pragmatic and logistical perspective, 139 PASS  8  there were no costs to participation (which was possible due to the program operating on military 140 premises) with parking also free. 141 Ball hockey games lasted approximately 45-60 mins, which was followed by opportunities to 142 socially connect in the mess (i.e., a designated area where military personnel socialize) afterwards, 143 over a beverage. The program initially ran as a pilot initiative from September to December 2019, 144 prior to being extended from January 2020 until March 2020 (at which point it was ‘paused’ due to 145 the COVID-19 global pandemic, and with the need to shut the armoury for non-essential services). 146 The current study represents data collected from participants in December 2019 at the end of the 3-147 month pilot phase. In general, approximately 10-20 individuals participated on a given night. Ball 148 hockey games were self-refereed, and took place in a large drill hall, with equipment already held at 149 the armoury. 150 Participants and Procedures 151 Twelve veterans (Mage = 39.83, SD = 8.07, Myears of service = 15.63, SD = 9.60) participated in 152 semi-structured interviews in person or over the phone in December 2019. In Canada, veterans 153 include any former member of the Armed Forces who successfully underwent basic training and 154 were honourably discharged (www.veterans.gc.ca). All participants were male, most were Canadian 155 veterans (n = 11), although one participant was a former British soldier. The majority of participants 156 had served in the army (n = 10), one participant had served in the navy, and one had served in both 157 the army and the navy. Participants had served in the regular force (n = 2), as reservists (n = 6), or in 158 both the regular and reserve force (n = 4) during their careers. Participants’ varied in their most 159 recent rank, which included junior non-commissioned members (Corporal, n = 4; Master Corporal, n 160 = 2), non-commissioned officers (Sergeant, n = 3), and junior officers (Captain, n = 2, Lieutenant in 161 the Navy, n = 1). The total sample size was guided by current recommendations, wherein a number 162 of interviews were conducted in order to identify meaningful patterns across the dataset and to 163 PASS  9  generate sufficient depth of understanding about the topic of interest (Braun, Clarke, & Weate, 164 2016).  165 Ethical approval was obtained from the first author’s research ethics board prior to study 166 commencement. Announcements were initially made at the end of program sessions in December 167 2019, inviting participants to take part in interviews, and through email to those on the program’s 168 registration list. To be included in the study, participants had to attend the program at least once. 169 Many, although not all, were participants who attended the program frequently. Participants were 170 encouraged to contact the first author if they were interested in taking part. They subsequently 171 received a letter of information and a consent form to review prior to their respective interviews. 172 Informed consent was subsequently obtained prior to the semi-structured interviews. Interviews 173 comprised of questions and probes that focused on participants’ personal/military backgrounds, 174 involvement in and experiences of the program, and program recommendations for the future (Smith 175 & Sparkes, 2016). The interviews lasted from 30 to 78 minutes (Mlength = 47.25) for a combined total 176 of 9 h and 45 min interview time. Interviews were audiotaped and transcribed verbatim. 177 Data Analysis 178 Philosophical Underpinning 179 The analysis was informed by an interpretivist paradigm, guided by the concept that realities 180 are socially constructed. This approach is closely aligned with ontological relativism, wherein there 181 are multiple, subjective realities (Burke, 2016). As part of a reflexive approach, it is understood that 182 both the interviewer and interviewee bring their own lived experiences (underpinned by personal, 183 social, and cultural differences) to the co-creation of data (Braun & Clarke, 2019). Coinciding with 184 the co-construction of data is the understanding that there are no objective criteria which can verify 185 that the mutual understanding created reflects the objective reality. As part of a reflexive thematic 186 analysis, the authors acknowledged that the research process cannot be conducted in a ‘theoretical 187 PASS  10  vacuum’ (Braun & Clarke, 2020); instead, the researcher must be reflexive about the lens through 188 which the data are interpreted and analyzed to ensure that final themes can be traced back to the 189 coded data. With this in mind, the research was conducted in a ‘Western’, English-speaking context, 190 as the program was located in Canada. The majority of the research team has extensive qualitative 191 research experience and all members (a) originate from a Western, English-speaking country, (b) are 192 white, and (c) have not served in the military. Further, the first author, who conducted the interviews, 193 is female (the other members of the research team are male, and all participants were male) and is 194 younger than all interview participants (i.e., aged 26 at time of data collection). Although no 195 substantial language barrier was evident, the use of military-specific terminology by participants 196 sometimes required elaboration.  197 Rigour 198 Inductive and deductive thematic analyses (Braun et al., 2016) were used to identify patterns 199 within the data in relation to veterans’ experiences of the PASS program, wherein such analysis was 200 ‘grounded in’ the data and the researchers’ theoretical lens of the social identity approach (see Braun 201 & Clarke, 2020). To start the analysis, familiarization with the data involved a review, by the first 202 author, of audio recordings and written transcripts, followed by an initial phase of coding the data. 203 Data were organized and inductively coded line-by-line using NVivo 12 (NVivo, 2018). Codes were 204 refined and clustered to identify and generate themes, while iteratively comparing and contrasting 205 raw data and final themes. In addition, codes and themes were considered in light of social identity 206 theorizing through a simultaneous deductive (‘top down’) analysis (Braun & Clarke, 2006). This 207 meant that final themes were created to reflect the inductive coding of the data, and the researchers’ 208 theoretical lens was used to deductively make sense of the data throughout the analysis. A reflexive 209 journal and critical dialogue with the second author were maintained (referred to as a ‘critical 210 friend’; Wolcott, 1994) throughout the analytic process (Smith & McGannon, 2018). A reflexive 211 PASS  11  journal was used to keep track of data analysis, theme development, and conversations with the 212 second author as codes were refined, condensed, or decided as irrelevant. The use of a ‘critical 213 friend’ encouraged reflection, provided a basis for feedback on interpretations, and enabled final 214 themes to be deliberated until agreement was reached. The ‘critical friend’ acted as an alternative to 215 multiple coders, as inter-rater reliability processes have been criticized as being counter to the 216 purpose of qualitative research (Smith & McGannon, 2018), which is to offer “complex, layered, and 217 rich interpretive insights of people’s lives” (p. 113). As this study was completed through an 218 interpretive epistemological paradigm (Smith & Sparkes, 2016), whereby knowledge is generated 219 through researchers engaging in constant and differing interpretations of each participants’ 220 experiences throughout the interview and analysis phases, the use of thematic analysis and a critical 221 friend are complementary to analytically rigorous qualitative research (Smith & McGannon, 2018). 222 While keeping in mind the relative nature of the analysis, the data might have the potential to expand 223 upon the use of social identity theorizing in similar contexts beyond the context of the PASS 224 program (referred to as analytical generalization), and may extend to settings beyond the military 225 context (referred to as transferability; Smith, 2018).   226 Results 227  In this section, four distinct themes are presented. The first three themes, and their associated 228 sub-themes, reflect the participants’ experiences in the PASS program. The final theme relates to 229 participants’ recommendations for the program if it were to continue in the future. 230 Benefits Derived From Participating 231 “Healthy Body, Healthy Mind” 232  Participants frequently mentioned getting exercise as both a reason to join the program, as 233 well as a benefit from their participation. Playing ball hockey was considered to be a challenging 234 physical activity whereby participants enjoyed “having a little bit of a sweat” for the associated 235 PASS  12  mental and physical health benefits. Mental health was mentioned as a benefit experienced by some 236 from connecting with others, as well as being directly linked to physical activity. This theme is best 237 captured by one participant who spoke about the important interconnection between physical and 238 mental health as “healthy body, healthy mind”. Participants highlighted the importance of physical 239 activity for managing mental health deficits such as trauma and depression, who either experienced 240 these benefits themselves or wanted to support other veterans’ mental health through participation in 241 the program: 242 “I shouldn’t say that I like working out, I do it ‘cause I have to, and because it’s good for 243 mental health. Like factor [in] everything you go through and obviously there [are] guys 244 dealing with everything, I’m not the only one. But that’s another benefit of the hockey, is the 245 mental aspect, it’s great. Endorphins get released and it’s great for depression. And I don’t 246 want to generalize, but it’s a really good way to fight depression.”  247 For some, the PASS program was reported to act as a catalyst for change that led to increased 248 health-promoting behaviors that extended beyond the program: 249 “I enjoyed the exercising which kinda like helped me get back into working out more and 250 taking time for myself rather than just always studying or working, or trying to pursue 251 something, just to take time to kinda relax and talk to people and just… yeah, exercise clears 252 the mind.”  253 The opportunity to be physically active as part of a group, rather than alone, was reported as 254 being beneficial for some because it increased their motivation to engage in physical activity. 255 Playing a team sport, in particular, was mentioned as an important mechanism for group bonding 256 through teamwork (i.e., suffering collectively, working together as a unit). In this way, socializing 257 with others through such aspects of the program was also credited as a reason for experiencing 258 positive mental health benefits: 259 PASS  13  “Because you’re getting that bonding sensation, sort of that teamwork when you’re doing 260 [physical activity] in a group. So whether you’re playing on a team, a hockey team or on the 261 side if I’m running, you’re doing something collectively and kinda suffering together which 262 helps build/forge bonds and friendships.” 263 Experiencing Social Connection, and Providing it for Others 264 The prospect of meeting new people enticed several participants to join the PASS program, 265 because expanding their social circle had been particularly challenging in a large, busy Canadian 266 city. While not everyone made friends that extended beyond the program, many did. Those who 267 made new friends spent additional time socializing outside the program and felt that these friendships 268 were a positive outcome of their involvement in the PASS program. More importantly, regardless of 269 whether or not participants made friendships that extended beyond their time in the program, the 270 experience of social connection was still felt. Many participants felt that their participation in the 271 program served as an opportunity to interact with peers and spend time outside of their home.  272  “Since I’ve been out I really haven’t had much of a social life. I mean I go out and I hang out 273 with my wife’s friends and stuff but I never really had my own sort of group.” 274  “For me it’s just a great opportunity to get together with like-minded people and not sitting at 275 home. Anytime I’m not sitting at home doing nothing, I’ll take that.” 276  While some sought to broaden their social circle and connect with peers, others joined the 277 program because they wanted to provide that same type of support to other veterans. Several 278 mentioned that it felt good to be able to help others. From their interactions, participants noticed that 279 others, who may have been isolated prior to their involvement in the program, were now benefiting 280 from getting out and building more connections. For many, it was interesting to learn what other 281 veterans have been doing since they left the military, and these types of conversations tended to act 282 as an icebreaker, as indicated by one participant:  283 PASS  14  “Getting to know everyone and getting to meet new people and it’s a good way to make 284 connections and a lot of the guys too, who come to play hockey, like they got issues at home 285 too, right? It’s good for them to come out and a lot of guys are out, like a lot of older people 286 that are out… yeah, it’s just really good for them to come and chit chat and play hockey with 287 us and stuff like that.” 288 Connection to Resources and/or Employment Opportunities 289 Through the networking that organically took place during the program (i.e., spontaneous, not 290 forced), participants learned about resources available to veterans and connected each other to 291 various employment opportunities. These included resources such as those offered through Veterans 292 Affairs Canada (e.g., Veteran’s Transition Centre), the Veterans Transition Network, and Veteran-293 specific education programs. Both newly retired veterans as well as those who had been retired from 294 service for a number of years benefited from learning about assistance programs that they were 295 previously unaware of or that had not existed when they left the military. As one participant 296 described: 297 “[PASS] has also linked me to other social events in the area that I was previously unaware of 298 and I was also encouraged to seek help from the Transition Centre that I did not even know 299 existed. I have met the staff there twice already and imagine I will eventually gain access to 300 the support I need. This wouldn't have happened without this small game of ball hockey. Yet 301 so much more!” 302 Shared Military Identity as a Means of Social Connection 303  Participants in the PASS program reported shared identities related to having served in the 304 military. This shared identity was further reported to be a catalyst for social connectivity among 305 participants: 306 PASS  15  Participant: So that is… it helps build a friendship a lot easier, like the chemistry will happen 307 naturally because you’ve lived in that environment but it’ll also happen naturally because you 308 don’t have as many barriers up when you meet someone like that, so… 309 Interviewer: You don’t have as many barriers… why? 310 Participant: Because you already know a great deal about them before you meet them. 311 The higher-order theme of shared military identity was further reflected in three sub-themes 312 that comprised (a) shared values, morals, and personal characteristics, (b) shared experiences of 313 military training and service, and (c) normalization of bonding over ball hockey and a beverage. 314 These are described below. 315 Shared Values, Morals, and Personal Characteristics 316 Because of their military identity, participants reported that they shared values, morals, and 317 characteristics. Many felt that there is a particular ‘type’ of person who is drawn to serve in the 318 military, and those characteristics which drove people to join the military continue to exist whether 319 you are currently serving or retired. For example, a few participants felt that they shared the same 320 sense of purpose or drive as others in the group. These deep-rooted similarities helped participants to 321 connect with each other in a way that felt different from their relations with civilians: 322 “I think I can read people who’ve served much easier than I can read people who haven’t, 323 ‘cause you either know if they subscribe or don’t subscribe to the same ethics and values.” 324 In addition to the feeling of being “like-minded” and similar to others (based on shared 325 characteristics and identities), participants also noted a number of unspoken social norms or ‘social 326 scripts’, tied to these shared similarities, which further enabled connection through eased 327 communication. For example, when playing ball hockey, participants felt that they were able to let 328 their guard down and relax in their social interactions (e.g., joking, ‘banter’) and could play at a 329 higher intensity. In contrast, participants felt that they had to be more careful when interacting with 330 PASS  16  civilians (e.g., recreational leagues, workplace settings) and felt they may need to monitor what they 331 say. The feeling of mutual understanding through their military similarities allowed for easier and 332 more free-flowing communication amongst PASS participants: 333 “I feel like in the military we communicate a little differently, you know? So we’re often not 334 afraid to say whatever, and I find working [in the] civy-side, we've got [to be] really careful 335 about what you say and what you do. It’s a little bit of almost like a relief when you play with 336 military people, you don’t have to constantly watch your back.” 337 Not only did the aforementioned social and cultural commonalities contribute to easier 338 communication, it also opened up the opportunity for an environment of cohesion and comradery, 339 comparable to the type of environment experienced in the military. A number of participants shared 340 that they had previously felt isolated, but cultivated ‘a sense of belonging again’ from engaging with 341 other current and former military members. One participant described the importance of that sense of 342 comradery among military members: 343 “They reminisce about the old times, old stories, courses, tours, and yeah, just opens up a 344 good environment for people to share and feel like that element of comradery, which most 345 guys will say is the one thing that they miss after military service, is that element of 346 comradery in their life and it is very special and as much as a bunch of tough army guys 347 won’t admit, it is an element that keeps them in and also, some of the best memories of 348 military service is just being with the boys or being with the team.” 349 Shared Experiences of Military Training and Service 350 In addition to perceiving that participants shared values, morals, and characteristics, 351 participants also spoke of shared experiences of military training and service which for some 352 reflected shared adversity. As part of serving in the military, it was understood that each participant 353 shared similar experiences unique to the military (e.g., training, deployment, hardships). Many 354 PASS  17  enjoyed being able to share their stories with an audience who could appreciate them. For example, 355 one participant was able to tell military stories for the first time in 15 years, using short-form and 356 abbreviated language, to an audience who more fully appreciated them because they had lived them 357 as well. While these shared experiences offered a topic for conversation, there was also the general 358 sense that these similarities in experiences were implied and did not necessarily have to be 359 verbalized. A feeling of mutual understanding, based on similar understandings of what it is like to 360 serve, contributed to participants’ experiences of connection as different from connection with 361 civilians. One participant felt that military personnel were more understanding than the general 362 civilian population, which was important for them to feel heard and valued: 363 “Yeah, it can be hard because nobody in the civilian world, nobody really understands like I 364 say where you’ve come from, what you’ve done, ‘cause in the army you kind of wear things, 365 you have these badges and medals and everything like that and nobody outside of the army, 366 like if you showed up they wouldn’t understand what any of that stuff is and they don’t 367 understand what you’ve done… that’s your life that you have on there, what you’re wearing.” 368 Normalization of Bonding Over Ball Hockey and a Beverage   369 A final facet of military identity involved the normalization of bonding over ball hockey and 370 drinks as a means of social connection. The structure of the PASS program was reminiscent of 371 military experiences of bonding over playing ball hockey and sharing a beverage. According to 372 participants, every Thursday on military bases across the country, there is time set aside to play 373 sports and ball hockey was a popular choice. Playing ball hockey during PASS reminded participants 374 of their time playing ball hockey on their military base, where it was a time to boost morale and build 375 unit cohesion. 376 According to participants, an integral aspect of military culture pertains to ‘bonding over a 377 beer’, which would happen at ‘the mess’. Many mentioned a ‘work hard, play hard’ motto that is 378 PASS  18  prevalent in military culture, and the times spent in the mess were remembered as being fun, helping 379 to open up conversations, and build social bonds. In the PASS program, having the chance to 380 socialize over a beverage following each ball hockey game was considered to be a crucial aspect of 381 the program. Notably, choosing to drink an alcoholic beverage or non-alcoholic beverage reportedly 382 made little impact on the benefits received from socially connecting with others. Rather, having the 383 time and space to connect after ball hockey was identified as more important for building 384 relationships. Participants felt that having a space to connect afterwards allowed them to get to know 385 each other better, in part because it was difficult to hold in-depth conversations while playing ball 386 hockey. 387 “The army is kinda similar to that, so it’s kind of like a work hard play hard mentality so they 388 say you work hard but when it’s time off you drink together as well and everybody does, 389 that’s just the way it was in the army. So after you’re done working hard you play hard and 390 those friendships and trusts and bonds are forged not just through work but again through 391 drinking and you spend so much time together and you’re bonding on so many different 392 various levels … but it’s very similar to the ball hockey where you’re going… working hard 393 and then you’re having your beers after, so you’re working together as a team and then you’re 394 bonding together as a team after, so you’re developing sort of those friendships and trust and 395 to a certain extent, respect, for one another.”  396 Structural Features of the PASS Program 397 Simple Structure of the Program 398 Broadly, the simplicity of the program contributed to participants’ enjoyment of PASS. The 399 informal, unstructured nature of the program was considered to be positive, and participants felt that 400 interactions were ‘organic’. Although the structure was consistently referred to as ‘simple’ – which 401 involved simply showing up when you can, grabbing a stick, and playing hockey – participants felt 402 PASS  19  that it was well organized. Some participants had previously been a part of recreational ice hockey 403 teams but found that the cost of renting ice time to play was a significant barrier. The simplicity of 404 the PASS program meant there was no associated cost for participants, which made the experience 405 positive for many.  406 Different From Other Programs Supporting Veterans 407  Participants noted a number of features in PASS that differed from other military programs 408 they were aware of or had been involved in. Other programs for veterans that provided physical 409 activity opportunities were mentioned, but these programs are/were predominantly restricted to ill or 410 injured veterans. Opening up the PASS program to anyone who has served was considered to be a 411 beneficial aspect of the program. Additionally, other veterans’ programs that were mentioned tended 412 to focus solely on networking or employment and did not incorporate physical activity (which was a 413 reason that participants joined PASS). While some participants had heard of a variety of programs or 414 clubs that supported veterans, others had never heard of or been involved in such programs. Another 415 reported difference between PASS and other veterans’ programs was that it was run by civilians 416 (rather than government or the military), which some considered to be favorable. Additionally, 417 having no ‘set agenda’ or (explicit) focus on mental health favourably distinguished the PASS 418 program from others which focus on group counselling: 419 “I love the idea of just talking openly without any topics, you know sometimes people want 420 you to talk about certain things, your experience or your mental health and all that. But I 421 kinda like that it’s just open and you can just talk about whatever you want to talk about.” 422 Overall, having an informal program structure and no explicit, or heavily overt, mental health 423 objectives contributed to a reduction in mental health stigma often felt by veterans at programs 424 designed specifically to target mental health challenges, such as counseling services.  425 Positive and Welcoming Environment 426 PASS  20  Many participants (perhaps unsurprisingly) loved to play ball hockey and this was an enticing 427 and fun aspect of the program. The atmosphere was competitive but not in a manner that felt 428 aggressive or hostile. Participants described the general environment of PASS as friendly, 429 welcoming, and inclusive.  430 “I think everyone’s friendly and gets along and it can get… some roughhousing a bit but it’s 431 all in good form, someone goes down and the guy’s right away helping the other person up.” 432 One participant highlighted that rank was rarely discussed or valued, and that this contributed 433 to a positive environment. Other participants mentioned that a few key individuals had a positive 434 impact on the program, namely the military bases’ commanding officer and the PASS program lead. 435 Having the approval of the commanding officer made the logistics of using the military base run 436 smoothly, and having such a high-ranked member occasionally drop in to play and show support for 437 the program was appreciated. A few mentioned the PASS program lead played a role in cultivating 438 the welcoming environment by introducing himself and demonstrating positive leadership qualities.  439 Participant Recommendations 440  Although the primary purpose of the study was to examine participants’ experiences of the 441 PASS program, with a view to ascertain its feasibility for sustained implementation and acceptability 442 by those who received the program, a secondary aim was to examine ways in which the program 443 might be optimized and enhanced in future iterations. With this in mind, participants were asked to 444 provided recommendations for program improvement. These are summarised below. 445 Keep the Same Formula, Expand the Reach 446 The consensus across participants was that the simple two-part program structure – physical 447 activity followed by socializing afterward – were integral aspects to maintain moving forward. While 448 a couple of veterans suggested expanding the type of physical activity to include other sports, others 449 felt that keeping it consistent and sticking to one sport (namely, ball hockey) was preferred. A few 450 PASS  21  suggested creating a platform to connect outside of the program (such as through group messaging) 451 so that participants could plan other activities in addition to Friday night ball hockey. A later start 452 time (18:00-18:30hrs) was implemented mid-way through the program, and participants commented 453 that this was beneficial for everyone to have time to commute to the location after the end of the 454 workday. The duration and location of the program was considered to work well, and a few 455 highlighted the convenience of an on-site location to socialize (the mess), which helped to ensure 456 people participated in the social aspect instead of dispersing after the ball hockey game had ended.  457 “The beer that you have afterwards, the ice cold beer after a hard activity, you feel good and 458 being all together to just chat and joke around, I think we need to maintain that… that 459 structure in activity, the decompression and comradery. Those two phases of the program, I 460 think are integral for success, so maintaining that structure.” 461 Most stressed that there was little room for improvement and that the program structure 462 should remain as is, with a few exceptions. First, a few participants suggested the equipment be 463 updated, including hockey sticks, jerseys, and proper side barriers. Second, the majority of 464 participants felt that increasing awareness for the program to reach more veterans should be the next 465 step. Some suggestions for this included creating a website or social media platform and reaching out 466 to the local units directly. If the numbers were to increase, a few participants suggested expanding 467 the program to include other locations, such other military bases within the province as well as other 468 cities across Canada.  469 Discussion 470  The overall purpose of this study was to explore the feasibility and acceptability of a social 471 identity-informed sport-based program designed to promote social connectivity and well-being 472 among military veterans. This was done by examining participants’ experiences of the program. The 473 PASS program was reported to result in a number of positive benefits, that a shared sense of social 474 PASS  22  identity (related to having all previously ‘served’) supported a sense of social connectivity, and that 475 various structural features contributed to participants’ enjoyment of the program. Veterans 476 highlighted benefits that pertained to physical and mental health, inter-personal relations, as well as 477 the program being a conduit to accessing other resources outside of the program. Participants felt that 478 the anticipated physical and mental health benefits associated with physical activity were an 479 important reason to join the program. In addition, these benefits were similarly reported to be 480 experienced by participants once they were in the program. Across a number of studies, researchers 481 have similarly found positive benefits derived from physical activity for (combat) veterans, including 482 improvements in measures of well-being and PTSD symptom reduction (Caddick & Smith, 2014). 483 This is noteworthy as veterans’ are at increased risk of poor mental health after leaving the military, 484 and some may not seek out support due to the stigma associated with seeking formal mental health 485 support services (Shields et al., 2016). When considering sport and physical activity research with 486 veterans, researchers have suggested that a focus on ‘exercise as medicine’ may be helpful for health 487 practitioners, but by doing so might pose a risk of enhancing stigma for veterans who do not want 488 ‘medical’ help/supports (Caddick & Smith, 2018).  489 Interactions among veterans were reported to result in positive social benefits that included 490 developing friendships that extended beyond the program, and a chance to get out of the house and 491 connect with peers. Previous research has found that when shared social identities are made salient, 492 individuals are more likely to provide social support to those with a similar identity (Levine, Prosser, 493 Evans, & Reicher, 2005; see chapter by Haslam, Reicher, & Levine, 2012 for an overview on the 494 topic). In addition to the social benefits derived from connecting with peers, participants in the PASS 495 program also described benefitting from the spontaneous networking that occurred during their 496 interactions. Many participants mentioned that through networking with others, they learned about 497 PASS  23  programs designed to support the transition out of the military and were connected to resources and 498 opportunities related to education and employment. 499  Guided by the social identity approach (C. Haslam et al., 2018; Turner, 1985; Turner, Hogg, 500 Oakes, Reicher, & Wetherell, 1987; Turner et al., 1994) the PASS program brought together a group 501 of individuals who shared an identity of having served in the military. This shared sense of identity 502 was expressed explicitly through conversations around similar military experiences, as well as more 503 implicitly experienced through shared values and social norms. Additionally, the structure of the 504 program (ball hockey, followed by socialization in the ‘mess’) was reported to be reminiscent of time 505 spent in the military. In a 5-day adventure course for ill/injured veterans, Carless and colleagues 506 (Carless, Peacock, McKenna, & Cooke, 2013) found that sport helped veterans reconnect with their 507 military identity, such as through sharing laughs and ‘banter’ with peers again, which resulted in 508 enhanced perceptions of well-being. Similarly, Caddick, Smith, and Phoenix (2015) found that 509 connecting with other veterans during physical activity positively influenced well-being by providing 510 respite from PTSD. When considering the delivery of physical activity programs for veterans, 511 Shirazipour and colleagues (Shirazipour, Aiken, & Latimer-Cheung, 2018) highlighted the 512 importance of implementing strategies that foster social connections among participants, such as 513 developing a group environment to create a sense of camaraderie. In the current study, participants’ 514 shared military identities appeared to contribute to easier communications compared to those held in 515 relation to their civilian day-to-day life. This finding is notable as many veterans experience 516 challenges in the transition to civilian life, such as a loss of identity and difficulty connecting with 517 non-military individuals more generally (Binks & Cambridge, 2018). A recent report by Veterans 518 Affairs Canada recommends identity-based peer support programs (i.e., ‘veterans helping veterans’, 519 p. 55) as a potentially useful means for supporting veterans’ well-being during the transition to 520 PASS  24  civilian life (Thompson et al., 2017). The results of the current study would appear to provide 521 support for this approach.  522  In general, participants viewed their experiences in the program as positive and highlighted a 523 few environmental features that contributed to their enjoyment. The overall context was viewed as 524 friendly, welcoming, and inclusive. In part, strong support from the commanding officer as well as 525 the positive leadership demonstrated by the PASS lead were reported to contribute to an enjoyable 526 experience for participants. The simplicity of the program structure, including having no required 527 registration or minimal level of commitment, no mandated agenda, and no associated costs, was also 528 viewed as positive. In contrast, recreational civilian ice hockey programs tend to be costly and other 529 veterans support programs often focus solely on employment or are tailored to ill or injured veterans. 530 Although PASS was not overtly structured to support veteran mental health (covertly the support of 531 veteran wellbeing was targeted), a number of participants felt that they experienced positive mental 532 health outcomes through their participation. As one participant suggested, the simplistic design of the 533 program, a primary focus on enjoying a game of ball hockey, and a secondary agenda of connecting 534 participants to appropriate mental health (and other) resources may make PASS more approachable 535 than more traditional counselling programs. These findings suggest that PASS may be more readily 536 accessible for some veterans due to the lessened mental health stigma typically associated with 537 programs primarily aimed at addressing veterans’ mental health and well-being.  538  Moving forward, PASS participants recommended that the same simple program structure 539 (drop-in ball hockey, followed by beverages) be maintained. A few participants suggested upgrading 540 the ball hockey equipment, so with this in mind, new hockey sticks were provided in January 2020, 541 along with new jerseys donated by a local National Hockey League (professional ice-hockey) 542 organization. Many felt that expanding the program, locally as well nation-wide, to reach more 543 veterans and increase the number of participants would be worthwhile. Some participants offered to 544 PASS  25  assist with this and made suggestions on how the program reach could be expanded (e.g., social 545 media, connect directly with regiments and the legions). With regard to recruitment it is also 546 noteworthy, that although the program was explicitly made available to military veteran men and 547 women, only men signed up and took part in the program. On the one hand, this may reflect the fact 548 that the majority of regular force and reserve members (84.10%; Government of Canada, 2020) are 549 men. Historically, women have experienced gender inequalities in the military (Reis & Menezes, 550 2020), which may deter them from seeking out military-related supports or programs after retiring 551 from service. In future, it would be important consider how women might be optimally supported 552 through this program and/or related programs. 553 Strengths and Limitations 554  There are a number of strengths of this study, including an in-depth analysis of a novel social 555 identity-informed sport program, as well as nuanced insights related to some of the psychological 556 processes embedded within the social identity approach (C. Haslam et al., 2018; Turner, 1985; 557 Turner et al., 1987, 1994). On the one hand, and from a pragmatic knowledge translation perspective, 558 the study sheds light on the feasibility and acceptability of a group-based program for veterans that 559 was informed by the social identity approach. In addition, and from a theoretical perspective, the 560 results provide support for the contention that when social identities are made salient, this may foster 561 feelings of connectivity. Indeed, it appears that when people share meaningful life experiences (as 562 former members of the armed forces) their social identities (as veterans) are made salient which can 563 translate into participants feeling ‘connected’ to one another. Identity salience appears to be powerful 564 psychological phenomenon, and thus represents a viable target for intervention.  565 In addition, the results also shed unique insight into some of the psychological processes 566 conceptualized within the social identity approach (C. Haslam et al., 2018; Turner, 1985; Turner et 567 al., 1987, 1994). For example, under the theme of ‘shared military identity as a means of social 568 PASS  26  connection’ it is worth noting that while participants described their shared experiences as serving as 569 means of fostering a shared identity, it is notable that participants also believed that they were 570 similar to one another in terms of their personal qualities (as per the theme that reflected ‘shared 571 values, morals, and personal characteristics’). This directly aligns with experimental work by Haslam 572 and Turner (1992) who found that when people perceive themselves to share identities with other in-573 group members (which, in the current study corresponded to shared identities as veterans), they tend 574 to assimilate those in-group members’ perspectives as their own. That is, they consider themselves as 575 more similar to those other in-group members when they believe they share the same social 576 identities. The results align with Haslam and colleagues’ (2018) connection hypothesis, which 577 suggests that shared identities might contribute to feelings of similarity.  578 Beyond the insights derived with regard to program feasibility and acceptability, as well as 579 theoretical insight, a pragmatic strength of the study corresponds to the inclusivity of the program in 580 seeking to reach out to all veterans, and not only veterans who are ill or injured. Although several 581 programs exist to support veteran well-being, many are only offered to veterans who are ill or injured 582 (e.g., Soldier On, Invictus Games). The literature similarly follows this trend, with much of the work 583 in the physical activity domain focused on the role of sport and physical activity in relation to 584 veteran mental health challenges (e.g., Caddick et al., 2015) or a physical disability (e.g., Shirazipour 585 et al., 2018) or both (Caddick & Smith, 2014). Although some participants in the PASS program 586 described previous/current mental health challenges, the program was not restricted to ill and/or 587 injured veterans, and was open to any veteran regardless of the presence or absence of illness/injury. 588 Casting a ‘broad net’ in this may may help to reduce stigma associated with enrolling in programs 589 designed to support veteran well-being (especially mental health), although future research is clearly 590 needed to examine this possibility. 591 PASS  27   Balanced against the aforementioned strengths of this study, limitations also should be 592 considered. First, our sample consisted of veterans who volunteered to speak about their experience 593 in the program and may have been more willing to contribute because their experiences were 594 positive. However, interviewees did include those who regularly attended the program, as well as a 595 few who had not attended as frequently. Perhaps unsurprisingly, participants all enjoyed playing ball 596 hockey, as this was one reason for joining the program. It should be noted that other sports would 597 likely be enjoyed by other veterans who did not choose to participate in the program. A final 598 limitation is that causality cannot be inferred from the findings. In future, experimental designs (e.g., 599 randomized controlled trials) will be invaluable to ascertain the extent to which programs such as 600 PASS are able to support the well-being of participants over time, as well as factors that lead to 601 participant retention and drop-out. 602 Conclusion 603  Our study revealed a number of positive outcomes and features of the PASS program, 604 including support for veteran health and social connection. This study, alongside other emerging 605 research (e.g., Steffens et al., 2019) provides support for the usefulness of the social identity  606 approach in guiding programs to promote well-being. Ultimately, further causal evidence is 607 warranted for the effectiveness of social identity-informed interventions and programs to support 608 military veteran well-being outcomes, before they can be implemented and delivered at scale. From 609 an implementation science perspective, one of the strengths of the PASS program is that it was 610 designed with scale-up in mind right from inception. It should be noted, however, that the program 611 required the support from the military to deliver the program on its premises, and any future scale-up 612 of the PASS program would require the ongoing support of the military. Nevertheless, what certainly 613 appears evident is that this initiative has considerable potential to support veteran wellbeing and 614 health, with minimal cost to implementation. 615 616 PASS  28  References 617 Arem, H., Moore, S. C., Patel, A., Hartge, P., Berrington De Gonzalez, A., Visvanathan, K., … 618 Matthews, C. E. (2015). 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