3.0 Planning and Design
3.1 Study Advisory Committee
3.2 Definition of a Vietnam Veteran
3.3 Characteristics of the Female Vietnam Veteran Cohort
3.4 Study Design
3.5 Confidentiality of Data
3.6 Questionnaire Development
3.7 Questionnaire Types
3.8 Study Proposal
3.9 Selection of Consultant
3.10 Deliverables
3.11 Strengths and Limitations of the Female SurveyThe female Vietnam veterans survey was planned and carried out using similar methodology to that of the male component of the study.
3.1 Study Advisory Committee
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At the direction of the Minister for Veterans' Affairs a Study Advisory Committee was established in April 1996 to oversee the conduct of the entire study.
The Advisory Committee was chaired by the Repatriation Commissioner. Its membership is shown at Appendix B.
3.2 Definition of a Vietnam Veteran
The Advisory Committee accepted the definition of Vietnam veterans contained in the Nominal Roll of Vietnam Veterans54, that is:
All members of the Australian Defence Force (ADF) and the Citizen Military Forces (CMF) who landed in Vietnam or entered Vietnamese waters including those who were seconded to the Army of the Republic of Vietnam (ARVN), the United States Air Force (USAF), the United States Navy (USN) and any other allied service, all members of Australian Army Training Teams Vietnam, all members, male and female, of civilian medical and surgical teams, all members of philanthropic organisations, all members of the Australian Forces Overseas Fund and all official entertainers and war correspondents who saw service in Vietnam during the period between 23 May 1962 and 1 July 1973.
3.3 Characteristics of the Female Vietnam Veteran Cohort
As shown at Table 1, there are 484 female Vietnam veterans on the Nominal Roll. Of these 484 veterans, 47 were Army health professionals, most of whom were nurses, 2 were Army doctors and 2 were Army physiotherapists. Air Force nurses totalled 106. The female civilian contingent comprised 172 members of medical/surgical teams sponsored by the SEATO aid program and 136 official entertainers. There were 23 members of philanthropic organisations who were civilians but served under military disciplines and are covered by the VEA.
Table 1: Number of female veterans by first Vietnam service54
Service Group Number Army Female health professionals 47 Air Force Nurses stationed outside Vietnam but whose duties took them into Vietnam 106 Philanthropic Australian Red Cross 21 Australian Forces Overseas Fund 2 Civilian SEATO aid program -- (medical/surgical teams) 172 Official entertainers 136 TOTAL 484
3.4 Study Design
When considering design options for the male and female surveys, the Study Advisory Committee decided to survey all Vietnam veterans who could be located. The Advisory Committee believed it was important for all veterans to have the opportunity to participate in the study and ESO advice was that this was the expectation of the veteran community itself. Further, it was believed that a survey of the entire population of veterans had the benefit of allowing for the identification of rare conditions.
The decision to survey all locatable Vietnam veterans dictated that the survey instrument would be a mailed-out, self-reporting questionnaire. This in turn affected the size and complexity of the questionnaire. The Advisory Committee formed the view that if the questionnaire was too complex or too long, then the probability of obtaining responses would be reduced.
The use of a survey led the Advisory Committee to agree that the survey would be conducted in three phases:
Phase 1 -- A mailed survey of all located surviving Vietnam veterans. Phase 2 -- Analysis of Phase 1, production of a report on the outcome of Phase 1, and decision on potential Phase 3 studies. Phase 3 -- Follow-on investigations if required, including the possibility of interview of a representative sample of Vietnam veterans. 3.5 Confidentiality of Data
All questionnaires mailed out to veterans included a bar code. Although the Advisory Committee recognised that the presence of the bar code was a potential disincentive to completion of the questionnaire, the bar code was included to allow the questionnaires to be tracked against the mail-out list so that non-respondents could be followed up.
As a means of ensuring that personal data provided by veterans remained confidential, the Advisory Committee contracted with an independent survey organisation to conduct the mail-out, follow-up non-respondents, and code and analyse the data.
The Advisory Committee also decided that, once the survey was complete, returned questionnaires and associated data should be stored outside of the Department of Veterans' Affairs and that identifiers to the data should be stored separately from the de-identified data itself.
3.6 Questionnaire Development
The Advisory Committee decided to base the survey questionnaires on hypotheses that Vietnam veterans' health, and that of their families, had in some way been compromised by service in the Vietnam war.
Initially twenty-five such hypotheses were proposed for both the male and female surveys. After discussion by the Advisory Committee this list was reduced to thirteen all of which were considered in the design of the questionnaires. In the final analysis the Advisory Committee found it practical to design the questionnaires around ten hypotheses. The hypotheses are:
- The general health of Vietnam veterans is worse than that of other Australians of a comparable age cohort.
- The worsening health status of Vietnam veterans has been a direct contributing factor in lowering the health status of members of their immediate families.
- The prevalence of cancer is greater in Vietnam veterans than in other Australians of comparable age.
- The prevalence of some specific disease conditions is greater in Vietnam veterans than in other Australians of a comparable age.
- The incidence of specific birth defects is greater in the natural children of Vietnam veterans than in children in the general population of Australia.
- The prevalence of cancer is greater in the natural children of Vietnam veterans than in children in the general population of Australia.
- The incidence of hysterectomy among female Vietnam veterans is greater than in a comparable age cohort within the general female population of Australia.
- The prevalence of fertility disorders among Vietnam veterans and their spouses is greater than in a comparable age cohort within the general population of Australia.
- The marital status profile of Vietnam veterans is different to that of the general Australian population.
- The prevalence of specific disease conditions is greater in the natural children of Vietnam veterans than in other Australian children of a comparable age.
3.7 Questionnaire Types
Three distinct questionnaires were developed for the survey -- male veterans; female veterans; and widow(er)s/divorced and separated partners. Each questionnaire contained slightly different questions depending upon the target population. A sample questionnaire for the female Vietnam veterans can be found in the ACNielsen report at Appendix C1.
Each questionnaire had in common two design elements:
- a fill-in response requiring the respondent to provide a short answer to questions; and
- a multiple-choice response where the respondent chose one or more responses from a short list of possible responses.
3.8 Study Proposal
A study proposal defining methods of data collection and analysis, privacy issues, confidentiality, strengths and weaknesses of the study and reporting considerations was prepared. The proposal covered all three questionnaires.
The study proposal was endorsed by the Advisory Committee and the DVA Ethics Committee.
3.9 Selection of Consultant
The Advisory Committee considered it desirable for an agency other than DVA to conduct the surveys. Furthermore, the task of conducting a national survey across all States and Territories and involving over fifty thousand individuals required planning, resources and specialised knowledge outside the capacity of the Department.
As a result, a decision was taken to outsource the full survey (all three components), the resulting tabulation of the data and the presentation of survey results. Preference was expressed for a single contractor able to provide the total service required to achieve these ends.
The Department of Social Security and the then Department of Administrative Services were asked to nominate organisations with the capacity to undertake the planned survey. A standard Government tender outline was used to prepare the Request for Tender with the assistance of the Office of Government Information and Advertising (OGIA). This was issued to the prospective consultants. At the close of the confined tendering process, six organisations had submitted a tender application. These were evaluated, again with the assistance of OGIA, and AGB McNair Pty Ltd was selected in April 1997 as the successful consultant.
Following the award of the contract AGB McNair Pty Ltd changed its name to ACNielsen McNair Pty Ltd and then to ACNielsen Research Pty Ltd. For the purposes of uniformity and to avoid any confusion, this report will make reference to the consultant as ACNielsen.
A copy of the tender brief for the study consultancy is located at Appendix E.
3.10 Deliverables
In summary, the Advisory Committee decided that the female survey would seek data that would be:
- from all locatable female Vietnam veterans;
- suitable to assist in testing the agreed hypotheses;
- either comparative or descriptive;
- relevant to conditions that may have been precipitated by exposure to possible dioxin/herbicide exposure in the Vietnam war; and
- able to form a basis for:
- short and medium term policy development;
- follow-up action or investigation of identified adverse health effects of service in the Vietnam war on veterans, their children and partner(s); and
- a decision as to whether or not additional quantitative and qualitative research on the morbidity/mortality of female Vietnam veterans as a separate undertaking was required.
3.11 Strengths and Limitations of the Female Survey
The major limitation of the female survey was that only half of the potential survey population could be located. There appeared to be an under-representation of married women due to the difficulty in locating those whose names have changed since service in Vietnam.
The small cohort size of female Vietnam veterans (484 versus 59 520 male veterans) combined with the incomplete sample (278 female veterans located) makes it difficult to reach conclusive findings in regards to this study.
Notwithstanding, of the women who were contacted and defined themselves as Vietnam veterans, that is, were in scope of the study, 81% returned a completed questionnaire.
The return rates of completed questionnaires were high for ex-service personnel:
Army 46/47 and Air Force 72/106. There were no Navy female veterans. This makes the data subset from these groups a potentially valuable tool for further examination into the health of these veterans as it is less subject to the sampling problems that applied to the remainder of the female Vietnam veteran cohort.
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