The Influence of Participation Attributes on Veterans’ Sense of Community in Adaptive Sport & Recreation Programs By Kristen Tarantino May 2024 Director of Thesis: David P. Loy, PhD Major Department: Department of Recreation Sciences ABSTRACT Many veterans experience traumatic events throughout their service that can lead to injuries, disabilities, and problems transitioning back to civilian life (Ahern et al., 2015). United States veterans are a unique and complex population that can experience many injuries, problems, and obstacles in life after military service (Olenick et al., 2015). One such issue is often community reintegration, where an individual struggles to live independently and participate in social and societal norms, roles, and responsibilities (Dijkeres, 1998). One aspect to community reintegration is fostering a sense of community between individuals and their community of support. Adaptive sports and recreation (ASR) have long been used as a rehabilitation tool and researchers have demonstrated the increasing benefits of participation for individuals with disabilities in domains such as community reintegration, quality of life, and sense of community (Iverson et al., 2021). In this quasi-experimental study, the influence of ASR attributes (intensity, frequency, duration, and social structure) on sense of community in veterans was examined. Results found that there were no significant (p>.05) relationships between ASR attributes and sense of community in veterans. A discussion is provided on the importance of the inherent social nature of adaptive sports and recreation regardless of activity structure. Implications of this study provide insight into how an ASR program fosters a sense of community in veterans and a greater understanding of the role of ASR in promoting community reintegration in veterans. The Influence of Participation Attributes on Veterans’ Sense of Community in Adaptive Sport & Recreation Programs A Thesis Presented to the faculty of the Department of Recreation Sciences East Carolina University In Partial Fulfillment of the Requirements for the Degree M.S. in Recreation Sciences Concentration: Recreational Therapy Administration By Kristen Tarantino May 2024 Director of Thesis: David P. Loy, PhD Thesis Committee Members: Cari E. Autry, PhD Clifton E. Watts Jr., PhD Stacy Warner, PhD © Kristen Tarantino, 2024 TABLE OF CONTENTS LIST OF TABLES..........................................................................................................................vi LIST OF FIGURES.......................................................................................................................vii SECTION 1: MANUSCRIPT..........................................................................................................1 Introduction..................................................................................................................................1 Literature Review.........................................................................................................................3 Veterans and Community Reintegration..............................................................................3 Sense of Community Theory...................................................................................5 Sense of Community in Sport and Recreation.........................................................6 Adaptive Sport and Recreation as an Intervention for Sense of Community in Veterans...8 Promoting Sense of Community through the Attributers of ASR….................................10 Purpose and Research Questions...............................................................................................12 Methods......................................................................................................................................14 Participants.........................................................................................................................14 Measurement and Description of Variables.......................................................................14 Sense of Community..............................................................................................14 Adaptive Sport and Recreation Participation.........................................................16 Physical Intensities.................................................................................................16 Social Structures....................................................................................................18 Demographics........................................................................................................18 Research Design and Survey Methodology.......................................................................19 Results........................................................................................................................................22 Data Preparation.................................................................................................................22 Demographics....................................................................................................................22 Frequency of ASR Participation........................................................................................25 Sense of Community in Sport Scores................................................................................25 Relationship of Veteran Demographics and Sense of Community...................................26 The Relationship of Adaptive Sports and Recreation Attributes and Sense of Community in Sport...............................................................................................................................27 The Influence of Adaptive Sport and Recreation Attributes on Sense of Community in Veterans.............................................................................................................................28 Discussion..................................................................................................................................30 Limitations.................................................................................................................................30 Study Design Issues...........................................................................................................30 Sampling Issues................................................................................................................ 31 Measurement of ASR Intensities.......................................................................................32 Measurement of Social Structure...................................................................................... 32 Examining Adaptive Sport and Recreation in Veterans Sense of Community……………….33 Promoting Meaningful Participation for Veterans…………………………………………….33 The Need for Social Participation..............................................................................................34 Understanding the Individual Social Experience in Adaptive Sport and Recreation................35 Trends in Veteran Participation in Adaptive Sport and Recreation…………………………...36 Future Research.........................................................................................................................37 Practical Implications of Study..................................................................................................38 Conclusion.................................................................................................................................40 References..................................................................................................................................41 SECTION II: EXTENDED LITERATURE REVIEW.................................................................52 Veterans and Community Reintegration....................................................................................52 Sense of Community Theory.....................................................................................................55 Sense of Community in Sport and Recreation...................................................................56 Adaptive Sport and Recreation as an Intervention for Sense of Community in Veterans………………………………………………………………………………….58 Promoting Sense of Community through the Attributers of ASR.....................................61 Appendix A: Demographic Survey................................................................................................65 Appendix B: The SCS-Sport Assessment......................................................................................70 Appendix C: The Compendium of Physical Activities..................................................................74 Appendix D: The Compendium of Wheelchair-related Physical Activities..................................87 Appendix E: East Carolina University Institutional Review Board Approval..............................90 Appendix F: Social Media Flyer....................................................................................................92 LIST OF TABLES 1. Table 1: Demographics of Participants..............................................................................24 2. Table 2: Sense of Community in Sport Mean Scores........................................................26 3. Table 3: Years of Military Service and SCS Social Spaces……………………………...27 4. Table 4: Meaningful Activity Social Structure and Sense of Community……………....28 LIST OF FIGURES 1. Figure 1: The Sport and Sense of Community Theory........................................…………7 SECTION I: MANUSCRIPT Introduction For many veterans with disabilities, reintegrating back into their communities and returning to their life as a civilian is a critical goal of rehabilitation (Resnick & Allen, 2007). Adaptive sports and recreation (ASR) can play an important role in the rehabilitation process of veterans with various disabilities (Lee & Uihlein, 2019). Research has shown that participation in ASR can lead to increased quality of life (Lundberg et al., 2011) that allows participants to find a safe place without stigmas and stereotypes to connect with others, build social networks within the community (Lee & Uihlein, 2019), and help acquire feelings of freedom, normalcy, and success (Greer et al., 2019). Within human services fields, there are many such terms that represent the ability of veterans to re-connect with their community. “Community reintegration” has been an umbrella term used to represent being engaged in mainstream community and family life through active roles and responsibilities in one’s society and social groups (Dijkeres, 1998). The concept of community reintegration has been particularly important to veterans who attempt to re-connect with their communities after one’s military service (Resnick & Allen, 2007). With the advancements in military technologies and weapons, more veterans are returning with a widely distributed spectrum of disabilities and injuries making post-duty reintegration into communities and social roles more challenging (Smith & Bellamy, 2005). Veterans are also at risk for various physical disabilities, psychological, cognitive impairments, and lower quality of life because of these negative bi- products of military duty (Bennet et al., 2014; Hale-Gallardo et al., 2016). While health care professionals may never know exactly what veterans see and experience during their deployments, they can help support and assist them with recovery by creating the most effective 2 treatment plans that address outcome goals that emphasize reintegrating back into their community and social lives. Sport and recreation activities have often been used as a rehabilitation tool to connect those with disabling conditions into communities after military service (Chockalingam et al., 2012). Adaptive sports and recreation (ASR) researchers have demonstrated the increasing benefits of participation for individuals with disabilities in domains such as community reintegration, quality of life, and sense of community (Iverson et al., 2021). Lee and Uihlein (2019) suggested that ASR can target various outcomes for individuals in three main domains including physical, psychological, and social by decreasing symptoms, promoting social networks, encouraging employment, rebuilding self-efficacy, and increasing physical aspects like balance, flexibility, and activities of daily living. While there are many positive outcomes that can result from participation in ASR (Greer et al., 2019), there is less focus placed on the benefits that different attributes of adaptive sports and recreation play in re-connecting veterans back into their communities as a civilian. Literature Review Veterans and Community Reintegration Many veterans deployed during service often experience traumatic events throughout their service that can lead to injuries, disabilities, and long-term problems transitioning back to civilian life (Ahern et al., 2015). In a qualitative study, Ahern and colleagues (2015) examined the problems that Afghanistan and Iraq veterans faced during their military to civilian life transition and suggested three main themes for veterans: military as family, normal is alien, and searching for a new normal. The military as family theme indicated that veterans share a familial bond with those they served with as these individuals have “been there and done that.” Normal is Alien addressed the alienation that veterans felt when returning to their civilian life and the disconnection from the community, loss of purpose, and lack of support from institutions. Finally, Searching for a New Normal encompassed all efforts, resources, support, and tools used to help integrate back into the community. However, most veterans spoke about the idea that the reality of what used to feel “normal” felt “alien” due to changes that occur within the veteran and their life at home (Ahern et al., 2015). Unfortunately, many veterans found more challenges with finding support due to others not fully being able to understand and relate to having those same experiences in military services. Veterans are a complex and unique population that can experience many injuries, problems, and obstacles in life post service especially for those who’ve experienced deployment and combat (Olenick et al., 2015). Olenick and colleagues (2015) attempted to gain more insight into veteran health issues, including reintegration needs, and better educate healthcare professionals working with veterans. First, veterans are at a higher risk of mental illnesses including substance abuse disorders, depression, anxiety, manic-depressive disorders and more. 4 Many male veterans (36%) experience post-traumatic stress disorder (PTSD) more often than those without military experience (8%) (Olenick et al., 2015). The researchers also discovered that PTSD is commonly linked to traumatic brain injuries (TBI), pain, psychiatric disorders, sleep problems and more. Furthermore, veterans have a 14% diagnosis rate for depression, an 82% rate of reporting chronic pain, and a substantial number (1,573 since 2010) have major limb amputations (Olenick et al., 2015). Amputations also can cause problems with mental health, mobility, body image, social interactions and experiences, and employment. Olenick and colleagues further stated that successful reintegration is vital for holistic and effective care that is often achieved through veteran-specific content highlighting the importance of obstacles that help address complex mental, physical, and behavioral disorders. Veteran research also has indicated that community reintegration is a recurring problem facing veterans in their transition from military to civilian life (Resnik & Allen, 2007). Resnik and Allen (2007) performed a pilot study to examine how the International Classification of Functioning, Disability and Health (ICF) can be used to understand various community reintegration problems for veterans. Veterans reported challenges in many aspects of community reintegration including community life (ICF d910), recreation and leisure (ICF d920), political life and citizenship (ICF d950), tolerance in relationships (ICF d7102), regulating behaviors in interactions (ICF d7202), informal social relationships (ICF d750), general domestic life (ICF d600), and more. While most veterans face adversity, results of this research found that those with more severe polytraumatic injuries had more challenges reintegrating compared to non-polytraumatic disabilities. Clinician interviews revealed that common traits among veterans are social isolation, withdrawal, and apathy due to this feeling of disconnect within communities. Interviews also indicated that many veterans experience a strain 5 or break in their intimate relationships, difficulties starting new social relationships, and emotional distance from those around them. Furthermore, numerous veterans reported not being able to attend community events due to an inability to tolerate large crowds or loud noises, feeling unsafe going out after dark, and physical limitations that create general disconnection from others around them. Community reintegration for the veteran population remains a challenge that requires an examination of the pathways that promote a successful transition into community life after one’s military duty. One such pathway in transitioning to community life may reside in the ability of veterans to re-connect within their social networks through a personal sense of community established at the ASR program level. Sense of Community Theory One aspect to community reintegration is fostering a sense of community between individuals and their community of support. In this study, a sense of community is defined as attributes within the community or environment that foster an individual's sense of belonging and support (Sarason, 1974). Macmillan and Chavis (1986) broke down sense of community into four main elements. The first element is membership which is known as the perception of sharing personal relatedness and belonging with others. The second element is influence, which comes from the perception of making a difference to a group, sense of mattering, and a group mattering to its’ members. The third element refers to the integration and fulfillment of one’s needs through membership in a group known as reinforcement. The final element is shared emotional connection which refers to members having common ground by having similar experiences, places, and history. Sense of community is typically developed by individuals interacting within one’s “community.” Gusfield (1975) suggested that one’s “community” refers to both 6 geographic territories (e.g., neighborhoods, towns, cities) and relational (e.g., those associations developed around similar interests and skills). Furthermore, Baumeister and Leary (1995) suggested that for individuals to have increased well-being there are certain needs that need to be met. Individuals inherently have a drive to create and maintain significant, positive and long-lasting interpersonal relationships (Baumeister & Leary, 1995) that can fill one’s fundamental need to belong (Pillow et al., 2016). Bryan and Heron (2015) also conducted a cross-sectional study that examined if this sense of belonging influenced post deployment depression in military personnel. Findings supported that a stronger sense of belonging served as a buffer to depressive symptoms before and after military deployment. Secondary findings also indicated that belonging to a cohesive group/team served as a shield from negative cognitions and emotions. Through participation in group social activities, such as sport and recreation, permitted community members an opportunity to focus on the greater group/team task at hand that often-emphasized unit cohesion and social support strength. Sense of Community in Sport and Recreation A sense of community within the sports world plays a major role in the possible benefits that increase quality of life for members (Warner & Dixon, 2011). Warner and Dixon (2011) developed the Sense of Community in Sport Theory through a study that examined athletes' perspective on sense of community within the context of sport. The researchers identified the key factors that fostered sense of community within a sport context including leadership opportunities, social spaces, administrative consideration, competition, equity in administrative decisions, leadership opportunities, and voluntary action (Warner & Dixon, 2011). Warner et al. (2013) further outlined factors as: a) administrative consideration refers to the vocalization of concern, care, and intentionality of program administrators; b) common interest is the group 7 dynamic that fosters social networks and friendships of individuals brought together through common interest; c) equity of administrative decisions refers to the commitment that all decisions are fair and show all members are equal; d) leadership opportunities can be informal or formal chances for members to guide and direct others within the community; and e) social spaces are those common areas that foster interaction between members and athletes. Figure 1 provides an overview of these five key factors of sense of community developed in sport. Figure 1 The Sport and Sense of Community Theory (Warner & Dixon, 2012) Sport and sense of community have become a more popular element of community reintegration in recent years. However, limited research has examined sport and sense of community among military populations. Pollock (2018) conducted a master's thesis that examined if sport and recreation could foster a sense of community in the Canadian military. Results indicated that voluntary action, defined as “self-fulfilling and self-determining activities resulting from little to no external pressure or incentive” (p. 41), was the only factor that had a 8 significant relationship (p<.05) with sense of community. The results also found that various attributes (e.g., the number of recreational activities, the number of combined activities, and total duration of participation) were significantly related (p<.05) to three factors of sense of community (administrative consideration, common interest, and voluntary action). This study provided evidence that the nature of sport and recreation activities fosters various factors of sense of community in military veterans. Sport and recreation have also been found to be a critical factor in fostering a sense of community in non-military populations (Warner & Dixon, 2011; Warner et al., 2012; Warner et al., 2013). Ahern et al. (2015) suggested the transition for military life can be promoted by creating an increased sense of community through common associations. Sport and recreation can often serve as common association of individuals with a shared interest. There remains a crucial need to further explore the impact of sport and recreation on sense of community in military populations. Adaptive Sport and Recreation as an Intervention for Sense of Community in Veterans Throughout the literature, there is evidence that ASR has positive impacts on sense of community. For example, Arthur-Banning and colleagues (2020) examined the effectiveness of a community-based adaptive sport model in reintegrating veterans back into their community. In doing so, they examined the perceptions, feelings, and insight into veteran’s experiences at a therapeutic sports camp. Many veterans stated that having sport as a buffer helped enhance and ease the transition of integrating and creating social networks within their community. This study provided evidence that structured community-based adaptive sports programs does have a positive impact in aiding and enhancing reintegration for veterans. Rogers and colleagues (2016) further examined the role of ASR in the community reintegration of veterans when they examined veterans' insight and attitudes towards outdoor recreation during a four-day overnight 9 event involving fishing, archery, and skeet shooting. Researchers gathered data through individual interviews, observations, and various informal interactions. One main theme that appeared from results demonstrated the development of a social community with veterans who understand what they’ve experienced, sometimes without even having to say it. Participants in this study started as complete strangers but through the ASR event were able to form and create this community they referred to as a “band of brothers.” Similarly, Brittain and Green (2012) used a qualitative study to examine the use of sports as a rehabilitation tool for personnel with sudden traumatic injuries received during military service. The first major theme found was the Rehabilitative Power of Sport and the enjoyment individuals received through participation. The next major theme was directions that included Discovering and Acknowledging Individual Limitations, improving the veteran’s quality of life through community reintegration and life skills. The third major theme was Self-Actualization including encouraging positive thinking/attitudes and gaining new coping strategies and behaviors that aided in their transition to their former life. The last major theme found was achievement including increased determination, focus, and increased ability to set goals. This study highlighted the important visible, and sometimes invisible, outcomes that ASR provided to help individuals reconnect back into their communities. Likewise, a master's thesis conducted by Pearsall (2019) examined how frequency and duration of ASR participation influenced sense of community and community reintegration. Results suggested that there were no significant positive relationships (p>.05) between frequency and duration of ASR participation and sense of community. However, results indicated a positive relationship (p = .01) between sense of community and community reintegration. A secondary finding of the study revealed that type of ASR activity had a high level of influence over a 10 participant's sense of community compared to frequency and duration of participation. The findings highlights the importance of fostering and maintaining sense of community levels has on community reintegration for participants. This study provided some insight into athlete perspectives on what factors were important for creating a sense of community within an activity. Promoting Sense of Community through the Attributes of ASR ASR has long been a mechanism for rehabilitation in populations with disabilities (Brittain & Green, 2012). While there has been less examination of how ASR facilitates the process of community reintegration through a sense of community, there do appear to be some scientific explanations of how the attributes within ASP contribute to positive outcomes for those with disabilities. For example, Loy et al. (2003) examined how physical intensity, social connections, and social identities developed with ASR influenced the ability of a person to assimilate within functional limitations and become fully engaged in his or her environment. Loy et al. (2003) also discovered support from the inherent social nature of most ASR activities had an indirect influence on one’s adjustment to disability. For an individual to be fully adjusted to their current situation in life, they must go through the process of reintegrating into their previous community life or develop new community connections based on their current life situation, functional limitations, and disability (Livneh & Antonak, 1997). Similarly, Hutchinson and colleagues (2003) suggested that the social support found within ASR networks often provides new coping skills and strategies. Results provided two main roles of ASR in promoting coping including: a) ASR as a “buffer’ and b) ASR as motivation to sustain coping strategies for daily challenges. This study highlighted how sport and recreation often provided mental distractions from challenges faced in daily life due to current situations 11 and an escape from the individual's disability or illness. Participants confirmed through qualitative interviews that involvement in recreation and sport activities increased their sense of belonging, decreased stigmas often associated with disability, and broadened their social connections. While the social structure of sports and recreation is not typically studied in individuals with disabilities, a study performed by Pedersen and colleagues (2017) examined the effects of team sports on physical functioning, quality of life and motivation in untrained older adults. The researchers indicated that those involved in team sports had a significant improvement (p<.05) in quality of life, psychological well-being and general health. Participants in the team group specified their main motivation to participate was enjoying the team atmosphere. The team atmosphere also allowed participants to forget about their physical and mental limitations of what they could not do before (Pedersen et al., 2017). Chan and colleagues (2019) further examined the contribution of certain ASR attributes when they performed a systematic review of the therapeutic benefits of physical activity. Some therapeutic benefits noted that those who frequently exercised had increased positive mood state, increased resilience to stress, and were less likely to have anxiety or depression when compared to inactive individuals. Specifically, the researchers examined the physical intensity of exercise as it related to mood improvements or other related benefits. While there are certainly well- established physiological reasons higher intensity exercises promote enhanced moods through the release of certain biochemicals (Mandolesi et al., 2018; Sveaas et al., 2020), the review by Chan and colleagues suggested various outcomes of mood enhancement for those activities with higher or lower physical intensities. Similarly, Loy and colleagues (2003) included frequency of sports and recreation participation as a latent variable in the examination of individuals' 12 adjustment with different spinal cord injuries. Results indicated that frequency of ASR was significantly linked to increased perceived health (p <.01) and subjective well-being (p <.05) of individuals with SCI. While frequency and intensity of ASR participation has limited research, Baird et al. (2018) provided a research protocol to promote and increase the evaluation of the frequency and vigorous intensities of a structured physical activity programs on the community reintegration of returning veterans. Further examination of the influence of ASR frequency and physical intensity is needed to better understand those attributes that lead to veterans having a better connection to their communities following military service. While research on the effects of frequency and physical intensity have been more generalized to those without disabilities, the current study looks to further examine if specific attributes of ASR activities influence a greater sense of community in veterans. In summary, veterans often encounter obstacles as they transition from military to civilian life (Ahern et al., 2015). Current research has found adaptive sports and recreation to be an effective form of treatment for veterans. However, examining different ASR attributes including the frequency, duration, physical demands, and social aspects can provide further depth to this potential therapeutic pathway and specific contributions of ASR to the sense of community of veterans. Purpose and Research Questions This study examined and compared different ASR attributes and their effect on sense of community in veterans. Addressing this gap can help us better understand the benefits of ASR and specific contribution of participation variables like frequency, duration, physical demands, and the social aspects can help personnel, such as recreational therapists, provide a more 13 effective and targeted treatment plan to promote sense of community in the veteran population. Therefore, the research questions for this study include: 1. What is the relationship of adaptive sports and recreation participation and the sense of community in veterans? 2. Do participation attributes in adaptive sports and recreation such as frequency, duration, social structure, physical intensity predict the level of sense of community in veterans? Methods Participants The target sample of participants for this study was determined by specific selection criteria to include veterans that : a) were discharged from service and transitioning from military to civilian life, b) completed a minimum of 4 years of military service and deployed or in combat, c) participated in some form of ASR over the last year (competitive or recreational activities, team or individual activities), d) self-identified as having a mental or physical disability or illness, e) English speaking and literate, and f) a valid email address. Participants were not excluded for type of disability diagnosis, age, mobility level, military rank, branch of military service, or deployment location. Participants were excluded if they did not meet selection criteria. Measurement and Description of Variables Sense of community. As mentioned, community reintegration is a multidimensional outcome with no consensus on a conceptual definition. Therefore, it is often difficult to define community reintegration due to the many factors and aspects that encompass it. Because this study was interested in the connections between ASR and veterans, the study focused on sense of community in sport. For an individual trying to reintegrate back into their community, sense of community, belonging, and support are important to reconnecting to one’s community (Demers, 2011). Because this study was particularly interested in the context of sport and recreation, The Sense of Community in Sport Scale (SCS, Warner et al., 2013) was used to measure a veteran’s sense of community in adaptive sport and recreation through an individual's sense of community within the sport of recreation activity. While there are many instruments that attempt to measure aspects of community reintegration, this instrument does so through the connections created 15 within the sport and recreation activity (Warner et al., 2013). Sense of community is an important aspect due to its connection to enhancing individuals' quality of life through numerous benefits (Warner et al., 2013) and is defined as community or environmental attributes that foster an individual's sense of support and belonging (Sarason, 1974). The SCS scale (see Appendix B) has been used in past research to examine the impact of sports on the sense of community in various populations (Warner et al., 2013; Kerwin et al., 2015). The SCS used in the survey used all seven domains from the Sport and Sense of Community Theory (Warner & Dixon, 2012). Due to recent findings in research voluntary action and competition were dropped from data analysis (Warner et al., 2013). Final data analysis included the 20-item SCS scale that utilized the five factors of sense of community with each factor comprised of four corresponding items (Warner et al., 2013). The five factors include: a) Administrative Consideration, b) Common Interest, c) Equity in Administrative Decisions, e) Leadership Opportunities, f) Social Spaces (Warner et al., 2013). Each item is rated on a 4-point Likert scale ranging from (1) “Not At All True”, (2) “Somewhat True”, (3) “Mostly True”, and (4) “Completely True” (Warner et al., 2013). Warner and colleagues demonstrated content validity (factor loadings ranged from 0.69- 0.88), construct reliability (p< 0.001), and high internal consistency (p<0.001) in the SCS. Results from testing found the various versions of SCS to have equivalence reliability with no difference between participant populations (p=.79) and methods used for data collection (p=.65) (Warner et al., 2013). The SCS is scored numerically based on an individual’s responses to each item. Higher scores in the SCS indicate that the individual is experiencing a higher sense of community in their identified sport or recreation activity (Warner et al., 2013). Specifically, the SCS protocol permits modifying items to include the context of a specific or general sport to contextualize the “community” for responders. For this research, items included the general 16 context of “adaptive sports and recreation activities” was inserted to allow an examination of ASR in respondents. The term “sense of community” is used thereafter to represent the positive social connections one makes that lead to a sense of belonging. Adaptive sport and recreation participation. To further examine ASR participation a survey was administered to examine how the many attributes of the respondent’s participation in adaptive sports and recreation created a sense of community. Frequent and most meaningful activities were measured as separate ASR participation factors because activities most frequently participated in are not always the most favorite or meaningful for an individual due to money, time, accessibility, geographical location, or seasonal influences (Simon & Dowse, 2013). The “most meaningful activities” were defined as those activities that provided the most meaning, purpose and significance to an individual. In addition, this approach was also chosen because it is impractical to capture one’s entire sport and recreation over an annual period. Then, respondents were asked to indicate the frequency and duration on a scale (frequency ranged from 3-50 times per year; and duration ranged from 37.5-150 minutes per session) to better indicate the nature of their participation in their most frequent and most meaningful ASR activities. A list of possible ASR activities was provided to each participant to guide potential ASR activities (see Appendix A). The options also included an “other” blank if respondent’s ASR activity was not listed. Physical intensities of ASR. Similar to Loy and colleagues (2003), physical intensities of ASR were calculated via the Compendium of Physical Activities (CPA) (Ainsworth et al., 2011) which assigns a physical intensity to physical activities as expressed in metabolic equivalent (MET) intensity levels for 605 specific activities. The CPA is a listing of the MET values range from .9 (sleeping) to 18 METS (running at 10.9 mph) and include physical intensities including 17 “light” (< 3 METs), “moderate” (3-6 METs), and “vigorous” (> 6 METs) (Ainsworth et al., 2011). Seventy different activity codes were included in the study and those activities not selected by participants were assigned a MET value from the 2011 CPA to capture the estimated physical nature of one’s ASR. The 2011 CPA is the latest and revised version of the 1993 original and major revisions included changes to previous codes that reflected new evidence, new codes for technology-based activities, emergent sports, conditioning, and specifically measured activities (Ainsworth et al., 2011). The MET value of the respondent’s activities was averaged to represent the total physical intensity of the respondents two “most frequent” and two “most meaningful” ASR activities (see appendix C). Then, the CPA for each activity was multiplied by the frequency and duration to obtain a more accurate total physical intensity for the veteran’s ASR experience. For example, an individual who plays kickball (MET value of 7.0) for 2 hours a week for a 6-month period has a physical intensity indictor of 84 (e.g., CPA score x frequency x duration = total physical intensity indicator). Because it may not be possible to capture all the ASR engagements in veterans, this procedure estimated the intensity of the veteran’s most popular/meaningful and frequent ASR activities. One limitation of the CPA (2011) is that it was designed to measure the MET values of only ambulatory populations in activities. Therefore, the Compendium of Wheelchair-related Physical Activities (CWPA) developed by Conger and Bassett (2011) was used to indicate the physical intensities (MET values) of ASR for manual wheelchair users (see appendix D). The CWPA included MET values for 63 wheelchair ASR activities ranging from 0.8 to 12.5 (Conger & Bassett Jr., 2011). While the use of the CWPA helped to reduce some limitations of measuring ASR physical intensities for wheelchair users in this study, not every possible wheelchair ASR activity was provided so ambulatory MET values were still used for those ASR activities not listed in the CWPA (2011). 18 Social structure. Social structure within ASR activities differed based on the social nature of activities. Individual sports were defined as those ASR activities where the structural emphasis in the activity included limited social requirements to participate with others and the participating individual was primarily dependent on himself or herself for their performance or experience (Fresno Pacific University Staff, 2021). Consequently, team sports are comprised of multiple people, each with different strengths and abilities, and often co-dependent on one another to work towards a common team goal (Fresno Pacific University Staff, 2021). The researcher classified each activity within the pool of those listed ASR activities in the survey as either “individual” or “team” structures to reflect the typical amount of social interdependence within the ASR activity. While some ASR activities could be viewed as individual or team oriented, ratings were made as the most traditional format for ASR activity engagement. The researcher’s ASR social structure ratings were reviewed by an ASR expert in the field to confirm proper social classification of each activity based on the definitions used in the study. Due to the nature of the survey and the level of information present, the expert agreed with all researchers' classifications except one. Specifically, tennis was originally classified as a team sport, but after panel feedback, it was changed to an individual sport. Demographics. Finally, a smaller questionnaire was embedded in the battery of items to determine the demographic attributes of the survey sample. This demographic information included severity of disability, time spent in military service, time since military service, military rank, family and marital status, employment status, age, gender, and race. 19 Research Design and Survey Methodology The study design of this research was a quasi-experimental design. A quasi-experimental design is used when attempting to identify a relationship between different independent and dependent variables (Maciejewski, 2018). This study was a single-group post-test only design that examined different independent variables to determine their potential effect on the dependent variable. The independent variables being examined were ASR attributes (e.g., physical demands and social aspects) and the dependent variable for this study was sense of community. This arrangement allowed examination of the individual influences of ASR attributes on sense of community in veterans. Mean scores of all participation attributes within “most frequent” and “most meaningful” ASR activities were created. Finally, a “combined” variable was also created with the same methods to reflect participation variables across both (i.e., most frequent and most meaningful). The sample population was divided into clusters and as many participants as possible were collected from each cluster (Bhattacherjee, 2012). Multiple agencies in the southeastern United States who provide recreational therapy services to veterans assisted in surveying military veterans who met inclusion criteria. Thirty agencies providing adaptive sport and recreation services to veterans were contacted for data collection. Out of those 30 agencies, six agreed to take part and distribute the survey to their contact list. A Qualtrics survey link was then sent to Certified Therapeutic Recreation Specialists (CTRS) (i.e., agency program leader) who in turn distributed the survey to any veteran client in their program that fit the inclusion criteria and were willing to participate. It was anticipated that using the CTRS at each agency would increase the response rates due to the pre-established rapport with veteran respondents. While an alternative printout version was also provided via email to the program CTRS to provide to 20 participants who preferred to complete it by hand rather than electronically, however no veterans requested or completed paper versions. While Wu and colleagues (2022) suggested that 20-25% response rates are often difficult to obtain, certain survey techniques can often be used to enhance return probabilities. Providing advance notification of the purpose of the study, mode of data collection, and importance of the study to the agency CTRS, and follow up notifications to non-respondents was provided to increase the responses (Bhattacherjee, 2012). Bhattacherjee (2012) also suggested that providing incentives for participation is often the most effective way to increase survey response rates. Therefore, to increase the anticipated response rate, participants who completed a full survey were provided a $20 Amazon gift card from funds obtained through a student grant. To protect the identity of respondents and survey responses, participants who wished to be compensated completed the link provided at the end of the survey to provide information to receive the response incentive. Incentive gift cards were emailed electronically to participants that completed the separate link. Study procedures were approved by the ECU Institutional Review Board (IRB) prior to data collection (see appendix E). A social media flyer with a QR code was created and distributed to program leaders and other social media outlets to help increase response rates (see appendix F). Informed consent was embedded in the survey and obtained from every participant agreeing to be a part of the study. To access the survey, participants clicked “agree” to giving consent to participate. Once consent was provided, participants were automatically directed to the beginning of the survey. If consent was denied, participants were automatically redirected to an end of survey message. While the program response rate was 30% (6/20), the total survey response rate was unable to be calculated as the 21 total number of veterans receiving the emailed link was not available from the recreational therapists assisting in survey distribution. Results The final sample had a total size of 35 usable surveys. While the program response rate was 30% (6/20), the total survey response rate was unable to be calculated as the total number of veterans receiving the emailed link was not available from the recreational therapists assisting in survey distribution. A multiple tiered analysis approach was performed to examine each research question. First, descriptive and frequencies of demographics were examined to determine the composition of the sample. Next, correlations were examined to determine relationships between demographics, independent variables, and dependent variables to provide a rationale for potential direct relationships and the need to control for confounding influences unrelated to the research questions. Finally, a linear multiple regression was planned to determine if participation attributes in adaptive sports and recreation such as frequency, duration, social aspects, physical intensity predicted the sense of community levels in veterans. Data Preparation After data collection, data were entered into SPSS for data preparation and analysis. Data cleaning was conducted to determine missing data and data entry errors. A boxplot of data distribution was also examined to determine potential outliers, but none were found. With the missing data that occurred, the researcher examined the scope of missing data to determine if data imputation methods or elimination of the response was needed (Bennett, 2001). Of the 35 usable responses, four respondents did not indicate their birth year, but those cases were kept in the sample since age was only a demographic variable and not a variable of influence. There were two missing data entry values for the SCS scale across all respondents (0.29% of all data responses). To determine if the missing data were random, the researcher ran an expectation– maximization (EM) and missing completely at random (MCAR) test and determined that results 23 were non-significant (p<.05) concluding that missing data were random. Therefore, because missing data were random and a small proportion of the data set, the researcher made the decision to impute the mean of each SCS column that had a missing value (Younhee & Jung, 2016). After accounting for unfinished or missing data, 35 surveys were determined to be usable and appropriate for analysis. Tests for multicollinearity found that no two predictors were too closely related, and when testing for normality; the SCS scale found that the kurtosis (-.62) and skewness (-1.19) indicated that data were normal (Pett, 2015). Further normality tests included using the Shapiro- Wilk test, whereas if the p-value of the test is significant (p<.05) the data was not normal. SCS scale factors are broken into 5 larger domains: administrative consideration, common interests, equity of administrative decisions, leadership opportunities, and social spaces. For each of these domains when tested separately, and the total participation variable (p=.025) the Shapiro-Wilk tests were significant (p<.05), indicating that the data set was not normal. For total sense of community variable, the p-value was not significant (p=.252) indicating that the data was normal. Once data was prepared and preliminary analysis was conducted to account for all assumptions, data analysis was then conducted to examine the established research questions. Demographics The final sample indicated the majority of respondents were Caucasian (74.3%), male (80%), ambulatory (91.4%), and served as enlisted soldiers in the military (57.1%). It should be noted that a sizable portion (n= 5) of unusable survey respondents were African American and had to be deleted due to incomplete or missing responses thus creating a racial demographics in the sample slightly different from the population in the southeastern region of the United States. While the representation of gender and military rank was expected, it was unexpecting that the 24 sample was disproportionately ambulatory with few participants utilizing a wheelchair to participate in ASR activities. Due to the nature of the survey, diagnosis and disabilities of the population are unclear. Refer to table 1 for further demographic and military service details of veteran respondents. Table 1 Demographics of Participants 25 Frequency of ASR Participation In the survey, respondents were asked to rank their two most frequent and meaningful activities among 38 different adaptive sports and recreation activities. There were 30 activities chosen across both categories. When combining the most frequently participated activities were fishing (n=7, 18.9%), fitness (n=10, 27.3%), dance (n=3, 9.7%), basketball (n=3, 9.7%), gardening/landscape (n=7, 20.8%), weightlifting (n=4, 11.1%), and golf (n=3, 8.3%). Furthermore, the combined most meaningful activities were meditation/yoga (n=5, 13.9%), fishing (n=7, 19.7%), basketball (n=3, 8.3%), gardening/landscaping (n=7, 19.7%) mountain climbing/hiking (n=3, 8.3%), bicycling/handcycling (n=3, 8.6%), and archery (n=3, 8.6%). Sense of Community in Sport Scores Sense of community in sport (SCS) scores were examined through the combined total and the 5 subscales individually (see table 2). Mean scores were calculated by combining SCS scale scores across all participants within their perspective activities. When examining the combined total score of SCS in participants ASR activities the mean (x̄ = 2.13) was found to be lower than most subscales. The highest mean scores came from the subscales administrative consideration (x̄ = 2.28) and social spaces (x̄ = 2.26). The next highest subscale mean score (x̄ = 2.2) came from the common interest subscales. This was followed (in order) by the two lowest subscale scores of leadership opportunities (x̄ = 2.07) and equity in administrative decisions (x̄ = 1.85). 26 Table 2 Sense of Community in Sport Mean Scores Min. Max. Mean Std. Deviation Mean of SCS Administrative scores .25 3.00 2.27 .67 Mean of SCS Common Interest scores 1.00 3.00 2.20 .64 Mean of SCS Equity in Admin Decisions scores .75 3.00 1.85 .48 Mean of SCS Leadership Opportunities scores 1.00 3.00 2.07 .58 Relationship of Veteran Demographics and Sense of Community Before examining research questions, a correlational analysis between ASR participation and participant demographics was conducted to determine if there was a need to control for potential confounding variables. Correlations were conducted between the demographic variables and each of the 5 SCS subscales (administrative consideration, equity in administrative decisions, leadership opportunities, and common spaces). Analysis indicated that there was only one significant relationship (p<.05) between demographic variables and sense of community subscales (see table 3). Specifically, the correlation between years of military service and social spaces was statistically significant (r= .374, p < .05). Because there was not a theoretical connection between the two and strength of this correlation was moderate, the relationship was not controlled in further analysis. Furthermore, relationships between other demographic variables and sense of community domains were non-significant (p>.05), as correlations ranged from –0.306 to 0.374. and were also uncontrolled in further analysis. 27 Table 3 Years of Military Service and SCS Social Spaces Social Spaces Years of Military Service Social Spaces Pearson Correlation 1 .374* Sig. (2-tailed) .027 N 35 35 Years of Military Service Pearson Correlation .374* 1 Sig. (2-tailed) .027 N 35 35 * Correlation is significant at the 0.05 level (2-tailed). The Relationship of Adaptive Sports and Recreation Attributes and Sense of Community in Sport To examine this research question, the researcher conducted a correlational analysis between sense of community and ASR participation attributes. Because research question two was concerned with the predictive value of ASR participation attributes through a multiple regression analysis, it was important to examine the relationship between dependent (i.e., COS) and independent (i.e., ASR participation attributes) variables. While not a pre-requisite, Nathans and colleagues (2012) suggested that correlations of variables (r) indicate the strength and direction of linear relationships in multiple regression. A correlation analysis between the five subscales of SCS and ASR participation attributes for both frequent and meaningful activities were tested. All relationships between the 5 subscales of SCS and participation attributes of most frequent activities were found to be non-significant (p>.0-5) and correlations ranged from -.309 to .205. Additionally, the majority of relationships between SCS subscale scores and most meaningful attributes were found to be non-significant (p>.05) and correlations ranged from - .429 to .316. Three significant relationships were found between social structure most meaningful and SCS administration consideration (r= -.363, p=.032), SCS equity in 28 administrative decisions (r= -.413, p=.014), and SCS social spaces (r= -.429, p=.010) (see table 4). Table 4 Meaningful Activity Social Structure and Sense of Community in Sport Domains Social Structure Equity in Admin. Decisions Admin. Scores Social Spaces Social Structure Pearson Correlation 1 -.413* -.363* -.429* Sig. (2-tailed) .014 .032 .010 N 35 35 35 35 Equity in Admin. Decisions Pearson Correlation -.413* 1 .744** .610** Sig. (2-tailed) .014 <.001 <.001 N 35 35 35 35 Admin. Scores Pearson Correlation -.363* .744** 1 .688** Sig. (2-tailed) .032 <.001 <.001 N 35 35 35 35 Social Spaces Pearson Correlation -.429* .610** .688** 1 Sig. (2-tailed) .010 <.001 <.001 N 35 35 35 35 *. Correlation is significant at the 0.05 level (2-tailed). **. Correlation is significant at the 0.01 level (2-tailed). The Influence of Adaptive Sport and Recreation Attributes on Sense of Community in Veterans The second research question asked, “Do participation attributes in ASR such as frequency, duration, social aspects, and physical intensity predict the level of sense of community in veterans?” For this research question, the researcher planned to run a hierarchical regression to examine if each ASR participation variable predicted sense of community. Due to a lack of relationships between demographic and sense of community variables, there was no need to control demographics in the hierarchical regression analysis. It was also noted that the 29 directionality of social structure was contrary to the assumptions by the researcher and previous findings. Specifically, individually structured ASR activities were correlated with social domains within the SCS. More significantly, the researcher did not conduct the subsequent multiple regression because of the lack of significant correlational relationships between the experimental variables (i.e., ASR participation attributes and sense of community in sport) and a rationale inconsistent with theoretical foundations of the study to conduct the subsequent multiple regression. Due to an inability to find significant relationships to effectively study both research questions, the researcher examined some secondary issues to better understand how participation influences sense of community in veterans. Discussion This study examined the influence of adaptive sport and recreation (ASR) activity attributes on sense of community in veterans. Analysis of data found that both research questions were non-significant due to a lack of a correlational relationship between the independent (ASR participation attributes) and dependent variables (sense of community). Therefore, this section will detail the numerous methodological and organizational issues that may have influenced results. While some research questions were found to be contrary to previous literature and researcher assumptions, there remains some important issues for future research and practitioner services for veterans. Limitations A few limitations were presented throughout this study that created some methodological challenges. Limitations are broken into various subsections including: Study Design Issues, Sampling Issues, Measurement of ASR Activities, and Measurement of Social Structure. Many of these issues may have limited results and consistency with previous literature. However, there is still much to learn concerning from these methodological limitations as it relates to this and future research studies. Study Design Issues Only using a single group post-test only design is the weakest form of quasi-experimental design (Price et al., 2019). In this study design, a more rigorous analysis was prohibited due to practical data restraints and the nature of the population being examined so it was therefore impractical to include a comparison group of veterans not participating in ASR. Another limitation in this study design was potential issues with recall and memory decay (Tourangeau, 31 2000). In this study, the researcher asked veterans to recall ASR patterns over the past year. As with all retrospective physical activity surveys, there may have also been issues related to incorrect memory recall (Baranowski, 1988). Related, the anonymous nature of the survey made it impossible to follow up with respondents if there were missing data or inconsistencies eventually resulting in lost data. Sampling Issues Another limitation was the composition of the sample. The demographics of the study sample tended to be nearly 10 years removed from their active service. Initially, the researcher preferred to have a younger veteran population that was discharged from service more recently and theoretically having more time sensitive issues with re-connecting with their civilian community. Those who have been discharged for recently tend to face more obstacles while reintegrating than those who have been discharged for a longer period (Hawkins et al., 2015). This may have created a “ceiling effect” for the sample and made determining the influence of adaptive sports and recreation (ASR) in community reintegration (and sense of community) more difficult. Finally, another limitation in this study may have been the number of survey usable responses. While many efforts were made to increase survey responses, reminder emails, there were 45 total survey responses and only 35 were usable for data analysis. Future methods should be used to ensure mandatory information was completed to reduce missing data. The reluctance of veterans to share health related information in fear that it will result in loss or adjustment of benefits or compensation received (True et al., 2015) This is a limitation because this reluctance often leads to increased difficulty when researching this population (Rogers et al., 2016). 32 Measurement of ASR Intensities As mentioned earlier, another potential limitation was the use of the 2011 CPA to measure the physical intensity of ASR participation. The 2011 CPA provides evidence-based MET values of energy levels used primarily for ambulatory activities. ASR offers a wide range of adaptations, versions, and modifications for ambulatory and wheelchair populations that may differ significantly from the ambulatory participation. While a few MET values for wheelchair users were used from Compendium of Wheelchair-related Physical Activities (CWPA, Conger & Bassett, 2011), the CWPA hasn’t been updated since 2011 and does not include all possible wheelchair activities and their MET values. Furthermore, it should be noted that the use of CPA and CWPA MET values in this study were estimates for veterans and not energy expended for actual ASR participation. Additionally, some participants used the “other” blank (instead of a pre-determined activity listed) to identify most meaningful or frequent activity. These selections did not always have specific MET values available making calculating the overall intensity more challenging. For example, beep baseball (for visually impaired) was an activity identified by a respondent that did not have any CPA or WCPA MET value listed and the researcher therefore used the CPA score for more traditional version of baseball instead. When an identified activity had multiple CPA values listed, the researcher averaged the sum of the multiple values to estimate the best possible estimation of the activity intensity. Measurement of Social Structure This study pre-determined the social nature of activities by classifying activities as either individual or team oriented. Due to the survey's nature, the researcher did not have specific information about what the typical social nature of the participant’s true engagement in the 33 activity. Therefore, the pre-determined classification of the social nature of the activities may not have been the most accurate way to determine the true sense of social engagement and connection in an ASR activity. Data may not have therefore indicated the true social nature of an activity and only accounted for the designed social structure of the activity. For future, researchers should have individuals classify their individual perceptions of the social nature of their activities. This will allow researchers to examine social aspects from individual perspectives rather than from a structural program perspective. This issue will be further discussed in this section. Examining ASR and Veteran Sense of Community While the stated methodological limitations may have directly impacted a lack of relationships, there remains some interesting findings that can help those serving veterans to promote community reintegration and sense of community. To gain further perspectives from this study, some additional measures were examined to help better serve those practitioners who design programs for veterans. The following provides some issues for consideration. Promoting Meaningful Participation for Veterans A secondary finding in this study indicated that attributes significantly differed (p<.001) when compared between most frequent and most meaningful activities suggesting a difference in what veterans frequently do and those activities most meaningful. Further understanding the constraints to this gap is the first step in determining why these are so different and what practitioners can do to reduce these gaps. If researchers can understand the individual cognitive processes that determine the difference in perspectives between those activities that are most meaningful and those that are most frequently participated, it will help better understand the 34 specific characteristics that make participation in these activities so meaningful so those can possibly be facilitated with those most frequent activities. This also provides practitioners the opportunity to investigate those challenges and constraints that make meaningful activities less frequently participated. Participants and athletes are key stakeholders in sporting environments and the sense of community fostered within each program may be an important element of making ASR activities more meaningful. Therefore, studying sense of community is an important aspect to determine within ASP programs. A strong sense of community is durable and will persist despite the natural flow of new athletes being introduced and older athletes departing (Warner & Dixon, 2011). Understanding the athletes' individual perspectives of an ASR program can help practitioners build strong programs with lasting levels of sense of community. In turn, it remains a priority for practitioners to help veterans participate in their more meaningful activities more often and for longer periods. The Need for Social Participation The most significant finding in this study was that the social nature of ASR is an important aspect of ASR programs and remains a critical need for veterans once removed from active service. The only significant correlations in this study involved the social aspects of sense of community. It is a human need to be socially connected with others (Baumeister & Leary, 1995). Veterans too have a need to be connected (Rogers et al., 2016). Rogers and colleagues (2016) explored the impact that outdoor recreation had on injured military members when they examined the role that outdoor recreation had on developing a social community for veterans. The small community created, where participants began as strangers evolved into them leaving as “best friends” which they referred to as a “band of brothers”. Participants in the Rogers et al. study revealed that while some had connections through military rank or branch, but ultimately 35 these factors did not matter to them. It was important to have those experiences with other veterans that only other military members would understand. These newfound social connections in ASR and unrelated to previously established military connections provided the opportunity for participants to form a sense of belonging. Participation in ASR resulted in a cohesive unit between participants that was interchanged with pervious military culture, values and training instilled in them. Understanding the Individual Social Experience in Adaptive Sport and Recreation As mentioned earlier, pre-designation of the social structure within the list of ASR activities to “traditional” engagement may have constrained and limited the various ways individuals, including veterans, experience ASR. Social engagement occurs even in “individual” activities and the perception of the degree of social nature is and always determined by participants. For example, track athletes traditionally compete as individuals but there is still extensive social engagement within and beyond the actual activity that may lead to the development of one’s sense of community. The sample mean (x̄ = 1.14) of social structure indicated respondents most frequently participated in ASR structured as “individual” activities. When examining the means of those ASR that were most meaningful the sample mean (x̄ = 1.1) indicated that social structures tended to be more “individual” in structure. Analysis revealed that despite activities being categorized as “individual”, participants still had opportunity to build social communities regardless of the social structure of the ASR. Regardless of the social structure of an activity, opportunities for participants to create social communities were present. Understanding what factors within a program can foster increased social nature of an ASR activity is important. While the social structure of activities mostly fell in the “individual” classification, participants still sought out these activities due to 36 their social nature. Sense of community mean scores for the social spaces (x̄ = 2.26) and common interest (x̄ = 2.2) indicated that participants did find a social community from these “individual” activity structures. Additional research on individual’s perspectives of the social nature and experience within an activity can help practitioners foster an increased sense of community in ASR programs. This has been confirmed in previous research. For example, Rogers and colleagues (2016) explored the impact that outdoor recreation on injured military members. A major theme that was found was the significant role that outdoor recreation had on developing a social community for participants. Most of these activities at this veteran event were individual in nature (e.g., archery, trap shooting, fishing). None-the-less, a small community was still created in those more informal social conversations and interactions beyond the mere individual ASR engagement. Rogers et al. (2016) suggested an organized ASR program for veterans created these newfound social connections unrelated to previously established military connections that ultimately provided the opportunity to form a new sense of belonging. Trends in Veteran Participation in Adaptive Sport and Recreation Finally, as mentioned earlier, the most frequent activities in the sample included fitness, weightlifting, basketball, dance, fishing, golf, and gardening/landscape. The major theme in most of the frequent ASR activities is the focus on physical fitness. The foundations and structure of military service emphasize these same patterns through consistent physical fitness for military preparedness. The experience of military service may create a physical fitness lifestyle habits for some veterans that carries over into civilian life. While interest is always contextualized to individual veterans, practitioners should consider this possibility of veterans desiring activities that focus on fitness due to the habits established during their previous military service. In 37 addition, examining the most “meaningful” ASR activities included fishing, yoga/meditation, gardening/landscape, mountain climbing/hiking, basketball, bicycling/handcycling, and archery. Overall, most meaningful activities were self-care oriented with focus placed on mindfulness, meditation and being in nature. While the value of the ASR experience for veterans is certainly pertinent to one’s individualized experience, it may be necessary to examine those activity participation patterns that seek needs that carry over from their military experience and those that may have potentially been created because of the military experience of veterans. Future Research Due to the many difficulties veterans face when transitioning from military to civilian life, there remains a need for future research on evidence-based interventions and policies to help ease the transition and eliminate some difficulties (Thomas & Bowie, 2016). Military technology and war tactics are rapidly advancing each year, in turn creating higher survival rates of soldiers and veterans with various disabilities and diagnosis (Smith & Bellamy, 2005) creating needs for advancements in the care and interventions veterans are receiving. Future research into specific interventions and their effectiveness will be vital for providing the highest level of care for all veterans. Another avenue for future research is to further examine the differences in sense of community between wheelchair users and ambulatory individuals. Those individuals who used wheelchairs for mobility had lower means across all five SCS domains than the ambulatory veterans (mean differences ranged from .218-.833). The total SCS mean score for ambulatory veterans was 2.175 while the non-ambulatory total SCS mean score was 1.700. This difference could not be reported as a finding in this study because of the disproportionate numbers of 38 ambulatory veterans vs. non-ambulatory, but the large difference in scores provides interest with future studies with more proportionate sampling. Examining sense of community across the presence of physical disability may provide further insights into the identity and reintegration challenges faced by those post-duty veterans with physical disabilities (Rogers et al., 2016). There are a few additional avenues for future research that allows for examination of specific aspects and how they influence community reintegration. One is examining the influence between serious leisure or sport specialization and its influence of sense of community. This will allow researchers to examine any potential benefits that specializing in one sport has on fostering a sense of community within its program and for its participants. Another avenue for future research is to provide face to face surveying as a method to increase response rates. A larger sample size will increase the precision of results (Andrade, 2020). Face to face surveying can decrease the reluctance in veterans to seek or share any information that relates to their health (Olenick et al., 2015). Finally, adding a limitation or cap to the years since being discharged (<5 years). Resulting in a population of veterans that are more recently discharged and in early stages of transitioning from military to civilian life. Practical Implications of Study The future implications of this research hope to provide feedback for CTRS’s to improve their services and create a sense of community in veteran populations. While findings in this study may differ somewhat from previous research (Baird et al., 2018), there remains key information that can provide CTRS’s with knowledge to help create the most effective and targeted treatment plans for clients. One of the flaws in this study may have been the inability of the survey methods to accurately capture the true essence of the veteran experience in ASR. The 39 CTRS needs to continue to strive to modify or adapt their program based off the clients' stated needs and experiences. Program evaluations are assessments of a specific program to gather feedback and evidence of the program's effectiveness in providing the outcomes it is intended to achieve (Savaya & Waysman, 2008). The survey used in this study, SSC (Warner et al., 2013) can be classified as a consumer-based program evaluation that asks consumers of services an accumulation of questions or procedures with the sole intention of how determining how effective a program is in achieving its intended outcomes through participant needs and opinions (Bledsoe & Graham, 2005). By providing insight into how an ASR program fosters a sense of community in veterans can lead to a greater understanding of how sense of community is created through ASR in the veteran population. A crucial factor of community reintegration is that adaptive sport or recreation program can foster sense of community for participants (Pollock, 2018). Sense of community is not often considered by the CTRS providing ASR programs for veterans. Warner defines sense of community as “community characteristics that lead to members feeling a sense of belonging, attachment, and shared faith and interests in common goals or values” (Warner, 2016). When a sport or recreation program has an elevated sense of community, it results in several benefits for not only participants but the sport, agency, and community (Warner, 2016) including increased retention of participation, health benefits, justification and demand of the sport, and civic participation (Warner, 2016). As mentioned earlier, adaptive sport and recreation activities often create an environment that draws like-minded individuals together based on the shared interests of the sport (Warner et al., 2012c). This social environment serves as a catalyst for creating and fostering a strong community within participants (Warner et al., 2012c). Sporting environments are created as a direct reflection of how a sports program is structured and managed for 40 participants (Warner et al., 2012c). Understanding the role of management and programming within sporting environments is beneficial for those in and around the program (Warner & Dixon, 2011). By providing facilitators with key context important to participants, managers and practitioners can help foster and maintain a sense of community for participants (Warner et al., 2012). Accounting for the athletes' perspective into sense of community and using the SCS survey can help sport and recreation leaders evaluate sense of community as key a key piece of the puzzle to better serve those in our veteran community. Conclusion In a survey on Iraq and Afghanistan war veterans, around 70% reported having difficulties transitioning from military to civilian life (Thomas & Bowie, 2016). Due to several emotional, physical, social, and societal issues, numerous veterans that return from war remain disengaged from society due to inability to reintegrate (Thomas & Bowie, 2016). While there were few to no significant correlations between demographic variables and participation in ASR, there remains important information related to the social connections veterans desire and can experience in ASR activities. Secondary findings found that the social nature of ASR activities played an important role in SCS scores regardless of the social structure. 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