Improving Resiliency in U.S. Air Force Healthcare Personnel
Phase: NA
Conditions: Military Personnel, Health Promotion
Sponsor: University of New Mexico

 
Improving Resiliency in U.S. Air Force Healthcare Personnel 
NCT05460663 
Document IRB Approval Date: 9-1-2020 

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Other requests for, or further releases of this document, shall be referred to  
Col Jacqueline M. Killian. 
Improving Resiliency in U.S. Air Force Healthcare Personnel  
AFRL IRB APPROVED 1 SEPTEMBER 2020 
1 
 
Section 1: General Study Information 
Instruction: The intent of this template is to guide the investigator when developing their research protocol 
for submission to the AFRL IRB. Please refer to the Protocol Guidance Document for additional information.  
 
This template is unlocked to provide you with the most flexibility for completion. The overall format/layout of 
the document should not be altered. Insert text in the cells/rows provided. Use black, 12 point Arial font.  
Title of Investigation: 
Improving Resiliency in U.S. Air Force Healthcare Personnel 
1.1 Principal Investigator 
Name: 
Jacqueline M. Killian 
Organization/Office: 
711th HPW/CL 
Rank/Title: 
Colonel/ Senior Nurse Scientist, 
711th HPW; Senior Science 
Advisor, United States Air Force 
School of Aerospace Medicine 
Duty E-mail Address: 
jacqueline.killian@us.af.mil  
Phone: 
937-255-3784 
1.2 Associate Investigator(s) & Study Personnel 
Will this study involve Associate Investigator(s) or other study personnel? 
☒ Yes  
☐ No 
If Yes, Complete and submit the additional study personnel checklist.  
1.3 Risk Level 
1.3.1 Does this study involve Minimal Risk or Greater than Minimal Risk? 
☒ Minimal Risk 
☐ Greater than Minimal Risk 
If Minimal Risk, Proceed to Section 2.  
If Greater than Minimal Risk, will this study enroll US DoD service members and 
recruit in a group setting?  
☐ Yes 
☐ No 
If Yes, identify an ombudsman who will observe group 
recruitment of US DoD service members.   
Name: 
 
If No, Please complete Section 2.  
Note: Research involving Greater than Minimal Risk requires a Research Monitor. Contact 711HPW/IR for additional 
submission requirements.  
 
Section 2: Facility / Contractor 
2.1 Please identify the following: 
Sponsor: 
TriService Nursing Research 
Program 
Funding Source and Amount: 
TriService Nursing Research 
Program, $359,258.00 
Contract#; CRADA#; or Cooperative Agreement#: 
 
Location(s) where activity will be conducted: 
Wright-Patterson Air Force Base: 711th HPW and 88th 
MDG 
Note: For locations outside of the 711th HPW, local Commanders must give their permission for research to be 
conducted on individuals under their command. Contact 711HPW/IR for additional submission requirements.  

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Improving Resiliency in U.S. Air Force Healthcare Personnel  
AFRL IRB APPROVED 1 SEPTEMBER 2020 
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Section 3: Conflicts of Interest 
Principal and Associate Investigators are responsible for disclosing any of the following that would reasonably 
appear to be affected by their participation in or by the outcome of the study:  
• 
Financial Interest  
o Anything of monetary value, including but not limited to; salary or other payments for services (e.g. 
consulting fees or honoraria), equity interests (e.g. stock options or ownership interests). 
• 
Intellectual Property  
o Patents, copyrights and royalties from such rights, trademarks, tradenames and trade secrets. 
• 
Any real or perceived personal conflict  
o Membership on a board of directors or advisory committee, having a commercial interest in the 
products or devices that are utilized in the study. 
Note: All staff must complete the Conflict of Interest (COI) checklist and file it with the PI. The PI must submit 
their copy of the checklist with the IR submission package.  
3.1 Do any members of the study staff have a COI? 
☐ Yes 
☒ No 
If Yes, Please explain in detail.  
 
 
Section 4: Background and Scientific Rationale 
Although the Department of Defense (DoD) has made substantial efforts to increase service 
member resilience, there is limited published evidence that these efforts increase resilience.1-3 The 
RAND Center for Military Health Policy Research reviewed factors related to service members’ 
psychological resilience and interventions to enhance it. They also assessed current resilience 
programs and found “generally very little rigorous research […] across the different resilience 
factors”1 (p. xvi), especially at family, unit, and community levels.1 Across programs they found a 
lack of consistency in definitions of resilience, outcomes, and evaluation measures; they also 
reported that inadequate buy-in and logistical support from military leadership were barriers to 
program implementation.1 The Institute of Medicine recommended the DoD utilize evidence-based 
resilience programs in 2013.4 In response, the DoD “reject[ed] the recommendation to eliminate 
programming judged by leadership to be beneficial, although not necessarily evidence based”5 (p. 
3). Subsequent literature reviews have identified a continued lack of resilience program evaluation 
and inadequate evidence for the efficacy of military resilience programs.2, 3  
 
The proposed study will be guided by the Defense Centers of Excellence (DCoE) Resilience 
Continuum (Figure 1).1 In the DCoE Resilience Continuum, psychological resilience is 
conceptualized as a process associated with maintenance and recovery of psychological health. 
Resilience has been variously defined as “the process of coping with or overcoming exposure to 
adversity or stress”1 (p. xiii) and as a process of […] negotiating, adapting to, or managing significant 
sources of stress or trauma”6 (p. 152). Resilience consists of “assets and resources within the 
individual, their life and environment”7 (p. 159) that promote a “capacity for adaptation and ‘bouncing 
back’ in the face of adversity”7 (p. 152). Resilience increases an individual’s ability to adapt his or 
her “body, mind, and spirit to current life circumstances”6 (p.76). Resilience is considered to be a 

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Improving Resiliency in U.S. Air Force Healthcare Personnel  
AFRL IRB APPROVED 1 SEPTEMBER 2020 
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protective factor against psychological problems for military service members and their families that 
is “characterized by hardiness, personal control, and positive coping strategies”8 (p. 47). However, 
few Department of Defense resilience training programs aimed to increase service member 
resilience had been empirically evaluated for their effectiveness in increasing resiliency.1, 3, 5 
 
Under the DCoE Resilience Continuum, optimal, mission-ready performance is sustained by 
providing supportive measures to service members and their families while engaging the support of 
leaders.1 Such efforts enhance the service member’s ability to maintain a positive outlook and sense 
of purpose in the face of challenges. As service members encounter “challenges and stressors”1 (p. 
6), they can shift into the state of ‘Reacting’, and possibly deteriorate to the states of becoming 
‘Injured’ or ‘Ill’.1 Individuals experience an increasing severity and worsening symptoms of distress 
as they progress through these states.1  Most service members are able to maintain a state of 
optimal, mission-ready functioning if they are provided “prevention and early intervention through 
education and training”1 (p. 6). This training also helps service members to recover more readily to 
optimal performance when they experience stressors, unless the service member experiences a 
state of becoming ‘Injured’ or ‘Ill’, in which case medical treatment may be needed to recover to 
optimal performance.1 
 
Stress Management and Resilience Training. The Stress Management and Resilience Training 
(SMART) program was developed by Dr. Amit Sood.  SMART focuses on improving the practices of 
gratitude, mindful presence, kindness, and developing a resilient mindset.9 The SMART program 
incorporates practices that focus on six individual factors that have been found to promote 
individual-level resilience: positive coping, positive affect, positive thinking, realism, behavioral 
control, and altruism.1 In this proposed study, SMART will be provided via either a two-hour, video 
teleconference (VTC) training or by completion of a self-paced, on-line version completed over a 
period of four to eight weeks. VTC or on-line versions will be utilized in order to assure the 
participants and researchers remain socially distanced to prevent transmission of severe acute 
respiratory syndrome coronavirus 2 (SARS-CoV-2). If in-person training is feasible and safe at a 
future time during the planned study period (Appendix A), in-person training will be used to 
supplement or replace VTC training.   
 
To date, ten studies, most with small sample sizes, have been published to report the effectiveness 
of SMART in increasing resilience and/or decreasing stress.10-19 Four of these studies were 
experimental, and six were quasi-experimental designs. A majority of the studies examined the 
SMART intervention with physicians or nurses; however, non-healthcare personnel were included in 
three studies. Five published studies incorporated a two-hour version of the in-person SMART 
training.10-13, 15 Of these studies, three showed a 7.7% to 10.6% increase in CD-RISC scores, with a 
large effect (d = 0.82 – 1.16), eight to twelve weeks after training was completed and a significant 
decrease in self-reported stress.10-12 Four of the six studies which utilized alternate forms of the 
SMART program showed that participant resilience significantly increased by 6.3% to 13.2% 
between twelve and thirty-six weeks after the program was completed.14, 17-19 
 
The SMART program has shown evidence of short duration efficacy when delivered via an in-person 
setting, but has not been tested with military personnel. To date, the effectiveness of the on-line 

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Improving Resiliency in U.S. Air Force Healthcare Personnel  
AFRL IRB APPROVED 1 SEPTEMBER 2020 
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training, as well as, its equivalency with the in-person training has not been evaluated. This 
proposed investigation is necessary to determine if the training is as relevant to and effective with 
AF service members using an appropriately powered, quasi-experimental design. If the SMART 
program has similar effectiveness to that reported in studies with civilians, it would have the potential 
to be the kind of evidence-based resilience intervention that has, thus far, been lacking for military 
service members.  
 
Section 5: Study Objective(s) and Purpose 
5.1 Purpose 
The purpose of this proposed study is to examine the effectiveness of the Stress Management and 
Resilience Training in increasing resilience in U.S. Air Force (USAF) healthcare personnel. 
5.2 Primary Objective 
The specific aim of this proposed quasi-experimental study is to examine the effectiveness of 
SMART in increasing levels of resiliency in active component USAF healthcare personnel (any 
4XXX Officer or Enlisted Air Force Specialty Code [AFSC]) assigned to 88th Medical Group (MDG) 
or U.S. Air Force School of Aerospace Medicine (USAFSAM) at Wright Patterson Air Force Base 
(WPAFB), OH.  
 
To accomplish this aim, the following research question will be asked: Does SMART increase levels 
of resiliency in active component U.S. Air Force healthcare personnel? 
5.3 Secondary Objective(s) 
N/A 
 
Section 6: Study Design 
6.1 Description of Study Design 
A pre/post-training quasi-experimental study is proposed to examine the effectiveness of the Stress 
Management and Resilience Training in increasing the levels of resiliency in healthcare personnel 
serving in the U.S. Air Force. 
 
Intervention Group Assignment. Simple randomization will be utilized for participant assignment 
into the intervention delivery type (i.e. VTC group sessions or on-line SMART program). However, 
participants will be allowed to switch to their desired delivery type. We will track those individuals 
who chose to switch their randomized assignment. This will enhance our recruitment process and 
permit a component of randomized trial within a quasi-experiment. If in-person training becomes 
feasible and safe during the planned study period, in-person training will be used to supplement or 
replace VTC. Based on our estimation of the sample size needed and potential attrition, we will seek 
to enroll at least 60 participants into both the VTC and on-line training groups. We will assess the 
participants’ level of resilience at baseline (enrollment) and at 12 weeks post SMART training. A 
second post-test will be attempted for participants who completed the SMART training no later than 
the end of February 2021 to test for longer-term changes in resilience. 

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Improving Resiliency in U.S. Air Force Healthcare Personnel  
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Variables and Measures. Baseline data will be collected from each participant prior to the delivery 
of the intervention. The baseline survey will include nine demographics questions to attain 
information for participant age, gender, marital status, race, ethnicity, previous deployment, military 
grade/rank, duty location, and military job duty (i.e. AFSC). Participants’ names and preferred e-mail 
and phone contact information will be requested. This information is necessary to arrange a follow-
up phone call for each participant approximately four weeks after completing the SMART training 
and to send follow-up surveys via the Research Electronic Data Capture System (REDCap™; see 
Intervention) at weeks 12 and 24 (if applicable) after participants complete SMART. The baseline 
and follow-up surveys will also include the Connor Davidson Resilience Scale (CD-RISC)20-21, 
Perceived Stress Scale (PSS)22-13, Generalized Anxiety Disorder Scale (GAD-7)24, and five-item 
Quality of Life (QoL) measures.25  
 
Change in resilience scores on the CD-RISC will be the primary endpoint of the study; secondary 
endpoints include changes in PSS, GAD-7, and the five-item QoL measure. Although stress, 
anxiety, and QoL are not primary outcome variables in this study, a decrease in stress and anxiety 
and an increase in QoL have been reported in past studies by participants who completed SMART, 
in addition to changes in resilience. Including the PSS, GAD-7, and QoL measure will offer an 
additional opportunity, with minimum response burden, to compare participant outcomes from this 
study with outcomes reported in previous studies. 
 
Connor Davidson Resilience Scale. The CD-RISC has been utilized to measure service member 
resilience in multiple studies.21, 26-30 The 25-item scale was developed from multiple studies of the 
characteristics of resilient individuals.6 Respondents can answer each item using a five point Likert 
scale ranging from not true at all (0) to true nearly all the time (4).6 A total CD-RISC score is 
calculated by summing the score of all 25 items for a total possible score of 100, with a higher score 
reflecting a greater level of resilience.6  
 
During the scale’s development, an intraclass correlation coefficient of 0.87 was reported for test-
retest reliability.6 The convergent validity of the scale was demonstrated by a strong positive 
correlation to the Kobasa Hardiness measure (r = .83, p <.0001), a strong negative correlation with 
the perceived stress scale (r = – .76, p <.001), and a modest negative correlation with the Sheehan 
Stress Vulnerability scale (r = –.32, p <.0001).6 The psychometric properties of the CD-RISC were 
favorable in a large sample of AF personnel (N = 57,692),21 in which the reported CD-RISC mean 
score was 83.66 (SD = 11), and Cronbach’s alpha was .91.21  
 
Perceived Stress Scale. The PSS was developed to provide a global measure and measure for 
current levels of perceived stress.22 The PSS is a 14-item instrument, and respondents answer each 
item on a four point Likert scale ranging from never (0) to very often (4).22 An individual’s score is 
calculated by reverse scoring seven items and then summing all item scores, resulting in a score 
range of 0-56.22 
 
The test-retest reliability of the PSS has been reported to be .55 and .85.22 Concurrent and 
predictive validity of the PSS has been reported. The PSS and Center for Epidemiological Studies 

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Improving Resiliency in U.S. Air Force Healthcare Personnel  
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Depression Scale were shown to concurrently and independently predict psychosomatic 
symptoms.22 The PSS has predictive validity for utilization of health services (r = .20, p <.001), social 
anxiety (r = .37, p <.001) and smoking cessation rates (r = .39, p <.001).22 
 
Generalized Anxiety Disorder Scale. The GAD-7 is a brief measure of anxiety. Respondents can 
answer each item using a four point Likert scale ranging from not at all (0) nearly every day (3).24 A 
total score is calculated by summing the scores of the seven items with possible scores ranging 
from 0-21.24 Scores between 5-9 are indicative of mild anxiety, and score between 15-21 are 
indicative of severe anxiety.24 
 
During the scale’s development, an intraclass correlation coefficient of 0.83 for test-retest reliability 
was reported.24 Construct validity for the GAD-7 scale was demonstrated by a significant (p <.05 for 
all comparisons) positive correlations to disability days (r = .27), physician visits (r = .22), and 
symptom related disability (r = .63).24 The convergent validity of the scale was demonstrated by a 
statistically significant, positive correlations to the Beck Anxiety Inventory (r = .72) anxiety subscale 
of the Symptom Checklist (r = .74), and Patient Health Questionnaire for Depression (r = .75).24  In a 
previous study, the SMART program demonstrated a decrease in participants’ reported levels of 
general anxiety (Estimated Treatment Effect = ̶ 1.74, 95% CI =  ̶ 4.7, +1.22).13 
 
Linear Analogue Self-Assessment (LASA) Quality of Life.  A five-item LASA QoL measure will 
be used for this study. The 5-item LASA QoL measure includes the overall QoL measure, as well as, 
measures of physical, emotional, spiritual, and intellectual QoL.25  Participants will respond to each 
item using a 10-point Likert scale ranging from as bad as it can be (0) as good as it can be (10).31 
Although each item is scored separately and represents a distinct aspect of quality of life, the 
reported Cronbach’s α for all five items suggests they share a common underlying construct.25  
 
The LASA overall quality of life item has been utilized as a brief, minimal burden assessment of QoL 
in clinical practice and clinical trials.31 The LASA overall QoL mean score for an healthy individual 
has been reported as 8.3 (SD = 10.2), and a score ≤ 5 can indicate a clinical concern.31  A lower 
LASA overall QoL scores is correlated with a worse performance status, and an increased likelihood 
of reporting a clinically meaningful deficit.31 In a previous study, the SMART program demonstrated 
a positive effect on participants’ QoL (Treatment Effect = +1.2, 95% CI = 0.0, 2.4, p = .044, d = 
.83).12 
 
Intervention. SMART is focused on improving the practices of gratitude, mindful presence, 
kindness, and developing a resilient mindset.9 In this study, SMART will be offered via a two-hour 
VTC training provided by Dr. Hernandez or Col Killian or via a self-paced on-line course. The two-
hour VTC will be provided synchronously to a maximum of 10 individuals. A study team member will 
contact participants in the VTC group to provide available dates and times of scheduled classes, 
and these participants will be scheduled for a class they would like to attend. Participants in the VTC 
group will be provided a web-link prior to the session, and each session will have a unique password 
to access the training. Participants in the on-line training group will be provided a code to access the 
training website. If local conditions permit in-person group meetings (i.e. Health Protection Condition 

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Improving Resiliency in U.S. Air Force Healthcare Personnel  
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[HPCON] Alpha or Bravo), in-person group SMART training in a classroom will be offered as an 
alternative to VTC sessions. 
 
In order to provide the in-person or VTC SMART training, instructors must complete the Transform 
course in Rochester, MN or at another designated location. The Transform course consists of two 
days of initial classroom training, at least three months of distance-learning with Dr. Amit Sood, the 
developer of the SMART training, and a one-day, end-of-course classroom training.32 Dr. Hernandez 
(PI) has completed the Transform course, and Col Killian  attended the two day classroom training 
July 17 and 18.  She is in process of completing the distance-learning portion with Dr. Amit Sood.  
 
In order to assure fidelity, Dr. Sood provides a standardized presentation, which is customizable by 
presenters. Dr. Hernandez has completed the Transform course and is approved to provide SMART 
training. During the initial delivery of the SMART training in month 3, Dr. Hernandez and Col Killian 
will make notations and jointly agree to incorporate recommendations for improving training delivery. 
At the end of the course, participants will be offered a copy of SMART with Dr. Sood: The Four-
Module Stress Management and Resilience Training Program at no charge to the participants. This 
book will serve as a review of the practices and course content for improving gratitude, mindful 
presence, kindness, and developing a resilient mindset.  
 
Additionally, in previous studies, individual participants were contacted by phone four weeks after 
attending the SMART course. These phone calls were offered to provide participants the opportunity 
to ask questions and to provide reinforcement of the principles presented during the SMART 
training.12, 15, 33-35 Therefore, study participants will be contacted by the PI two weeks after 
completing the SMART training by e-mail or phone and asked if they would like to schedule a follow-
up phone meeting. If so, the PI will work to schedule a 30-minute follow-up phone call with 
participants. At the end of this follow-up session, participants will be provided the option to schedule 
a final 30-minute follow-up phone call. All phone consultations will be completed before the 12-week 
follow-up survey. These consultations will be a budget item for the proposed study and provided at 
no cost to participants. 
 
Procedures. Letters of support have been received from the 88th MDG and USAFA Commanders. 
These letters of support includes permission to recruit potential participants with posted flyers, 
newspapers, social media, and informational e-mail announcements. Recruitment materials will be 
distributed in accordance with any limitations set by the governing IRBs and any future Commander 
instructions. Study information will be distributed as broadly as possible. 
 
Initial recruitment and randomization will be completed during months 3 through 10 of the study. 
However, if the study team determines the need to recruit additional participants to ensure adequate 
statistical power, additional participants will be recruited in month 11 and 12. The study team will 
work with identified local points of contact to develop a schedule to assure the maximum number of 
participants can receive information about SMART during a variety of times. If approved by the chain 
of command, SMART could be completed during the participants’ scheduled period of work. The 
study team will assure an IRB approved ombudsman will be present if informed consent is obtained 
in a group setting. 

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After informed consent is obtained and prior to the delivery of the intervention, a survey will be 
administered to collect demographic information and baseline measurements with the CD-RISC, 
PSS, GAD-7, and QoL measures. Participant demographic data, e-mail and phone contact 
information, and responses to survey items will be initially completed using a paper survey prior to 
the delivery of SMART and manually entered into the Research Electronic Data Capture System 
(REDCapTM; DHHS/NIH/NCRR #8UL1TR000041) by a study team member. If a participant prefers, 
they will be provided a web-link to enter the initial information directly into REDCapTM. 
 
REDCap™ is a secure and encrypted, web-based platform licensed to and managed by the 
University of New Mexico Health Sciences Center Clinical and Translational Science Center (UNM 
HSC CTSC).36 REDCap™ includes a suite of research tools for project management, survey 
administration, encrypted database storage and retrieval, and reporting.36 REDCap™ will be utilized 
to administer follow-up surveys at week 12 and 24 (if applicable) after participants complete 
SMART. We propose to collect the 24-week follow-up survey responses in order to conduct an 
exploratory analysis to assess the longevity of the effect of SMART on resilience and stress.  
 
Study team members will verify participant data has been entered correctly. Participant e-mail and 
phone contact information will be used to schedule a follow-up phone call two weeks after 
completing the SMART training (see intervention). Participants’ e-mail contact information will be 
used be utilized to send follow-up surveys through REDCap™. Each survey will take approximately 
10 to 15 minutes for participants to complete. If the participant does not respond to the initial 
REDCapTM invitation, a maximum of three e-mail reminders (one reminder per week after the initial 
e-mail is sent) will be sent to complete the survey.37 If a participant does not complete the survey 
after all e-mail requests have been sent, a study team member may call the participant to verify their 
e-mail information and offer to assist the participant with accessing the survey. Because participants’ 
demographic information will be associated with an individual’s contact information in REDCap™, 
demographic information will not be requested as part of the surveys at weeks 12 or 24. All data will 
be de-identified prior to exporting the data for analysis. 
 
Data Analysis. IBM® SPSS® Statistics (version 26) and R (survey package, version 3.61) will be 
used for the statistical analysis. Initial analysis will include descriptive statistics, including means or 
medians, frequencies and percentages, as appropriate, to characterize demographic status, military 
grade, duty location, military occupation, and previous deployment status. Cronbach’s α will be 
calculated for each multi-item scale.   
 
The objectives of our analysis include testing and estimating the efficacy of the intervention by 
comparing pre-post intervention changes (improvements) in the outcome measurements of interest. 
Analyses will be reported as point estimates with 95% confidence intervals and appropriate 
estimates of effect size. In this analysis, both the VTC and on-line groups will be analyzed 
separately and scores will also be pooled together to test for overall intervention effects.  
 
To better understand factors that can impact the intervention effects, we will conduct regression 
models on the pre-post intervention difference while controlling for demographic characteristics, 

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AFSC, and previous deployment. We will also take into consideration potential clustering effects 
among the participants from the same organizational unit using random effects (e.g. in regression 
models).  
 
Changes in resilience, stress, anxiety, and QoL over time will be assessed by separately analyzing 
changes from baseline to week 12 and to week 24. A joint analysis of the longitudinal trend over the 
three time points at baseline, 12-week, and 24-week will be completed. We will also consider a joint 
analysis of resilience, stress, anxiety, or QOL, as well as, analysis for subscales of any specific 
domain of interest. 
 
Section 7: Subject Selection 
7.1 Do you plan to target a specific population for your study? 
☐ Yes 
☒ No 
If Yes, please complete 7.2 
7.2 Equitable Subject Selection Rationale 
 
7.3 Inclusion & Exclusion Criteria 
A subject who has met all of the following criteria is eligible for participation in the study:  
 
Participants must be active component healthcare personnel (any 4XXX Officer or Enlisted AFSC) 
serving in the U.S. Air Force, assigned to 88th MDG and USAFA at WPAFB, OH. Participants must 
be ≥ 18 years of age to participate.  
A subject who meets any of the following criteria is disqualified from participation in the study:  
 
Adults unable or unwilling to provide consent and individuals who are not yet adults will be excluded 
from this study. Active component Air Force service members without a healthcare AFSC will be 
excluded from the study. 
7.4 Recruitment Plan 
Study team members will work to recruit a sample of active component Air Force healthcare 
personnel. The 88th MDG and USAFA Commanders have provided letters of support to recruit 
potential participants with posted flyers, newspapers, social media, and informational e-mail 
announcements.  
 
If allowed by University of New Mexico and WPAFB guidelines, study team members will travel to 
WPAFB to provide scheduled informational sessions and to attain participant consent. VTC 
informational sessions will also be scheduled and provided. For in-person recruitment sessions, all 
infection control practices and guidelines required by the installation will be enforced. Informational 
sessions will be coordinated at the 88th MDG and USAFA to occur at unit or staff meetings and 
open sessions in prearranged locations. The purpose of these sessions is to maximize study 
recruitment by providing information regarding the proposed research and answering any questions 
that potential participants may have. The location, number, and timing of these sessions will be 
designed to make information about the study accessible to service members on all shifts. On-site 

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liaisons will assure an IRB approved ombudsman will be present for all group informational 
sessions.  
 
Team members will be attired in civilian clothing during these meetings. Although Col Killian is a 
Colonel in the active component Air Force and Dr. Hernandez is a Colonel in the Air Force Reserve, 
neither individual is in the chain of command of any of the potential participants. Therefore, the PI 
and AI cannot order a potential participant to complete the proposed study or affect any of the 
potential participant’s careers. 
7.5 Informed Consent 
7.5.1 Waiver of Documentation of Consent 
7.5.1.1 Indicate whether either of these apply  
☐ Yes 
The only record linking the subject and the research would be the consent document and the 
principal risk would be potential harm resulting from a breach of confidentiality. Each subject will be 
asked whether the subject wants documentation linking the subject with the research and the 
subject’s wishes will govern.  
☒ No 
OR 
☐ Yes The research presents no more than minimal risk of harm to subjects and involves no procedures 
for which written consent is normally required outside of the research context.  
☒ No 
If Yes to either, this study qualifies for a Waiver of Documentation of Consent. Please use the Abbreviated 
Consent template.  
7.5.2 Consent Plan 
Informed consent will be completed by a study team member after the completion of the described 
information sessions with individuals or groups. Any potential participant who wishes additional time 
to review the study information before providing consent will be able to do so. Participants will be 
provided with a copy of the consent document and will be informed that they may withdraw from the 
study at any time. Informed consent will be obtained from participants prior to baseline data 
collection. 
7.6 Protected Health Information (PHI) 
7.6.1 Does this research involve the use of PHI? 
☐ Yes 
☒ No 
If Yes, and subjects will provide written consent to participate in this study, a HIPAA Authorization should be 
signed. 
If Yes, and you are requesting a waiver of documentation of consent, you should also submit a request for 
waiver of HIPAA Authorization. 
7.7 Compensation 
Per Department of Defense guidance, participants will not receive incentives. 
 
Section 8: Experimental Plan 
8.1 Equipment 

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N/A 
 
Section 9: Risk/Benefit Analysis 
9.1 Benefits 
The SMART training provides short, everyday individual practices, which have been shown to 
increase individual’s resilience in past research with healthcare personnel and other participants. 
However, the effectiveness of the training has not been evaluated in military personnel. The 
information learned from this study may help demonstrate if the training is effective in increasing the 
resilience of military personnel. 
9.2 Risks 
There are no known risks to participating in this study. It is possible a participant’s reflection on past 
experiences or memories during or after the SMART training may be uncomfortable. Due to this 
possibility, all participants will be provided contact information for seeking confidential mental health 
support through local resources or Military One Source. 
 
Section 10: Statistical Consideration and Plan 
10.1 Sample Size 
We have conducted a thorough analysis to determine a sample size for this proposed study using 
information derived from the available literature (see Background and Significance: Stress 
Management and Resilience Training). We considered changes in CD-RISC scores, the primary 
outcome, from baseline to 12 weeks post-intervention after receiving SMART training (efficacy). We 
assumed a pre-post intervention change in CD-RISC scores of 7.7 (SD = 8.7) to be achievable and 
meaningful.10 This corresponds to a standardized mean difference between 0.8 and 0.9 SD. 
Sample size estimates specified a two-tailed alpha error of .05 for either paired or two-sample t-tests or 
corresponding nonparametric tests (i.e. Wilcoxon signed ranks or rank sum tests) using a range of effect size 
and power specifications for mean difference. 
 
Based on this analysis, we propose to recruit 120 active duty service members in total. Assuming up 
to 25% attrition between enrollment and 12 weeks post-intervention follow-up (i.e. a final sample of 
90 or 45 per group), this would be sufficient to achieve 90% power to detect a standardized mean 
difference of 0.5 SD in either a paired t-test or Wilcoxon signed ranks test. 
 
Section 11: Subject Re-Contact 
11.1 Do you wish to re-contact participants for possible participation in 
future research protocols? 
☐ Yes 
☒ No 
If Yes, Permission to re-contact participants for future research projects must be sought via a separate re-
contact registry. Contact the IR Office. 
 

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Section 12: Samples 
12.1 Will this activity involve the use of biological samples/tissue? 
☐ Yes 
☒ No 
If Yes, Choose one:  
☐ Identifiable Specimens 
☐ De-identified Specimens 
If No, Proceed to Section 13. 
12.2 How will samples will be provided to the investigator, labeled, stored, maintained or 
destroyed, etc.? 
N/A 
12.3 Do you wish to use blood, cells, bodily fluids, tissues and/or other 
identifiable health information and personal identifiers from patient 
records (medical, research, hospital, etc.) for use in more than one 
protocol? 
☐ Yes 
☒ No 
If Yes, a tissue/health information registry must be approved if you intend to collect and use tissue and/or health 
information outside of the parameters of a single IRB approved protocol.  
12.4 Will you be shipping ANY bodily specimens? 
☐ Yes 
☒ No 
If Yes and your protocol includes shipping of blood or other potentially infectious material (OPIM), please ensure 
that the protocol includes a plan for shipment. Additionally, the protocol and transport plan should be sent to 
Biosurety (711HPW.IR.Biosurety@us.af.mil) to ensure that it meets all required regulations.  
12.5 Does your protocol include the manipulation of blood or other 
potentially infectious material beyond collection and/or direct analysis? 
☐ Yes 
☒ No 
If Yes, the protocol must also be submitted to Biosurety (711HPW.IR.Biosurety@us.af.mil) for review and 
approval.   
If No, personnel must complete annual Blood borne Pathogens (BBP) training and the laboratory must have an 
Exposure Control Plan.   
 
Section 13: Safety Monitoring 
The PI will ensure that mishaps or injuries sustained during research will be reported as required pursuant to 
AFI 91-204. 
• The Principal or Associate Investigator will provide the test subject(s) a short safety briefing 
explaining what to do in the event of an emergency. Briefing will include where the exits are 
located, tornado and shelter-in-place locations, and building evacuation assembly location(s).  A 
mishap is an unplanned occurrence, or series of occurrences, that results in damage or injury, 
as described in AFI 91-204.  In the event of a mishap involving government personnel or 
property, an AF Form 978, Supervisor Mishap Report, will be completed for property damage, or 
by the injured personnel's supervisor, and returned to the appropriate government safety office 
within five (5) workdays following the mishap, or notification of the mishap, whichever is earlier. 
 
Established local infection control practices to minimize the risk of SARS-CoV-2 infection will be 
followed. Possible examples of these practices include: 
• Wearing a cloth mask at all times. 

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• Maintaining physical distancing (6’). 
• Reducing the number of people in a room to no greater than five at a time. 
• Minimizing the number of staff who have “face to face” contact with study participants. 
• 
Washing hands before and after any in person contact with participants. 
 
Section 14: Data Management and Confidentiality 
All data will be collected from participants specifically for research purposes. This study will involve 
minimal impact, risk, and approximately three hours of time commitment for participants. 
 
Participants will be asked to complete a baseline survey and provide phone and e-mail contact 
information. This information will be collected by paper after consent is provided and manually 
entered into REDCap™ by an authorized study member. If desired, participants will be provided a 
web-link to directly enter their information into the REDCap™ system. Participants names, phone 
numbers, and e-mail contact information will be coded as a protected identifier to prevent 
unintentional export of the information from the REDCapTM system.   
 
To ensure confidentiality, the collected data will be entered into and stored on the secure REDCap™ 
server at the University of New Mexico (UNM) Health Sciences Center (HSC) Clinical and 
Translational Science Center (CTSC). Paper surveys will be maintained in a locked cabinet located 
in Dr. Hernandez’s office. No other individuals utilize the same office space. UNM HSC IRB approval 
is required to use REDCap™ for data collection related to human subjects research. Researchers 
must provide the approved protocol number and study closure date prior to putting a REDCap™ 
database or survey into production status. The CTSC's implementation of REDCap™ is not intended 
to be a long-term repository or warehouse for personal health information, and the PI will be 
required to provide the study's IRB expiration date. As the expiration date approaches, the system 
administrator we will contact the Dr. Hernandez for proper disposition of the REDCap™ data. 
 
Participants will be made aware that the SMART course may be provided in a group setting. During 
any interactive portion of the course, participants may volunteer to provide information, thoughts, 
and feedback; however, they are not required to provide any information. All follow-up phone calls 
will be scheduled at a time and location of the participants’ choosing. For all baseline and follow-up 
surveys, participants may choose which items they complete.      
 
All data files used during the data analysis will be password protected. Any printouts from software 
(e.g. IBM® SPSS® Statistics) will be de-identified. Settings in REDCap™ will be enabled to ensure 
that only Dr. Hernandez will be able to identify a specific participant and their survey responses 
based upon a linked number assigned by REDCap™ when the surveys are completed. 
 
Section 15: Data Sharing Plan 
Collected data will be stored in the REDCapTM project database hosted by the UNM HSC CTSC 
Informatics behind the firewall of the HSC. Access from outside of the UNM HSC will require the use 
of a secure UNM HSC Net ID. Dr. Hernandez and other team members who are employees of the 

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UNM HSC will complete the planned data analysis. Printed study documents will be locked a filing 
cabinet located in Dr. Hernandez’s office.  
 
After the study is completed, the de-identified data may be placed in a central storage location at the 
UNM HSC. Identifiers (i.e. name, phone and e-mail contact information) will be removed from the 
data and non-identifiable data could be used for future research studies or distributed to another 
investigator for future research studies without additional informed consent from participants. The 
purpose is to make study data available to other researchers.   
 
Study findings will be disseminated to the chain of command and research site locations at WPAFB. 
Dissemination at WPAFB will be aided by the on-site liaisons to coordinate leadership and PI 
communication either by email or video teleconference/telephone briefings. Presentations of study 
findings are planned at the Military Health System Research Symposium and TriService Nursing 
Research Program Dissemination Course. Manuscripts of study findings may be submitted to 
Nursing Research and Military Medicine. Study results will be presented in summary form only. 
 
Section 16: References 
1 Meredith, L., Sherbourne, C., Gaillot, S., Hansell, L., Ritschard, H., Parker, A., & Wrenn, G. 
(2011).  Promoting psychological resilience in the U.S. Military. Retrieved from 
http://www.rand.org/content/dam/rand/pubs/monographs/2011/RAND_MG996.pdf   
 
2 Thompson, S. R., & Dobbins, S. (2018). The applicability of resilience training to the mitigation of 
trauma-related mental illness in military personnel. Journal of the American Psychiatric Nurses 
Association, 24(1), 23-34. doi:10.1177/1078390317739957 
 
3 Rocklein Kemplin, K., Paun, O., Godbee, D. C., & Brandon, J. W. (2019). Resilience and suicide 
in special operations forces: State of the science via integrative review. Journal of Special 
Operations Medicine: A Peer Reviewed Journal for SOF Medical Professionals, 19(2), 57-66.  
 
4 Committee on the Assessment of Resiliency and Prevention Programs for Mental and Behavioral 
Health in Service Members and Their Families (2014). Prevention of psychological disorders in 
service members and their families: An assessment of programs. Washington, DC: Institute of 
Medicine. 
 
5 Department of Defense. (2015, July).  Report to Congressional Armed Services Committees:  
Implementation of recommendations of Institute of Medicine on improvements on certain resilience 
and prevention programs of the Department of Defense. Retrieved from 
https://www.pdhealth.mil/report-implementation-recommendations-institute-medicine-improvements-
certain-resilience-and    
 
6 Connor, K. M., & Davidson, J. R. T. (2003). Development of a new resilience scale: The Connor-
Davidson Resilience Scale (CD-RISC). Depression & Anxiety, 18(2), 76-82.  
 

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DISTRIBUTION C:  Distribution authorized to U.S. Government agencies and their contractors (administrative).  
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Improving Resiliency in U.S. Air Force Healthcare Personnel  
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7 Windle, G. (2012). The contribution of resilience to healthy aging. Perspectives in Public Health, 
132(4), 159-160. doi: 10.1177/1757913912449572  
 
8 Committee on the Assessment of Resiliency and Prevention Programs for Mental and Behavioral 
Health in Service Members and Their Families (2014). Prevention of psychological disorders in 
service members and their families: An assessment of programs. Washington, DC: Institute of 
Medicine. 
 
9 Resilient Option. (n.d.). Resilient option on-line program. Retrieved June 30, 2020 from  
https://www.resilientoption.com/online-program    
 
10 Loprinzi, C. E., Prasad, K., Schroeder, D. R., & Sood, A. (2011). Stress Management and 
Resilience Training (SMART) Program to decrease stress and enhance resilience among breast 
cancer survivors: A pilot randomized clinical trial. Clinical Breast Cancer, 11(6), 364-368. 
doi:10.1016/j.clbc.2011.06.008 
 
11 Sood, A., Prasad, K., Schroeder, D., & Varkey, P. (2011). Stress Management and Resilience 
Training among Department of Medicine faculty: A pilot randomized clinical trial. Journal of General 
Internal Medicine, 26(8), 858-861. doi:10.1007/s11606-011-1640-x 
 
12 Sood, A., Sharma, V., Schroeder, D. R., & Gorman, B. (2014). Stress Management and 
Resiliency Training (SMART) program among Department of Radiology faculty: A pilot randomized 
clinical trial. Explore (NY), 10(6), 358-363. doi:10.1016/j.explore.2014.08.002 
 
13 Chesak, S. S., Bhagra, A., Schroeder, D. R., Foy, D. A., Cutshall, S. M., & Sood, A. (2015). 
Enhancing resilience among new nurses: Feasibility and efficacy of a pilot intervention. Ochsner 
Journal, 15(1), 38-44.  
 
14 Magtibay, D. L., Chesak, S. S., Coughlin, K., & Sood, A. (2017). Decreasing stress and burnout 
in nurses: Efficacy of blended learning with stress management and resilience training program. 
Journal of Nursing Administration, 47(7-8), 391-395. doi:10.1097/nna.0000000000000501 
 
15 Kashani, K., Carrera, P., De Moraes, A. G., Sood, A., Onigkeit, J. A., & Ramar, K. (2015). Stress 
and burnout among critical care fellows: Preliminary evaluation of an educational intervention. 
Medical Education Online, 20.  doi:10.3402/meo.v20.27840 
 
16 Stonnington, C. M., Darby, B., Santucci, A., Mulligan, P., Pathuis, P., Cuc, A., . . . Sood, A. 
(2016). A resilience intervention involving mindfulness training for transplant patients and their 
caregivers. Clinical Transplantation, 30(11), 1466-1472. doi:10.1111/ctr.12841 
 
17 Werneburg, B. L., Jenkins, S. M., Friend, J. L., Berkland, B. E., Clark, M. M., Rosedahl, J. K.,… 
Sood, A. (2018). Improving resiliency in healthcare employees. American Journal of Health 
Behavior, 42(1), 39-50. doi:10.5993/ajhb.42.1.4 
 

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Other requests for, or further releases of this document, shall be referred to  
Col Jacqueline M. Killian. 
Improving Resiliency in U.S. Air Force Healthcare Personnel  
AFRL IRB APPROVED 1 SEPTEMBER 2020 
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18 Dyrbye, L. N., Shanafelt, T. D., Werner, L., Sood, A., Satele, D., & Wolanskyj, A. P. (2017). The 
impact of a required longitudinal stress management and resilience training course for first-year 
medical students. The Journal of General Internal Medicine, 32(12), 1309-1314. 
doi:10.1007/s11606-017-4171-2 
 
19 Sharma, V., Sood, A., Prasad, K., Loehrer, L., Schroeder, D., & Brent, B. (2014). Bibliotherapy to 
decrease stress and anxiety and increase resilience and mindfulness: A pilot trial. Explore (NY), 
10(4), 248-252. doi:10.1016/j.explore.2014.04.002 
 
20 Connor, K. M., & Davidson, Jonathan R. T. (2003). Development of a new resilience scale: The 
Connor-Davidson Resilience Scale (CD-RISC). Depression & Anxiety, 18(2), 76-82. doi: 
10.1002/da.10113 
 
21 Bezdjian, S., Schneider, K. G., Burchett, D., Baker, M. T., & Garb, H. N. (2017). Resilience in the 
United States Air Force: Psychometric properties of the Connor-Davidson Resilience Scale (CD-
RISC). Psychological Assessment, 29(5), 479-485. doi:10.1037/pas0000370 
 
22 Cohen, S., Kamarack, T., & Mermelstein, R. (1983). A global measure of perceived stress. 
Journal of Health and Social Behavior, 24(4), 385-396.  
 
23 Cohen, S., & Williamson, G. (1988). Perecived stress in a probablility sample of the United 
States. In S. Spacapan & S. Oskamp (Eds.), The social psychology of health (pp. 31-67). Newbury 
Park, CA: Sage. 
 
24 Spitzer, R. L., Kroenke, K., Williams, J. W., & Löwe, B. (2006). A brief measure for assessing 
generalized anxiety disorder: The GAD-7. Archives of Internal Medicine, 166(10), 1092-1097. 
doi:10.1001/archinte.166.10.1092 
 
25  Locke, D., Decker, P., Sloan, J., Brown, P., Malec, J., Clark, M., . . . Buckner, J. (2007). 
Validation of single-item linear analog scale assessment of quality of life in neuro-oncology patients. 
Journal of Pain and Symptom Management, 34(6), 628-638. 
doi:10.1016/j.jpainsymman.2007.01.016 
 
26 Pietrzak, R. H., Goldstein, M. B., Malley, J. C., Rivers, A. J., Johnson, D. C., & Southwick, S. M. 
(2010). Risk and protective factors associated with suicidal ideation in veterans of Operations 
Enduring Freedom and Iraqi Freedom. Journal of Affective Disorders, 123, 102-107.  
 
27 Hernandez, S. H. A., Parshall, M. B., & Morgan, B. J. (2017). Treatment-seeking beliefs and 
behaviors in Air Force nursing personnel. Military Medicine, 182(7), e1687-e1692. 
doi:10.7205/MILMED-D-16-00397 
 
28 Hernandez, S., Morgan, B., & Parshall, M. (2016). Resilience, stress, stigma, and barriers to 
mental health care in Air Force nursing personnel. Nursing Research, 65(6), 481-486. 
doi:10.1097/NNR.0000000000000182 

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DISTRIBUTION C:  Distribution authorized to U.S. Government agencies and their contractors (administrative).  
Other requests for, or further releases of this document, shall be referred to  
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Improving Resiliency in U.S. Air Force Healthcare Personnel  
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29 Maguen, S., Turcotte, D. M., Peterson, A. L., Dremsa, T. L., Garb, H. N., McNally, R. J., & Litz, B. 
T. (2008). Description of risk and resilience factors among military medical personnel before 
deployment to Iraq. Military Medicine, 173(1), 1-9.  
 
30 Pietrzak, R. H., & Southwick, S. M. (2011). Psychological resilience in OEF–OIF veterans: 
Application of a novel classification approach and examination of demographic and psychosocial 
correlates. Journal of Affective Disorders, 133(3), 560-568. doi: 10.1016/j.jad.2011.04.028 
 
31 Singh, J. A., Satele, D., Pattabasavaiah, S., Buckner, J. C., & Sloan, J. A. (2014). Normative data 
and clinically significant effect sizes for single-item numerical linear analogue self-assessment 
(LASA) scales. Health and Quality of Life Outcomes, 12, 187. doi:10.1186/s12955-014-0187-z 
 
32 Sood, A. (n.d.). Transform course. Retrieved June 30, 2020 from 
https://www.resiliencetrainer.com/transform-course    
 
33 Chesak, S. S., Bhagra, A., Schroeder, D. R., Foy, D. A., Cutshall, S. M., & Sood, A. (2015). 
Enhancing resilience among new nurses: Feasibility and efficacy of a pilot intervention. The Ochsner 
Journal, 15(1), 38-44.  
 
34 Loprinzi, C. E., Prasad, K., Schroeder, D. R., & Sood, A. (2011). Stress Management and 
Resilience Training (SMART) Program to decrease stress and enhance resilience among breast 
cancer survivors: A pilot randomized clinical trial. Clinical Breast Cancer, 11(6), 364-368. 
doi:10.1016/j.clbc.2011.06.008 
 
35 Sood, A., Prasad, K., Schroeder, D., & Varkey, P. (2011). Stress Management and Resilience 
Training among Department of Medicine faculty: A pilot randomized clinical trial. Journal of General 
Internal Medicine, 26(8), 858-861. doi:10.1007/s11606-011-1640-x 
 
36 Harris, P. A., Taylor, R., Thielke, R., Payne, J., Gonzalez, N., & Conde, J. G. (2009). Research 
electronic data capture (REDCap): A metadata-driven methodology and workflow process for 
providing translational research informatics support. Journal of Biomedical Informatics, 42(2), 377-
381.  
 
37 Dillman, D., Smyth, J., & Christian, L. (2009). Internet, mail, and mixed-mode surveys: The 
tailored design method (3rd ed.). Hoboken, NJ: John Wiley & Sons. 
Section 17: Attachments 
Attachment 1: Timeline 
Attachment 2: Letters of Support 
Attachment 3: Survey  
 
 

 
Improving Resiliency in U.S. Air Force Healthcare Personnel 
NCT05460663 
Document IRB Approval Date: 9-1-2020 

 
Informed Consent Document 
 
Protocol Title: Improving Resiliency in U.S. Air Force Healthcare Personnel 
DISTRIBUTION C:  Distribution authorized to U.S. Government agencies and their contractors 
(administrative). Other requests for, or further releases of this document, shall be referred to  
Col Jacqueline M. Killian, COMM: 937-255-3784, DSN 785-3784 
Improving Resiliency in U.S. Air Force Healthcare Personnel 
FWR20200166E v1.00 
AFRL IRB APPROVED 1 SEPTEMBER 2020 
1 
You are being asked to participate in a research study.   
 
Key study information you should know: 
 
• The purpose of the study is to examine the effectiveness of the Stress Management and 
Resilience Training (SMART) program for increasing resilience in officer and enlisted Air 
Force healthcare personnel. SMART training provides short, everyday individual practices, 
which have been shown to increase individual’s resilience in past research; however, the 
effectiveness of the training has not been evaluated in military personnel. Information from 
this study may help demonstrate if the training is effective in increasing the resilience of 
military personnel. 
 
• If you choose to participate, you will be asked to complete a survey at the time you enroll in 
the study, you will be randomly assigned into either a video teleconference (VTC) training 
or a self-paced, on-line version of the training, and then be asked to complete up to two 
additional surveys 12 and 24 weeks after you complete the training. This will take a total of 
approximately three to four hours of your time for the duration of study. 
 
• Risks associated with participating in this research are minimal. It is possible your reflection 
on past experiences or memories during or after the SMART training may be 
uncomfortable. Due to this possibility, you will be provided contact information for seeking 
confidential mental health support through local resources or Military One Source if you so 
wish. Additionally, complete privacy and confidentiality of your personal information 
cannot be promised. To mitigate the risk of loss of privacy or confidentiality, investigators 
will utilize RedCap to collect and store your data and it will be stored on a secure server in 
which only the investigators have access.  
 
• Taking part in this research project is voluntary. You can discontinue participation at any 
time without penalty or loss.  
 
• Your data will be de-identified and used for future research.  
 
• There will be no cost to you for you to complete the SMART training or for any optional 
follow-up study related visits. The cost of the training is being paid for through a grant 
provided by the TriService Nursing Research program (https://www.usuhs.edu/tsnrp).       
 
Please take time to read this entire document and ask questions before deciding whether to take 
part in this research project. 
 
If you participate in this research, the study investigators will ask you to: 
 
• Complete a survey. 

 
Informed Consent Document 
 
Protocol Title: Improving Resiliency in U.S. Air Force Healthcare Personnel 
DISTRIBUTION C:  Distribution authorized to U.S. Government agencies and their contractors 
(administrative). Other requests for, or further releases of this document, shall be referred to  
Col Jacqueline M. Killian, COMM: 937-255-3784, DSN 785-3784 
Improving Resiliency in U.S. Air Force Healthcare Personnel 
FWR20200166E v1.00 
AFRL IRB APPROVED 1 SEPTEMBER 2020 
2 
o The survey will ask you to provide your demographic information, e-mail and phone 
contact information, and questions that measure your levels of resilience, stress, 
anxiety and quality of life.  
o You can complete a paper survey or ask for a web-link to complete the survey on-
line.  
 
• We will let you know if you have been assigned to the VTC or on-line training group. If you 
would like switch your group assignment, we ask that you contact the study staff.  
• We will send you information to access the VTC or on-line training. We ask that you 
complete the assigned training.  
o VTC Training: We will contact you with the dates and times of scheduled VTC 
classes and schedule you for the class you would like to attend. VTC training will be 
completed as a group training with a maximum of 10 Air Force healthcare personnel 
over approximately two hours. If in-person training is feasible and safe during the 
study period, in-person training will be used to supplement or replace VTC. 
o On-line Training: The on-line version of SMART is self-paced and can be completed 
over a period of four to eight weeks. 
o After you complete the training, we will provide you a free copy of SMART with Dr. 
Sood: The Four-Module Stress Management and Resilience Training Program at no 
charge. This book can help you review practices and course content for improving 
gratitude, mindful presence, kindness, and developing a resilient mindset. 
• Approximately two weeks after completing the SMART training, we will contact you by e-
mail or phone.  
o We will ask if you would like to schedule an optional phone meeting. These phone 
consultations will be provided at no cost to you. 
o The purpose of the phone meeting is to provide you the opportunity to ask questions 
and to provide reinforcement of the principles presented during the SMART training.  
o If you would like to schedule a phone meeting, we will work to schedule a 30-minute 
phone call with you at a day and time of your convenience.  
o At the end of this call, you will be provided the option to schedule a second 30-
minute follow-up phone meeting.  
 
• We will send an e-mail asking you to complete an on-line follow-up survey 12 weeks after 
you complete the SMART training.  
o The survey will take approximately 10 to 15 minutes for you to complete. 
o If you don’t complete the survey within a week after we send the initial e-mail 
request, a maximum of three e-mail reminders (one reminder per week) will be sent 
to ask you to complete the survey.  
o If you don’t complete the survey after all e-mail requests, we may call you to verify 
your e-mail information and offer to assist you with accessing the survey. 
 

 
Informed Consent Document 
 
Protocol Title: Improving Resiliency in U.S. Air Force Healthcare Personnel 
DISTRIBUTION C:  Distribution authorized to U.S. Government agencies and their contractors 
(administrative). Other requests for, or further releases of this document, shall be referred to  
Col Jacqueline M. Killian, COMM: 937-255-3784, DSN 785-3784 
Improving Resiliency in U.S. Air Force Healthcare Personnel 
FWR20200166E v1.00 
AFRL IRB APPROVED 1 SEPTEMBER 2020 
3 
• We may send an e-mail asking you to complete an additional on-line follow-up survey 24 
weeks after you complete the SMART training. 
o The survey will take approximately 10 to 15 minutes for you to complete. 
o Your responses to this survey will help show if the training continues to help improve 
your resilience over time.  
o If you don’t complete the survey within a week after we send the initial e-mail 
request, a maximum of three e-mail reminders (one reminder per week) will be sent 
to ask you to complete the survey.  
o If you don’t complete the survey after all e-mail requests, we may call you to verify 
your e-mail information and offer to assist you with accessing the survey. 
• When the study is completed, we will provide a summary of the findings to the leaders at the 
88th Medical Group and the U.S. Air Force School of Aerospace Medicine. We may present 
the information at scientific conferences and prepare manuscripts for publication in scientific 
publications. All results will be summarized so that no findings can be linked to any 
individual’s responses. You can contact the study team if you would like a copy of the 
summary results for this study.   
The researchers will take the following precautions to maintain the confidentiality of your data:  
After enrolling in the study, you will be asked to complete a survey to provide your 
demographic information, e-mail and phone contact information, and answer questions to 
measure your levels of resilience, stress, anxiety and quality of life. This information will be 
collected by paper and manually entered into the Research Electronic Data Capture (REDCap 
system by an authorized study member. If desired, you will be provided a web-link to directly 
enter their information into the REDCap system. Your name, phone number, and e-mail contact 
information will be entered as protected information to prevent unintentional export of the 
information from the REDCap system. REDCap is a secure web application for building and 
managing online surveys and databases. Settings in REDCap will be enabled to ensure that only 
authorized study members will be able to identify a specific participant and their survey 
responses based upon a linked number assigned by REDCap when the surveys are completed. 
Collected data will be stored in the REDCap project database hosted by the University of New 
Mexico Health Science Center (UNM HSC) behind a firewall. Access from outside of the UNM 
HSC will require the use of a secure UNM HSC Identification.  
Paper surveys will be maintained in a locked cabinet located in a study member’s office and 
properly disposed of after the completion of the study. All data files used during the data 
analysis will be password protected. Any printouts from software will be de-identified. Printed 
study documents will be locked a secure filing cabinet located in an authorized study member’s 
office.  
Identifiers (ex. your name, phone and e-mail contact information) will be removed from the data 
and non-identifiable data could be used for future research studies or distributed to another 
investigator for future research studies without additional informed consent from you. After the 
study is completed, the de-identified data may be placed in a central storage location at the 
UNM HSC. The purpose is to make study data available to other researchers.  These data will 

 
Informed Consent Document 
 
Protocol Title: Improving Resiliency in U.S. Air Force Healthcare Personnel 
DISTRIBUTION C:  Distribution authorized to U.S. Government agencies and their contractors 
(administrative). Other requests for, or further releases of this document, shall be referred to  
Col Jacqueline M. Killian, COMM: 937-255-3784, DSN 785-3784 
Improving Resiliency in U.S. Air Force Healthcare Personnel 
FWR20200166E v1.00 
AFRL IRB APPROVED 1 SEPTEMBER 2020 
4 
not include your name or other information that can identify you.  
The data may be accessed by the Department of Defense for auditing purposes. 
If you have questions regarding the study, contact the Principal Investigator: Col Jacqueline M. 
Killian at COMM: 937-255-3784, DSN 785-3784 or jacqueline.killian@us.af.mil or Col 
Stephen Hernandez at 318-617-0020 or shhernandez@salud.unm.edu. If you have questions 
regarding your rights as a research subject, contact the AFRL IRB: 937-904-8100 or 
afrl.ir.protocolmanagement@us.af.mil.