Soldiers' Personal Technologies on Deployment and at Home

Survey Content Development

A primary goal for the content of PTEC was to be comprehensive: To quantify in detail the gamut of common devices and software in use by service members, the level of that use, and additionally to allow respondents to offer qualitative opinion and explanation.

Our first step was to conduct exhaustive Web and literature searches of the commercial market places, technology market research sites, and consumer resources, for examples of both popular and more cutting-edge personal technologies and their use. The product of that endeavor was a pool of potential main topics with extensive subtopics. With those data we constructed an initial prototype of the survey.

Our next step was to conduct a series of semistructured key informant interviews with service members and former service members to provide advice on the military applicability of initial content. Each interviewee reviewed the entire pool of items and recommended modifications, additions, and deletions to wording and topic choices. Using that detailed feedback we constructed a substantially refined version of the survey.

Last, we tested this penultimate version of the survey with three additional former service members, who completed the entire series of items under naturalistic conditions and provided final feedback about content and ease of completion. Average time to complete was between 15 and 20 min.

Final PTEC Content

The operational PTEC survey was a 13-page paper-and-pencil questionnaire. For those who had previously been deployed to a warzone, the instrument asked respondents to answer questions about their technology use and availability of personal technologies both while on deployment (“most recent deployment: Where you were stationed the majority of your time”), and at permanent duty station or home. Respondents who had never been deployed to a warzone completed permanent duty station/home items only. Instructions throughout emphasized that respondents should answer questions as they related to their “personal use (non-work-related) only.” To aid ease of completion, we combined extensive use of checkbox items with less frequent categorical responses and open-ended questions.

PTEC including the following sections:

1. Personal and service demographics, including deployment history

Design, Setting, and Eligibility

This study used a cross-sectional design. We collected PTEC data periodically from a convenience sample of service members attending a processing and registration center at a large military installation between May 2010 and February 2011. A broad cross-section of service members typically wait for extended periods for service each day in this “Welcome” Center. Our eligibility criteria required that participants be Active Component, Reserve, or National Guard service members at least 18 years old.

Procedures

Study staff approached service members in waiting areas at the Center, explained the study, provided an information sheet to read, and, if willing, issued the PTEC self-assessment survey with both verbal and written instructions. Consenting and all other study procedures were approved by the Madigan Army Medical Center Institutional Review Board.

Participants then completed surveys at their own pace at tables in the waiting areas. Participants were instructed to complete the entire survey if time allowed or, if called to leave the waiting area for their appointment, to mark the survey at the point of last response. All surveys were then to be placed personally by the respondents into a locked collection box overseen by study personnel.

Attrition

A proportion of participants had to cease responding to the survey at various points of completion to attend their appointments in the Welcome Center. Those items not completed because of this attrition were excluded from the analysis on a case-by-case basis. This is reflected in the varying sample sizes (n values) and denominators for specific items in the results, tables, and figures presented here.

Sample and Demographics

Our final sample comprised 331 Army service members, nearly 95% of whom were Active Component. Table 1 displays details of personal and service demographics for those 211 participants who reported having been deployed to a warzone and for those 120 individuals who had never deployed. Mean age over both groups was 28.3 years (SD=7.8), which was representative of the Army as a whole (28.4 years in 2009). ¹⁹ Most participants were male (88.2%), again reflecting closely the overall Army proportions (86.6%). ¹⁹ The sample was in the majority white (61%) with a substantial minority of African American (16.4%) and Hispanic (11.8%) representations. Participants most commonly were married enlisted individuals with some college, technical school, or graduate experience. For those previously deployed, 85% had ended their most recent deployment to a warzone between 2009 and 2011, with 78% having served most recently in Iraq (OIF) (39.6% with multiple OIF deployments) and 22% in Afghanistan (OEF) (39.5% with multiple OEF deployments).

There were noteworthy demographic distinctions between the previously deployed and never deployed groups. Table 1 shows clearly that the never-deployed group was significantly younger (on average by more than 5 years) than the previously deployed counterpart [two-sample t (329)=6.098, p<0.0001]. Compared with the presumably more experienced and longer-serving previously deployed group, the younger, never-deployed sample had higher proportions of females, single/never married individuals, and junior enlisted (E1–E4) and was less educated.

Computers and the Internet

When asked to rate their computer skills and their Internet skills, more than 87% and 91%, respectively, of service members judged themselves to be competent, proficient, or expert (n=169).

Table 2 depicts personal use of computers on deployment and at home. Most notable is that the use of laptop computers was almost ubiquitous on deployment and widespread at home. Figure 1 shows that time spent on computers was substantial across venues, with 50% of service members using computers more than 10 h/week for personal use. Most typical use of computers was for connecting to the Internet, with watching movies, listening to music, writing, gaming, and education by computer also popular.

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Fig. 1.

Personal use of computers (in hours per week).

Among the wide-ranging data concerning Internet/Web usage in Table 3, we can see that Web-searching, e-mailing, instant messaging, and social networking were highly utilized by service members while deployed and were as commonplace as at home. In general, Internet and Web use was equivalent in both participant groups and across deployed and home venues. Figure 2 depicts the relative times spent by respondents using the Internet for specific activities. A considerable number of hours each week appears to be occupied with Internet gaming, instant messaging, education, and the other pastimes displayed. However, the number of respondents reporting for some activities is relatively low, making interpretation in those instances difficult. Open-ended items on the survey suggested that the Internet was used frequently both on deployment and at home for accessing the Army's Army Knowledge Online ²⁰ for various services including e-mail.

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Fig. 2.

Mean usage of the Internet (in hours per week).

Phones and Other Portable Devices

Table 4 contains details of phone use on deployment and at home. Personal cellphones and, to a lesser extent, smartphones were used by almost all PTEC respondents at home. A subset of 76 respondents indicated which cellphone platform or operating system they personally owned and used: Android™ (Google) phones were preferred by 38%, with the iPhone^® (Apple) used by a further 22% and the BlackBerry^® (Research in Motion Ltd.) by 15% (25% unspecified “other”). The only comparable data of which we are aware for prevalence of cell phone use by military personnel come from the CDS's Behavioral Risk Factor Surveillance System (BRFSS) ²¹ annual telephone health survey. In the most recent BRFSS 2009 survey, more than 83% of 1,954 active duty service members and more than 77% of recently retired military veterans questioned reported that they had a cellphone for personal use. Our own data show personal cellphone rates for active service members at home exceeding those BRFSS figures (Table 4).

On deployment, mobile phone use was less prolific (25.8–46.9% of service members). In contrast, conventional landline phones or static phone shacks were reportedly used by more than one-third of respondents while on deployment, but such use was extremely scarce at home (less than 10%). At home, voice communication and texting were the most prevalent (>60%) purposes for phone use in both previously deployed and never-deployed service members. In fact, in the younger, never-deployed cohort, pervasiveness of texting exceeded conventional voice communications. On deployment, voice was by far the preferred medium of communication by phone, although texting was reported by one-fifth of survey participants.

Figures 3 –5 variously illustrate the amount or duration of weekly use of phones, both static and mobile. It is notable that Figures 3 and 4 show an interesting disparity between the use of cellphones and landline phones. The majority of previously deployed service members used cellphones and landlines very little or not at all while on deployment. The bulk of never-deployed respondents also reported minimal landline use at home but, in contrast, judged their home cellphone use to be in excess of 20 h/week. For the smaller subset of the two cohorts who rated their time spent on specific phone activities, most cellphone time was occupied texting, downloading and using “apps” (mobile device software applications or programs), and conversing (Fig. 5). More than half of all participants additionally reported having downloaded one or more free apps to their phones in the previous year, including nearly 20% who had downloaded more than 10. More than 39% also responded that they had purchased apps in the previous 12 months, although only 5.5% had bought more than 10.

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Fig. 3.

Personal use of cellphones (in hours per week).

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Fig. 4.

Personal use of landline phones (in hours per week).

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Fig. 5.

Mean usage of cellphones (in hours per week).

Table 4 also briefly inventories use of the few non-phone portable devices in common currency. Clearly, personal digital assistants such as PalmPilots (Palm) were only in moderate circulation among respondents, and the penetration of e-Readers such as the Kindle (Amazon) or Nook^® (Barnes&Noble) was almost nonexistent. However, approximately half of all participants related using iPods or other MP3 players on deployment and at home.

Electronic Gaming

Recreational use of electronic gaming machines was widespread, nearly as much on deployment as at home (played by more than 60% of service members), with the Microsoft XBox^® and Sony PlayStation^® the most frequently cited devices (Table 5). “First person shooter” games such as “Call of Duty” or “Halo” and action/adventure games such as “Grand Theft Auto” were the apparent favorite categories of games played across locations, played for between 5 and 7 h/week (Fig. 6). In fact, for those smaller subsets of the overall sample who quantified the duration of their electronic gaming, the broad spectrum of game categories were played for between 4 and 7 h/week. Modern gaming devices also are capable of Internet browsing independently of gaming. Approximately one-fifth of respondent also used their gaming hardware to access the Internet for non-gaming purposes (Table 5) such as watching movies (frequently highlighted in open-ended responses).

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Fig. 6.

Mean usage of gaming devices (in hours per week).

TV and Radio

Watching TV (personally owned or service-provided) was a regular pastime on deployment for more than half of participants and was extremely prevalent (nearly 80% or higher) for service members at home (Table 6). Between one-fifth and nearly one-half of respondents reported watching non-scheduled or recorded TV media such as DVDs, Netflix, or On Demand programming. Time spent each week watching TV was relatively modest (slightly more than an hour a day [see Table 6]). Listening to radio was less common on deployment and at home.

Warzone-Specific Personal Technology

PTEC posed a series of questions exclusively to those participants who had been previously deployed about the availability of relevant technology and their satisfaction with technology resources in the warzone while they were last deployed. Specifically, participants were asked about the availability of various technologies in their living quarters and in the local MWR facilities. Respondents reported substantially higher availability in MWR facilities of connections to the Internet (75%), of phones for calling family and/or the United States (68.8%), and of videogames (53.5%) than in their personal or shared living quarters (Table 7), although living quarter technologies nonetheless were moderately prevalent (24.3–52.8%). All respondents were moderately or quite satisfied with the availability of those technologies on deployment, but satisfaction with availability of resources at MWR was judged higher across the board (Fig. 7).

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Fig. 7.

Satisfaction with availability of communication and recreation technologies. The question asked was “How satisfied are/were you with the communication and recreation technologies available to you while deployed?” The answer choices were 0 (not at all), 1 (a little), 2 (moderately), 3 (quite), and 4 (very). MWR, service-provided Morale, Welfare and Recreation facilities, programs, and resources.

Technology and Access to Mental Health Services

To further inform our mission to enhance psychological health through technology, we also asked previously deployed service members to rate their satisfaction with their access to mental health services should they be needed, on two 5-point categorical scales (0=“Not at all,” 1=“A little,” 2=“Moderately,” 3=“Quite,” and 4=“Very”). Respondents were moderately satisfied with their access to mental health service while on deployment (mean=3.0, SD=1.2, n=127) and slightly more satisfied with access at home (mean=3.4, SD=1.1, n=128). These ratings were further qualified by an array of comments solicited by our open-ended survey questions. Some service members reported that care was good and accessible on deployment, whereas others noted that there were not enough caring, well-trained providers and suggested increasing availability and decreasing stigma in the warzone. Comments about home access were similar: More providers, less red tape, more confidentiality, and less stigma. Finally, when asked which technologies should be made available for receiving mental healthcare, soldiers emphasized provision of interactive apps or devices to manage stress, self-assessment exercises, live chat with providers, and assurance of privacy without involvement of chain of command. Fifty-nine percent of participants further relayed that they would be willing to download health-related apps to their cellphones.

At Home

At home or at permanent duty station, service members appeared to be enthusiastic consumers of personal technology and, as such, were apparently no different from their civilian peers. We measured high rates of laptop computer ownership used frequently for general Internet tasks, for e-mailing and instant messaging, for social networking, and for watching videos and listening to music. Personal cellphones and smartphones were ubiquitous among service members at home, with mobile texting and voice communications pervasive, and acquisition of “apps” relatively routine, whereas static landline use was uncommon. Standalone MP3 and other portable music players were widespread, and gaming devices were popular. It is interesting that while watching TV was extremely prevalent among soldiers at home, their reported average of approximately 8–9 h watched each week was surprisingly low compared with the typical American viewing figures for 18–34 year olds of between 26 and 32 h a week. ²² Across almost all measures, use of these personal technologies was greater in the younger, never-deployed service members.

On Deployment/In Warzone

Our profile of personal technology use by soldiers on deployment showed some differences from home use, most likely driven by restrictions in availability, connectivity, opportunity, and military regulation in the warzone. As at home, our data showed frequent use of personal laptop computers for Internet searching, e-mailing, instant messaging, social networking, watching videos, and other activities, prevalent MP3 player ownership, and regular electronic gaming and TV watching, while on deployment. However, there was considerably lower availability and use of mobile phones and greater reliance on landlines and phone shacks on deployment, especially in service-provided external MWR centers, than at home.

Our open-ended items and key informant interviews provided more insight into the personal technology facilities and resources in the warzone at the time (predominantly 2009–2011) when the majority of our respondents were last on deployment. In particular, various respondents reported that possession and use of personal cellphones while on deployment were usually prohibited, although a few units permitted them, and military-owned prepay cellphones occasionally were issued temporarily for specific personal tasks or needs. The Internet, however, was available in many living quarters; service members often would pool resources to pay for local wireless Internet service provider (ISP) service for their personal laptop computers and gaming devices. Similarly, TVs would be shared and used for watching communal collections of movies and for gaming. Limited access to personal e-mail and other online resources sometimes also was available from military-provided computers via the DoD's unclassified Non-secure Internet Protocol Router Network. ²³ Respondents described technology resources and services provided by MWR facilities that varied considerably from FOB to FOB. Participants made several suggestions for improvements: Allowing service members to pay for personal ISP usage under an umbrella contract with the Army instead of purchasing local service, providing free phones and Internet access to deployed service members, offering more phones and computers in MWRs and other military facilities, and more privacy for existing phones and computers. A common complaint was with the price, speed, and reliability of Internet services that were available.

Implications for Health Technology Developers

Our results reveal important information for health technology developers. Our data suggest that soldiers' home uses of the spectrum of popular personal technologies were ubiquitous in 2010. Equally important, PTEC findings indicate a high prevalence of personal online activities among soldiers while on deployment, even 3 or more years ago. In the civilian world, market penetration of personal technologies continues to increase from year to year, ²⁴ as does the quality of connectivity. Our service members' adoption of consumer technologies at home and, to a lesser degree, on deployment appears to mirror that of their civilian counterparts. Consequently, we might assume that personal technology availability and use among military personnel since our survey have become even more widespread and habitual. We hear anecdotally from service members returning from deployment that technological resources in living quarters and MWRs are advancing; for example, that communicating regularly with family in the United States by personal laptop and Skype™ (Microsoft), by instant messaging, and by e-mail has become routine. We also see at our own installation a population of young service members who exemplify the new “techno-social” norm.

The most notable personal technology of the moment is the smartphone and associated “apps.” Forecasters predict that up to 900,000 free and paid apps will have been released for public download by late 2011. ²⁵ The military increasingly is recognizing the potential of smartphones and apps for its own mission. For example, the Army currently is considering a plan to issue every soldier an iPhone or Android cell phone ²⁶ with secure access to e-mail, contacts, and calendars. The U.S. Army also has established its own marketplace ²⁷ site to discover, publish, rate, and discuss applications for smartphones and ultimately to provide the best and most relevant apps for use by soldiers. Although our survey showed restricted use of smartphones on deployment, home ownership was omnipresent, and app downloading by service members was commonplace. Accordingly, T2 and other health and psychological health technology developers also increasingly are focusing on creating apps tailored to service member needs.