Understanding healthcare accessibility for military veterans living with Charles Bonnet Syndrome: co-production of a psychoeducational toolkit

Introduction
Charles Bonnet Syndrome (CBS) is a condition characterized by visual hallucinations in individuals with visual impairments. Among military veterans, CBS can cause considerable distress, leading to health-related anxiety and delays in seeking help. Despite its prevalence, awareness of CBS remains limited across healthcare services, resulting in underdiagnosis and inadequate support. There is a need to better understand experiences of managing CBS and accessing healthcare services, from both healthcare and service user perspectives. Additionally, tailored resources are needed to address these gaps. This study explored these experiences and co-produced a toolkit to support military veterans, their families, and healthcare professionals in managing CBS and improving access to appropriate care.

Methods
A two-phase, qualitative, co-production design was employed. In Phase 1, military veterans with CBS (n = 7) and specialist healthcare professionals working in the visual impairment and veteran sector (n = 13) participated in a workshop that explored the current management of CBS, the accessibility of healthcare services, and support needs. Thematic analysis identified key themes that guided the initial development of the toolkit. In Phase 2, a second focus group with military veterans (n = 4) and specialist healthcare professionals working in the visual impairment and veteran sector (n = 5) gathered feedback on the toolkit and areas for improvement. Thematic analysis was used to identify areas of refinement.

Results
A psychoeducational toolkit was developed in the form of podcasts and a video animation, as preferred by users. One podcast focused on raising awareness of CBS among healthcare professionals and providers, two podcasts focused explicitly on military veterans and their families/carers, and finally, an animated whiteboard video targeted toward all audiences. All the podcasts and video animations included a practical strategy for managing visual hallucinations.

Conclusion
The multiple toolkits developed address key barriers to healthcare, promote early recognition of CBS, and provide accessible self-management strategies for veterans, their families, and healthcare professionals.