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considerations may be consistent (e.g., physical, ergonomic, products from those assessments are more widely applicable
nutritional demands), differences are certain to exist (e.g., op- while remaining grounded by the Servicemember communities
erational tempo, social dynamics). that these needs assessments are designed to serve.

Psychological, spiritual, and social priorities are more likely Acknowledgments
than the physical/ergonomic domain to be tied to a specific The authors would like to thank those 2W1 community mem-
context, particularly since those three domains significantly bers who participated at each of the three installations, their
overlap and can be challenging to tease apart from context. health and performance personnel, and the HAF/MAJCOM
For that reason, it may be tempting to skip exploring the Career-field Managers for their engagement and enthusiasm
health and performance priorities in those domains altogether during the CBB and for their passion for supporting the 2W1
or to over-extrapolate from one base to the next. Either would community. Without them, the CBB and all the efforts that
be a mistake. Working with career-field members across instal- have emerged from it would not have been possible. The au-
lations has highlighted how important those three domains are thors would also like to thank Dr. Roger Erich and Mr. Lindsay
to enhancing performance across the TFF wheel, mitigating Buckalew of the 711th Human Performance Wing for their
risks, and improving sustainability. Physical injuries, for exam- support. Finally, the authors would like to thank our CBB team
ple, have social, spiritual, and psychological components that members current and emeritus—Dr. Travis Lunasco, Col (ret)
must be attended to in order to ensure Servicemembers seek Kylene Ruth, Col (ret) Colleen McBratney, Ms. Elizabeth Al-
and connect with the care they need, experience a full recovery, ders, Ms. Brooks Ford, Ms. Kelsey McCoskey, Dr. Gloria Park,
and reintegrate smoothly with the capabilities required to be and Dr. Patricia Deuster—for all their contributions to the CBB.
mission ready. Simultaneously, strain or injury in the social,
spiritual, or psychological domains of TFF can have cascading Author Contributions
implications for physical readiness as it relates to critical tasks. RC and DC were part of the original CBB pilot and conceived
the study design. RC, DC, and RM were a part of the CBBs
Working across 2W1 sites also highlighted how these ca- with 2W1s referenced in this article and contributed to the
reer-field requirements, working environments, missions, etc. data collection, analysis, and write-up of the 2W1 CBBs, as
can shape how career fields interface with health and per- well as the compiled analysis and the writing and revision of
formance personnel. The team structure that provided 2W1s this manuscript.
with a strong sense of community and social support, and
was foundational for mentorship and performance, also made Disclaimer
some 2W1s hesitant to seek medical attention when they were The opinions and assertions expressed herein are those of the
injured because they did not want to let their team down or authors and do not reflect the official policy or position of the
become a burden. The same pride 2W1s took in being knowl- Uniformed Services University or the Department of Defense.
edgeable, physically and mentally strong, and dependable made
it challenging at times for them to take a knee when they were The contents of this publication are the sole responsibility of
injured, especially if those injuries were invisible. These kinds the authors and do not necessarily reflect the views, opinions
of contextual factors add dimension to understanding how and or policies of The Henry M. Jackson Foundation for the Ad-
why 2W1s interface with health and performance personnel vancement of Military Medicine, Inc. Mention of trade names,
and the need to engage with these factors at each site. commercial products, or organizations does not imply en-
dorsement by the U.S. Government.
Conclusion
Disclosures
Understanding the ways in which the various domains of The authors have no financial interests or relationships to
TFF interact with and impact each other, and how those in- disclose.
teractions can shape health and performance demands and
outcomes for U.S. Servicemembers can be critical to ensuring Funding
that individuals and units are mission ready. CBB, as a unit- This work was supported by the Defense Health Agency and
based health and performance needs assessment, has shown the United States Air Force.
itself to be useful for identifying key barriers and facilitators
to critical task completion. In this article, we have examined References
what we can say beyond the unit level about the scalability of 1. Office of Inspector General. Evaluation of Department of Defense
this type of rapid qualitative inquiry. Through the compari- Military Medical Treatment Facility Challenges During the Coro-
son of three separate blueprints conducted with 2W1 work- navirus Disease-2019 (COVID-19) Pandemic in Fiscal Year 2021
ing on three separate airframes within a single career field, (DODIG-2022-081). Department of Defense; 2022.
we have identified health and performance factors that can be 2. Deuster. PA, O’Connor FG, Henry KA, et al. Human perfor-
generalized across a career field, as well as some factors that mance optimization: an evolving charge to the Department of De-
fense. Mil Med. 2007;172(11):1133–1137. doi:10.7205/milmed.
remain context specific. We have also identified relationships 172.11.1133
that can exist between generalizable and context-dependent 3. Lunasco T, Chamberlin R, Deuster P. Human performance optimi-
health and performance factors that could prove helpful for zation: an operational and operator-centric approach. J Spec Oper
assets tasked with providing support for Servicemembers in Med. 2019;19(3):101–106. doi:10.55460/sn5g-cmoa
these career fields and across TFF domains. While we have 4. Tvaryanas A, Brown L, Miller NL. Managing the human weapon
shown the opportunities of beginning with “thick” data and system: a vision for an Air Force human performance doctrine. Air
& Space Power Journal. 2009:34–41.
moving towards “big” data, future health and performance 5. Total Force Fitness DOTmLPF-P Change Recommendation.
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